Could it be perimenopause?

Perimenopause is usually recognised from two things together: a change in your periods, and symptoms such as hot flashes, night sweats, poor sleep or mood changes. For people aged 45 or over with both, the UK guideline from NICE says a doctor can identify it from those symptoms without a blood test. The form below sorts your answers against that picture and flags the bleeding and heart symptoms that should be reported whatever the cause.

How the checklist reads your answers

It sorts your answers. It does not add them up. Each answer is matched against what three sources say, and the result tells you which description fits and where it comes from.

• Period changes come first. The NHS says one of the first signs of perimenopause is usually a change in your periods, which may come more or less often and get heavier or lighter. Section 2 asks about exactly those changes.
• Symptoms come from the NHS list. Section 3 is that page's list of symptoms, from hot flushes (the NHS word for hot flashes) and night sweats to sore gums. Having several of them strengthens the picture, though none of them belongs to perimenopause alone.
• Age decides what a doctor does next. NICE says that in healthy people aged 45 or over, perimenopause is identified from vasomotor symptoms and irregular periods without hormone tests. An FSH blood test is something a doctor may consider at 40 to 45, and under 40 when early menopause is a possibility.
• A few answers always go to the top. ACOG lists bleeding between periods, bleeding after sex, heavy bleeding and periods that are heavier or longer than usual as not normal at any age. The NHS adds palpitations and any bleeding after 12 months without a period. Any of those puts a "report these" list above your result.

A missed period followed by unusual bleeding and tummy pain is handled separately. The NHS page on bleeding between periods treats it as urgent because it can be an ectopic pregnancy, and pregnancy is still possible in perimenopause.

What each result means

"Your answers fit the usual picture" (45 or over). You ticked at least one cycle change and at least one symptom. That is the combination NICE uses to identify perimenopause at your age, so a GP can usually talk it through with you without sending you for a blood test.

The same result at 40 to 44. The pattern is the same, and the doctor has one more tool. Perimenopause in your early 40s is common, and an FSH test may be offered alongside your symptoms.

Under 40. Any of these changes before 40 is worth a GP appointment on its own, because menopause before 40 is considered premature and doctors investigate it differently. Our guide to when perimenopause starts explains what counts as early.

Contraception or a medical reason controls your periods. The NHS notes that the progestogen-only pill, the hormonal coil, the implant and the injection can make periods irregular or stop them, which hides the main sign. Your symptoms still count, and a doctor can look at them and your age together.

No period for 12 months. By definition that is menopause, and the years before it were your perimenopause. Symptoms can carry on afterwards, and any bleeding from now on needs checking.

"Not enough to point either way." You noticed no cycle change, so the first sign the NHS describes is missing. Symptoms on their own have many causes, including thyroid problems and premenstrual mood disorders, and a few months of records will show more than one checklist can.

A worked example

Say you are 47, your periods are still coming, and over the last year they have arrived further apart with one skipped. You tick night sweats, trouble sleeping and brain fog, and nothing in section 4. The result reads "Your answers fit the usual picture", explains that NICE does not use blood tests at your age, and points you to the symptom diary so you can take two months of dates to your appointment.

Change one answer, ticking "a period that lasts more than 7 days", and the same result appears under a "report these first" list with that line on it. Nothing else in the result changes, because a long period can be perimenopause and still needs a doctor to look at it.

When it might be something else

Tiredness, weight gain, low mood, dry skin and changes to periods also come with an underactive thyroid. Our page on telling perimenopause and thyroid problems apart lists the signs that lean one way or the other. Low mood that comes in the week or two before each period and lifts once bleeding starts follows a different rhythm, which our guide to PMDD or perimenopause explains. If your periods are your main worry, start with our guides on irregular periods, two periods in one month, heavy periods and clots, or spotting between periods.

My take

I'd treat the result as a way to choose the next step and nothing more. If section 4 produced a list, book the appointment now and bring the list. If it did not, I'd start the printable symptom diary tonight and keep it for two cycles, because a doctor can do far more with dated periods and nightly ratings than with "I think it has been worse lately". And if you are 45 or over and someone suggests a hormone test to settle it, ask whether it will change anything, given what NICE says.