# Perimenopause symptoms and how to track them · Peri Signals > Source: https://perisignals.com/articles/perimenopause-symptoms Symptoms ## Perimenopause symptoms and how to track them The first sign is usually a change in your periods. Hot flashes, poor sleep, mood changes, brain fog and aching joints often follow, and most of them are expected. Bleeding that gets heavier or longer, bleeding between periods and a racing heart are the ones to take to a doctor. By Nora Whitfield, updated 1 November 2026 ### What perimenopause is Perimenopause is the run-up to menopause, the years when the ovaries make less estrogen and make it unevenly. [MedlinePlus](https://medlineplus.gov/menopause.html) says the transition usually begins in your 40s, sometimes earlier, and can last several years. Menopause itself is a single point: 12 months in a row with no period. The [American College of Obstetricians and Gynecologists](https://www.acog.org/womens-health/faqs/the-menopause-years) puts the average age of that last period at 51. Because hormone levels rise and fall rather than drop in a straight line, symptoms come and go. A month with night sweats can be followed by a month with none. That unevenness is what makes perimenopause hard to recognise from memory, and it is why a written record helps so much later on. ### The first sign is usually your periods The [NHS](https://www.nhs.uk/conditions/menopause-and-perimenopause/symptoms/) names a change to your periods as one of the first signs. They may come more often or less often, and bleeding may get heavier or lighter. ACOG describes the same pattern: cycles that get shorter or longer than is usual for you, skipped periods, and flow that changes. For a sense of scale, ACOG gives a typical cycle as 24 to 38 days from the first day of one period to the first day of the next, with bleeding that lasts up to 8 days. Cycles that drift outside the range you have known for years are the signal. Most women do not notice the drift until they count. Our guide to [irregular periods in perimenopause](/articles/irregular-periods-perimenopause) walks through each change, from periods closer together to long gaps, and which ones to report. ### The other common symptoms Some women have no symptoms or only a few mild ones, and others have many that are severe, according to ACOG. The NHS list is long, and it helps to see it grouped: * **Heat and sleep:** hot flashes (a sudden heat in the face, neck and chest that can bring sweating, a pounding heart or dizziness), night sweats, and trouble falling or staying asleep. * **Mood and thinking:** mood swings, low mood, anxiety, irritability, and problems with memory or concentration that many people call brain fog. * **Body:** muscle aches and joint pain, headaches or migraines that are worse than before, palpitations, weight gain around the stomach, thinning hair, and dry or itchy skin. * **Vaginal and urinary:** dryness, burning or itching, painful sex, needing to pee more often, leaking, and more urinary tract infections. * **Less talked about:** lower sex drive, and sensitive teeth, sore gums or other mouth problems. Sleep and mood are linked. The NHS notes that low mood and memory problems can feel worse when night sweats are breaking up your sleep, so a bad week of thinking may start with a bad week of nights. If your worst mood days cluster before each period instead, our guide to [PMDD or perimenopause](/articles/pmdd) shows how to read that pattern. Background matters too. The NHS says ethnic background can affect how severe symptoms are and how long they last, and that women from a Black ethnic background are more likely to have hot flashes that are severe and continue longer. ### How long symptoms last The NHS says symptoms usually last 7 to 9 years, sometimes longer, and that they change along the way. You might have hot flashes and night sweats for a stretch that then ease while low mood or anxiety becomes the main thing. Some symptoms, joint pain and vaginal dryness among them, can carry on after menopause. The ages at which the transition usually begins, and why the transition itself is shorter than the symptoms, are set out in [when perimenopause starts and how long it lasts](/articles/when-does-perimenopause-start). That shifting is one more reason to write symptoms down as they happen. A symptom that was severe in spring and mild by autumn is easy to forget by the time you sit in front of a doctor. ### Which changes are expected and which to report ACOG calls changes in bleeding normal during perimenopause and still asks you to report them, because abnormal bleeding can be a sign of a problem. Its list of bleeding that is [not normal](https://www.acog.org/womens-health/faqs/perimenopausal-bleeding-and-bleeding-after-menopause) is short and worth keeping: * bleeding or spotting between periods, which has [its own guide on causes and when to go](/articles/spotting-between-periods-perimenopause) * bleeding or spotting after sex * heavy bleeding during your period * bleeding that is heavier or lasts more days than usual * any bleeding after menopause, once you have gone 12 months without a period The NHS adds palpitations to the reasons to contact a doctor, along with bleeding that is getting heavier rather than lighter. It also says any bleeding after 12 months without a period needs checking, even a single episode, even a small amount, even pink or brown discharge. Most of the time the cause is not serious, and the NHS points out that finding the rare serious cause