# Perimenopause symptoms: the full list

> It is not just hot flushes

Category: Perimenopause · 4 min read · Written by the Splash team · Sources checked October 2026
URL: https://splash.care/learn/perimenopause/symptoms

## Quick answer

Perimenopause is the time before menopause when hormone levels change, usually starting in your mid-40s. Common symptoms are changes to your periods, hot flushes, night sweats, trouble sleeping, low mood or anxiety, brain fog, joint aches and vaginal dryness. Symptoms vary a lot, and a GP can usually diagnose it from symptoms if you are over 45.

- Symptoms go far beyond hot flushes: mood, sleep, brain fog, joints, bladder and more.
- They can start while you still have periods.
- Symptoms usually last 7 to 9 years, and treatments help.
- Hormonal contraception can mask the usual signs.

Many people expect [hot flushes](https://splash.care/learn/perimenopause/hot-flushes). Fewer expect [anxiety](https://splash.care/learn/mind-mood/luteal-anxiety), itchy skin or forgetting why they walked into a room. [Perimenopause](https://splash.care/learn/glossary/perimenopause) can affect your whole body, and symptoms can come and go and change over time.

## What are the symptoms of perimenopause?

- Changes to your periods: more or less often, heavier or lighter
- Hot flushes and night sweats
- Difficulty sleeping
- [Low mood](https://splash.care/learn/mind-mood/why-mood-shifts), anxiety, irritability or mood swings
- Brain fog and problems with memory or concentration
- [Headaches](https://splash.care/learn/period-care/migraines) or migraines that are worse than usual
- Joint and muscle aches
- Vaginal dryness, discomfort during sex, and lower [sex drive](https://splash.care/learn/body-literacy/libido-cycle)
- Needing to pee more often, leaking, or more urinary infections
- Heart palpitations
- Dry or itchy skin, and thinning hair or hair loss
- Weight gain, often around the tummy
- Sensitive teeth, sore gums or other mouth problems

**7 to 9 years** How long the NHS says symptoms usually last (sometimes longer). Symptoms can change over that time.

Background matters. The NHS says, for example, that women from a Black ethnic background are more likely to have hot flushes that are severe and last longer. If you are using hormonal contraception such as the pill, coil, implant or injection, it can hide or change the usual signs, because it affects your periods.

**Myth:** If you are still having periods, your symptoms cannot be hormonal.

**Fact:** Perimenopause symptoms often begin while periods are still happening, sometimes years before they stop.

**Myth:** It is all in your head.

**Fact:** Symptoms like brain fog, anxiety and joint pain are well recognised parts of the transition. That does not mean everything is “just hormones”, which is why an open chat with a doctor helps.

> **Splash says:** log symptoms for a couple of months. Patterns like “anxiety + night sweats + irregular cycles” help a doctor see the bigger picture.

### When to see a doctor

See a GP if symptoms are affecting your life, or you have a fast heartbeat (palpitations) that worries you. Call 999 for chest pain, severe breathlessness, or signs of a stroke (face drooping, arm weakness, slurred speech). See a GP if you have bleeding after sex, bleeding between periods, periods that become much heavier than before, or any vaginal bleeding after 12 months without a period, even if it is only once or just a little. These need checking.

## Questions people ask

### What age does perimenopause start?

Usually in your mid-40s, though it can start earlier. The average age of menopause in the UK is 51 (NHS). Menopause before 40 is called premature ovarian insufficiency and needs a doctor’s advice.

### Do I need a blood test for perimenopause?

Usually not if you are over 45: NICE guidance says it can be diagnosed from symptoms. Under 45, a GP may suggest tests.

## Sources

1. [NHS: Symptoms of menopause and perimenopause](https://www.nhs.uk/conditions/menopause-and-perimenopause/symptoms/)
2. [NICE NG23: Menopause: identification and management](https://www.nice.org.uk/guidance/ng23)
3. [Jean Hailes: Menopause](https://www.jeanhailes.org.au/health-topics/menopause/)

This is general information, not medical advice. Splash can’t diagnose. If you’re worried, talk to a GP, pharmacist or sexual health clinic. In an emergency call 999 (UK) or 911 (US).