What to tell your doctor about perimenopause

What goes on the page, and where each part comes from

• Period dates and cycle lengths. The NHS calls a change in your periods one of the first signs of perimenopause: more often or less often, heavier or lighter. The page counts the days from each start date to the next and prints every cycle, the shortest and the longest. It marks any cycle outside the 24 to 38 days that ACOG describes as normal, and any gap of 60 days or more. Our stage finder explains what those long gaps usually mean.
• Your worst symptoms. NICE asks doctors to explain that symptoms can range from minor to severe, so each one is rated mild, moderate or severe, along with how often it happens. The last column is the one people tend to leave out: how the symptom affects your daily life. The NHS notes that symptoms can have a big impact on relationships, family life and work, and a line like "missed two days of work in October" tells a doctor more than a rating.
• Bleeding and heart changes, first. The NHS asks you to contact a GP about palpitations, about bleeding that is getting heavier, and about any bleeding after 12 months without a period. ACOG adds bleeding between periods, after sex, and bleeding that lasts longer than usual. Anything you tick in section 4 moves to the top of the sheet, so it gets read even if the appointment runs short.
• Hormones and medicines. NICE warns doctors that perimenopause is harder to identify in someone taking hormones, and the NHS says the progestogen-only pill, hormonal coil, implant and injection can make periods irregular or stop them. If you take HRT, the NHS expects irregular bleeding to settle within 6 months, and the summary reminds you to mention it if yours has not.
• Your questions. Each one leads to something you can act on. NICE tells doctors to talk through the benefits and risks of every option they discuss and to give advice on bone health. The NHS says you still need contraception for 2 years after your last period if you are 40 to 49, and for 1 year if you are 50 or over. The test question changes with your age, because NICE advises against hormone tests to identify perimenopause at 45 or over and keeps the FSH test for people aged 40 to 45, or under 40 when early menopause is suspected.

When not to wait for the appointment

Bleeding that soaks a pad every hour for more than 2 hours, with dizziness, chest pain or breathlessness, is a reason to call 999 or 911 or go to the emergency department, according to ACOG. If you tick that line, the summary still builds, with that advice above it. Bleeding after 12 months with no period is not an emergency, but book the GP appointment now instead of waiting for a routine review. The NHS says to get it checked even if it happened once or was only a pink or brown discharge, and our page on bleeding after menopause explains why.

Not sure whether your bleeding counts as heavy? The PBAC blood loss scorer gives you a number to put in the summary's effect box, and the bleeding checker sorts other bleeding into expected, worth an appointment, and urgent.

A worked example

Say you are 47 and take no hormones. Your last four periods started on 30 June, 14 August, 5 September and 24 October 2026, and your bleeding is heavier than it was a few years ago. Your worst symptoms are night sweats (severe, a few times a week, "wake soaked, then awake until 5am"), poor sleep (moderate, most days) and joint pain (mild, about once a week).

The summary works out three cycles of 45, 22 and 49 days. All three fall outside 24 to 38 days, and the shortest and longest are 27 days apart. Because you chose "heavier", the sheet opens with "My bleeding is heavier than it used to be" under the heading for things to look at first. Below it sit the dates, the three symptoms in a small table and your questions, with the test question worded for 45 or over: can perimenopause be identified from my symptoms, without a blood test? At 47, a changed cycle together with recent night sweats matches what NICE describes.

Handing it over

Give the sheet to the doctor at the start, before you begin talking, and keep a copy for yourself. One page is quick to read, and the conversation then starts from your record instead of your memory. Ask the doctor to note the summary and any requests you made in your medical record, so the next appointment does not start from scratch.

If you have no dates yet, the printable symptom diary gives you a month-long grid to fill in each evening, and its notes cover what to do if you leave an appointment feeling dismissed. The cycle length calculator handles a longer run of dates than the six this page takes.

My take

I'd start with three symptoms and skip the other two rows. Five fit on the sheet, but a doctor with limited time will act on the first two, so put the one that affects you most at the top, even if a different one is more frequent. I'd judge each rating by the effect box beside it and fill that box in every time, because "severe" means different things to different people and "left a meeting twice" does not. And if anything lands under "Please look at these first", I'd say it out loud as well as hand it over.