Perimenopause and Menopause: Symptoms and Diagnosis

Perimenopause and menopause are natural stages of life, however, the journey is different for everyone. Some women have very few symptoms, while others find that menopause has a significant impact on their physical health, emotional wellbeing, relationships and quality of life.

Understanding what is happening to your body can help you feel more informed and confident about seeking support and finding the right treatment.

Let’s clarify the definitions:

• Perimenopause is the time leading up to a natural menopause – when periods become different (lighter, heavier, closer together, further apart) and menopausal symptoms start to happen. It can last for up to 10 years and symptoms commonly start in the late 30’s early 40’s. Blood tests are not used for diagnosis as hormone levels fluctuate wildly. This is diagnosed by listening to your symptoms.
• Menopause (for women 45 years or older) is the day one year after the last natural menstrual period. The average age in the UK is 51, but this age varies between different cultures.
• Postmenopause is the time after menopause. As the average life expectancy of a woman in the UK is now 82, women can spend, on average, 30 years of their lives after menopause.
• Surgical menopause is the day the ovaries are removed during an operation (before a woman has gone through her menopause).
• Induced or iatrogenic menopause (may be permanent or temporary )and is when periods stop because the ovarian function is affected by medication or treatment such as chemotherapy, radiotherapy, or hormone blockers.
• Early menopause is when menopause happens between the ages of 40-45 years. Periods become irregular or stop for 3-4 months and a blood test for follicle stimulating hormone (FSH) is raised. Women with early menopause need specialist advice about hormone therapy (in a similar way to those with POI) in order to protect their future health.
• Premature ovarian insufficiency (POI) is when menopause occurs before the age of 40 years. Periods become irregular or stop for 3-4 months and a blood test for follicle stimulating hormone (FSH) is raised.Women with POU need specialist advice about hormone therapy in order to protect their future health.

So we can see that there are different stages as you transition through the menopause.

What are the symptoms of perimenopause and menopause?

Not every woman will experience all of them and symptoms can vary significantly. 80% of women experience symptoms and for 25%, the symptoms are significant enough to affect their quality of life.

Common symptoms include:

Vasomotor Symptoms – affect about 75% of women

• Hot flushes
• Night sweats
• Feeling suddenly overheated
• Chills after hot flushes

Sleep Symptoms – affect 40-60% of women

• Difficulty falling asleep
• Waking during the night
• Poor quality sleep
• Early morning waking
• Think: Do you snore? Could you have obstructive sleep apnoea affecting your sleep?
• Think: Do you have restless legs? This is associated with a low ferritin level.

Psychological and Cognitive Symptoms

• Anxiety
• Low mood
• Mood swings
• Irritability
• Loss of feelings of joy
• Loss of confidence
• Brain fog
• Poor concentration
• Poor memory

Physical Symptoms

• Fatigue/tiredness
• Joint and muscle aches
• Headaches
• Palpitations
• Light headedness
• Weight changes and change in body shape
• Dry itchy skin
• Feeling of things crawling under the skin

Genitourinary Symptoms – called Genitourinary Syndrome of the menopause

• Vulval and vaginal dryness
• Decreased lubrication during sex
• Discomfort or pain during sex
• Bleeding after sex
• Decreased arousal, orgasm, desire – change in libido
• Irritation, burning, or itching of the vulva or vagina
• Urinary frequency and urgency
• Urine infections

These symptoms can affect a woman’s quality of life at work.

Do these symptoms stop after the menopause?

Symptoms commonly last 4-7 years, but for some women they continue after the menopause. If this is happening to you, please speak with a health professional.

How is perimenopause diagnosed?

This is diagnosed when symptoms start to happen and when periods start to change (lighter, heavier, closer together, further apart). Blood tests are not used to diagnose perimenopause because hormone levels fluctuate wildly. Hormone tests may be normal but symptoms can be significant.

How Is menopause diagnosed? Remember that there are different types of menopause

For women aged over 45

• Menopause is the day one year after your last natural menstrual period

• Blood tests are not usually needed – we diagnose based on your menstrual pattern and symptoms. Blood tests might be required if another medical condition needs to be excluded.

For women under the age of 45 – early menopause (aged 40-45) and premature ovarian insufficiency (POI) aged under 40 years

• For women under the age of 45, menopause is diagnosed in a different way.
• You do not need one whole year without a period to diagnose menopause if you are under the age of 45 years.
• If for 3-4 months your periods become irregular, or your periods stop, this is the time to speak with your Dr, even if you have no symptoms. Blood tests are required to test FSH in order to diagnose menopause under the age of 45.

Surgical Menopause

• Surgical menopause occurs when both ovaries are removed during surgery before a woman has gone through the menopause.
• The day that the ovaries are removed is the day of menopause (you do not ‘go through menopause’ again).
• Unlike natural menopause, hormone levels fall suddenly. Symptoms can therefore develop rapidly and may be more severe.

Medical Menopause

• Medical menopause occurs when treatment or medication affects the ability of the ovaries to function (ovulate and produce hormones)
• This may happen following treatment such as chemotherapy, pelvic radiotherapy, ovarian suppression injections, certain treatments for endometriosis, some cancer treatments

Women experiencing POI, early menopause, surgical menopause or medical menopause often benefit from specialist menopause support and may require different treatment approaches. It is really important to ask for help.

When Should You Seek Help?

Speak to a healthcare professional if:

• Symptoms are affecting your quality of life
• Your periods become irregular or stop unexpectedly under the age of 40 (you think you may have POI or early menopause)
• If you are planning to have your ovaries removed before you go through the menopause (a surgical menopause)
• If you have menopause after cancer treatment

You do not need to wait until symptoms become severe before seeking support.

There are many different ways of managing menopause. The advice is individual for every woman. It may include lifestyle changes, hormone therapy, non hormonal therapies, talking therapies, complementary or alternative treatments.

Make an appointment with Dr Carys Sonnenberg at Rowena Health for menopause support.

More reading for you

Women’s Health Concern Fact Sheets

Understanding menopause booklet

Last updated September 2026 Dr Carys Sonnenberg founder/director of Rowena Health, BMS registered Menopause Specialist and co-author of Women’s Health Made Easy.

© Rowena Health | rowenahealth.co.uk

The information in this article was correct at the time of publication. This is for general information only and is not intended to be, nor should it form, individual medical advice. Always seek advice from your health professional about you medical care. Throughout the Rowena Health website, we use the term women when describing people who experience hormonal symptoms. However, we acknowledge not only those who identify as women require access to menopause and hormone health information. For example, some trans men, non-binary people, intersex people or people with variations in sex characteristics may also experience menopausal symptoms and hormonal mood changes such as PMS and PMDD.