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Symptoms

Perimenopause: early signs, and when to see a GP

You're not imagining it. Here's what the NHS lists as the early signs of perimenopause, how a GP can tell, and when it says to book an appointment.

Last checked September 2026 · 4-minute read · Sources

Bleeding after menopause

Please see a GP about this. The NHS advises seeing a GP about any bleeding after menopause, even if it has only happened once or is only a small amount. If you feel very unwell, call NHS 111. In an emergency, call 999.

If you're having thoughts of harming yourself, you don't have to cope alone. Call Samaritans free on 116 123, any time, or call 999 if you're in immediate danger. For urgent help, call 111 and select the mental health option. 111 will tell you the right place to get help. You may be able to speak to a trained mental health professional over the phone.

Sources: NHS, Symptoms of menopause and perimenopause (reviewed 19 May 2026); NHS, Where to get urgent help for mental health. Last checked September 2026.

In short

  • A change to your periods is usually one of the first signs of perimenopause.
  • Menopause usually happens between 45 and 55, but it can happen earlier.
  • If you're over 45, a GP can usually tell from your symptoms. You won't usually need a blood test.
  • If you're under 45 and think it's started, see a GP.
  • You can still get pregnant during perimenopause.

What perimenopause is

Perimenopause is the time when your periods become irregular, before they stop. It happens because your hormone levels fall.

Menopause itself means you haven't had a period for 12 months, and you're not using hormonal contraception.

The NHS says menopause usually happens between the ages of 45 and 55, but it can happen earlier. NHS inform, the NHS in Scotland, says the average age in the UK is 51.

Symptoms usually last 7 to 9 years, sometimes longer. They can change over time.

The early signs the NHS lists

One of the first signs is usually a change to your periods. They may come more often or less often. Bleeding may get heavier or lighter.

The NHS lists other symptoms, including:

  • hot flushes and night sweats
  • problems getting to sleep, or staying asleep
  • mood swings, low mood or depression
  • problems with memory or concentration, sometimes called brain fog
  • weight gain
  • dryness, burning, irritation or itching in and around the vagina
  • more urinary tract infections (UTIs), or symptoms that feel like one
  • a faster, slower or more noticeable heartbeat (palpitations)
  • headaches and migraines that are worse than usual
  • muscle aches and joint pains
  • hair thinning or hair loss, and dry or itchy skin
  • a lower sex drive
  • sensitive teeth, painful gums or other mouth problems

You might notice a few of these, or many. The NHS says ethnic background can affect which symptoms you get, how severe they are and how long they last.

Things like this are common in perimenopause, and can have other causes. A GP can help work out which.

When the NHS says to contact a GP

The NHS says to contact your GP if:

  • you think you have symptoms of menopause or perimenopause, and want to know your options
  • you have symptoms like a fast heartbeat (palpitations)
  • you still have periods, but you're bleeding more, not less, than before
  • you haven't had a period for 12 months or more, and you have any vaginal bleeding

If you're under 45

Early menopause is when you stop having regular periods before 45. Premature menopause is when this happens before 40.

The NHS says it's important to replace missing hormones if menopause starts before 45. That's because there's a higher chance of problems with your bones and heart. The NHS advises seeing a GP if you're under 45 and think you have menopause symptoms.

How a GP can tell

There's no routine test for perimenopause or menopause. The NHS says a doctor may diagnose it based on your age and symptoms.

NICE guidance for GPs says:

  • Over 45: if you're otherwise healthy, perimenopause can be diagnosed from hot flushes or sweats and irregular periods, without blood tests.
  • 40 to 45: a GP may consider a blood test for follicle-stimulating hormone (FSH), if you have symptoms including a change in your periods.
  • Under 40: blood tests may be used if menopause is suspected.

Hormonal contraception can make it harder to tell, because it can change your periods. If you use it, mention it to your GP.

Bleeding after menopause

If you haven't had a period for 12 months and then get any vaginal bleeding, see a GP. The NHS says it needs to be checked. That includes spotting, or pink or brown discharge, even if it's only happened once.

It's not usually serious, but it can be a sign of cancer. Cancer may be easier to treat if it's found early.

The NHS says a GP should refer you to a hospital or a special clinic. You should not have to wait more than 2 weeks to see a specialist.

Contraception

You can still get pregnant during perimenopause. The NHS says you still need contraception:

  • for 1 year after your last period, if you're 50 or over
  • for 2 years after your last period, if you're 40 to 49

A GP can talk through which contraception suits you now.

Your next step

Write down what you've noticed and when it started. Then book a GP appointment. Our guide to preparing for your GP appointment can help you make the most of it.

Sources

  1. NHS, What are menopause and perimenopause? (reviewed 19 May 2026)
  2. NHS, Symptoms of menopause and perimenopause (reviewed 19 May 2026)
  3. NHS, Early or premature menopause (reviewed 11 March 2025)
  4. NHS, About hormone replacement therapy (HRT) (reviewed 7 February 2023)
  5. NHS, Postmenopausal bleeding (reviewed 24 September 2026)
  6. NICE, Menopause: identification and management (NG23) (last updated November 2024)
  7. NHS inform, Menopause (updated 29 November 2022)

Last checked September 2026. Next check September 2027.

This guide gives general information. It isn't medical advice, and it can't tell you what's right for you.

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