Perimenopause or something else?

How the finder matches your answers

Each look-alike has a short list of answers that point to it, taken from the source named below. An answer from section 2 counts twice and a symptom counts once. A look-alike only shows up when you tick its key answer (such as a possible pregnancy, two weeks of low mood, or focus problems since childhood) or enough of its symptoms. The list then runs from most matches to fewest. There is no overall score for perimenopause.

• Pregnancy. The NHS list of early pregnancy signs includes several that perimenopause can cause too: a missed period, light bleeding, tiredness, sore breasts and mood changes. Feeling sick and a metallic taste belong to pregnancy alone, so they push it up the list.
• Depression. The NHS advises seeing a GP when symptoms of depression last most of the day, every day, for more than 2 weeks. That one line is enough for the finder to show it.
• PMDD. Timing decides this one. ACOG describes premenstrual symptoms that start in the days before a period and ease within about 4 days of bleeding starting, cycle after cycle.
• Thyroid problems. Feeling cold, constipation, losing weight while eating more and shaky hands point to a thyroid problem, because perimenopause does not usually cause them. Without any of those, the finder needs four shared symptoms (such as tiredness, weight gain, dry skin and thinning hair) before it shows the thyroid page. NICE's thyroid guideline reminds doctors that menopause symptoms can mask thyroid disease.
• Anaemia from low iron. The NHS page on low iron calls heavy periods a very common cause and lists tiredness, shortness of breath, palpitations, pale skin and headaches. Ticking heavy periods is enough to show it. So is feeling tired along with either getting out of breath or looking pale.
• Stress. The NHS stress page names headaches, muscle tension, a faster heartbeat, poor concentration, forgetfulness, irritability and sleeping too much or too little. Several of those are perimenopause symptoms too, so stress appears only if you said you have been under a lot of pressure.
• ADHD. Symptoms of ADHD in adults usually start before the age of 12. Problems that began in your 40s point elsewhere, so the finder only shows ADHD when you say yours go back to childhood.

Three more pages can appear. If you use hormonal contraception, you get our page on how it can mask perimenopause. If you are under 40, you get the page on early menopause. Ticking forgetfulness adds the brain fog page, which explains the blood tests for B12, folate and iron.

When to get help today

Section 4 covers situations that need help straight away, before any reading. Thoughts of harming yourself mean calling 999 or going to A&E if you are in danger now, or calling NHS 111, Samaritans on 116 123, or 988 in the US. A missed period followed by unusual bleeding and tummy pain can be an ectopic pregnancy, which the NHS treats as urgent. ACOG's bleeding guidance sends anyone soaking a pad every hour for more than 2 hours, with dizziness, chest pain or breathlessness, to emergency care. Bleeding after 12 months with no period is not an emergency, but it always needs a GP appointment, as our page on bleeding after menopause explains.

A worked example

Say you are 46 and your periods still come but have changed over the past year. In section 2 you tick heavy periods. In section 3 you tick night sweats, poor sleep, feeling tired and getting out of breath. Anaemia comes up first with four matches, because heavy periods count twice and the other two symptoms once each. Below it, the result says perimenopause still fits, since at 46 your periods have changed and you have night sweats as well.

Now add "low mood most of the day for 2 weeks or more". Depression joins the list with three matches (two for the low mood, one for poor sleep) and sits just below anaemia. Both can be true together, so the result keeps them side by side and leaves the choice of what to check first to you and your GP.

When perimenopause is still the likeliest answer

Suppose you are 45 or over, your periods have changed, and you get night sweats or sleep badly. The NICE menopause guideline says a doctor can identify perimenopause from that alone, without hormone tests, and the finder tells you so when it sees that combination. If a look-alike shows up as well, it is one more thing to rule out. Perimenopause stays on the table. Our perimenopause symptom checklist looks at that side of the question in more detail.

My take

I'd read the top one or two pages the finder gives you and skip the rest for now. Then I'd take the result to a GP and ask two direct questions: would a full blood count and a thyroid test change anything for me, and is a pregnancy test worth doing first? Those three are routine tests, and between them they cover pregnancy, anaemia and the thyroid. If you are over 45 and the GP says no to both questions, a few months of dated notes from our printable symptom diary will tell you more than another test.