early makes it easier to treat. For the measured signs of a period that is too heavy, and what clots and flooding mean, see [heavy periods and blood clots in perimenopause](/articles/heavy-periods-perimenopause). You do not need a red flag to book an appointment. Symptoms that are disrupting your work, sleep or relationships are reason enough, and the NHS says early advice can reduce those effects. ### Do you need a blood test? Often, no. The UK guideline from [NICE](https://www.nice.org.uk/guidance/ng23/chapter/Recommendations) says that in otherwise healthy people aged 45 or over, perimenopause is identified from symptoms: hot flashes that have recently started together with any change in the menstrual cycle. It advises against using hormone tests such as anti-Müllerian hormone or estradiol to identify perimenopause at that age, and keeps the follicle-stimulating hormone (FSH) test for people aged 40 to 45 with symptoms, or under 40 when early menopause is suspected. In practice that puts your own account of your symptoms at the centre of the appointment. The clearer and better dated it is, the more your doctor has to go on. A blood test does come in when your doctor wants to rule out something else. The most common example is the thyroid, whose symptoms overlap with perimenopause on tiredness, weight, mood and periods: our guide to [perimenopause or thyroid](/articles/perimenopause-or-thyroid) sets out the clues and when a thyroid test is used. One thing can blur the picture. The NHS says hormonal contraception, including the progestogen-only pill, the hormonal coil, the implant and the injection, can make periods irregular or stop them, which makes it harder to tell whether perimenopause has started. You can still get pregnant during perimenopause, and the NHS advises contraception until 2 years after your last period if you are 40 to 49, or 1 year if you are 50 or over. ### What about treatment? There are treatments for perimenopause symptoms, hormonal and non-hormonal, and which one suits you depends on your symptoms, your health history and your preferences. That is a conversation for your doctor. MedlinePlus and NICE both set out the options a doctor will talk through with you, and we do not give treatment advice here. ### How to track your symptoms so the record is useful A useful record answers three questions for each symptom: when it happened, how bad it was, and what else was going on. Keep it simple enough that you will still be doing it in month three. * **Period days and flow.** The first day of each period, how many days it lasted, and whether flow was light, medium or heavy. Note any spotting between periods or after sex on its own line. * **Each symptom, rated mild, moderate or severe.** Three levels are enough to compare one month with the next. Note the time for hot flashes, since they often cluster at certain hours. * **Sleep.** Roughly when you went to bed and got up, how often you woke, and whether night sweats were part of it. * **Anything new.** A new medicine, a change in contraception, an illness or a hard week at work. I would keep a record for at least two or three cycles before an appointment. Cycle length only shows up across several cycles, and a few months of ratings show whether a symptom is steady, getting worse or coming in waves. Bring a one-page summary, and add the two or three questions you most want answered at the top. The [printable symptom diary and appointment checklist](/articles/printable-perimenopause-symptom-diary-and-appointment-checklist) builds both from the symptoms you tick. A paper notebook works, and so does the notes app on your phone. If you want the summary built for you, [Her Good Days](https://hergooddays.com/#get) is a free app that keeps a dated log of perimenopause symptoms, periods, sleep and medication. You log a hot flash, brain fog or joint aches with how severe it was and the time, and before an appointment it makes a PDF for the dates you pick: period dates, cycle lengths, how often each symptom came and how severe it was, sleep, medications and your notes, marked as reported by you and with no reading of what they mean. Every feature is free, with no paid plan. The iPhone and Android apps are coming soon, and the link above is where they will be. ### My take If you are in your 40s and your cycle has started to change, I'd treat perimenopause as a likely reason and start writing things down now, before you are sure. I'd skip long descriptions and use the three-level rating, which is quicker and easier to compare month to month. And I'd be most careful with notes on bleeding, because bleeding is where the line between expected and worth checking is clearest. Then take the record to your doctor and let it do the talking. ### Related reading Each part of this overview has its own topic on Peri Signals: [symptoms one by one](/topics/symptoms), [periods and bleeding](/topics/periods-and-bleeding), [telling perimenopause from other causes](/topics/is-it-perimenopause), [tracking and appointments](/topics/tracking), and [when it starts and how long it lasts](/topics/stages-and-timing). Written by Last checked 2026-11-01 --- [Peri Signals](/) Perimenopause symptoms, explained and tracked Plain answers on perimenopause symptoms for women 35 to 65: what is common, what to tell your doctor, and how to keep a useful symptom record. Some links on this page may earn us a commission. It never decides what we write about or recommend. © 2026 Peri Signals. Independent and reader-supported.