The perimenopause symptom checklist, grouped by system
Print this before your appointment. Every common perimenopause symptom, organised by body system, with the ones that need urgent review flagged.
Most women can name three symptoms. The list runs to more than thirty, and the ones that arrive first are rarely hot flushes.
In short: Perimenopause symptoms come from fluctuating oestrogen and cluster into six systems: cycle changes, mood and cognition, sleep, vasomotor, musculoskeletal, and urogenital. Psychological and sleep symptoms often appear years before periods change.
Cycle
- Shorter or longer gaps between periods
- Heavier or lighter bleeding
- Missed periods
- Worsening premenstrual symptoms
- New clotting or flooding
Mood and cognition
- New or worsening anxiety, often worst on waking
- Irritability and reduced tolerance for noise and interruption
- Low mood that does not match circumstances
- Brain fog, word-finding difficulty, losing the thread mid-sentence
- Loss of confidence, particularly at work
- Feeling like your usual coping strategies have stopped working
Sleep
- Waking at 3am and not returning to sleep
- Night sweats
- Unrefreshing sleep despite adequate hours
- New restless legs
Vasomotor
- Hot flushes
- Palpitations
- Temperature intolerance
- Dizziness or light-headedness
Musculoskeletal
- Joint aches, especially hands, hips and knees
- Frozen shoulder
- Tendon pain that takes longer to settle than it used to
- Muscle loss despite the same activity
- New lower back pain
Urogenital and skin
- Vaginal dryness and discomfort during sex
- Recurrent urinary tract infections
- Urinary urgency
- Reduced libido
- Dry, itchy or crawling skin
- Thinning hair and increased facial hair
Flag these for urgent review
- Bleeding between periods, after sex, or after twelve months without a period
- Very heavy bleeding soaking through protection hourly
- Periods stopping before age 45
- Severe low mood or thoughts of self-harm - contact your GP urgently, or 999 or Samaritans on 116 123
How to use this list before an appointment
Tick what applies, note roughly when each started, and mark the three that affect your life most. Appointments are short; leading with your top three and the duration gives a clinician far more to work with than a full list read in order.
Common questions
Can I have perimenopause symptoms with regular periods? Yes, and it is common early on.
Do I need a blood test? Usually not over 45. UK guidance advises diagnosing on symptoms because levels fluctuate too widely to be reliable.
Could this be something else? disease and iron deficiency mimic perimenopause closely and are worth excluding.
Read the full perimenopause guide or find a menopause specialist.