In short
Overview
Perimenopause is diagnosed from your cycle and your symptoms, not from a blood test. That is the single most useful thing to know before booking an appointment.
Direct Answer
The diagnosis rests on the pattern: cycles becoming irregular, closer together or further apart, alongside symptoms.
A single hormone level rarely settles anything, because levels swing week to week in perimenopause and can look completely normal on a good month.
Median age at final period is 51.4. Hot flushes affect up to 80 per cent of women but only 20 to 30 per cent seek treatment, which is the gap worth closing.
Who This Applies To
- Cycles changing in length or regularity
- Hot flushes and night sweats
- Sleep that is broken or no longer restorative
- Mood changes, irritability, low mood
- Difficulty concentrating, often described as brain fog
- Vaginal dryness or discomfort with sex
- Heavier or unpredictable bleeding
- Periods stopping before 40, which is primary ovarian insufficiency and is treated differently, at a higher dose, to protect bone
- Bleeding between periods, after sex, or after a year without periods
- Very heavy bleeding, which needs an endometrial biopsy before any hormone treatment
Option Comparison / Decision Criteria
until 12 months without a period. Standard hormone therapy is not contraception
, 12 days a month, producing a monthly bleed in 80 to 90 per cent of women
during the transition but not after menopause, which is a genuine difference
Why an In-Person Physician Review Matters
The mood point, taken seriously The risk of new onset depression during the transition is around 30 per cent, and around 60 per cent for women with a previous history.
Rates then fall after menopause. In one trial of 50 perimenopausal women with depression, 68 per cent went into remission on transdermal oestradiol against 20 per cent on placebo. Where mood and flushes are both severe, both hormone therapy and an SSRI are often needed. Yet screening is patchy: in a survey of practising obstetricians and gynaecologists, over a third did not routinely screen perimenopausal women for depression, and only about half felt confident managing it. The sleep trap Restless legs and obstructive sleep apnoea often begin in the same decade. In women investigated for sleep disturbance around menopause, 53 per cent had one or both. Those need their own treatment. Attributing all sleep problems to hormones is a common and consequential mistake. What the examination and history cover The cycle pattern, in detail, with dates rather than impressions Contraception needs, since pregnancy is still possible in 2 to 3 per cent of women aged 45 to 49 using nothing Bleeding heaviness, since very heavy bleeding needs investigating first Cardiovascular and breast cancer risk, calculated before any hormone is considered
Frequently Asked Questions
Usually not. Hormone levels swing week to week in perimenopause, so a single result can look entirely normal on a good month. The diagnosis rests on your cycle pattern and your symptoms.
Longer than most women are told. Median total duration of hot flushes is 7.4 years, with a median of 4.5 years continuing after the final period. Over 40 per cent of women aged 60 to 65 still have them.
Yes, until 12 months without a period. Standard hormone therapy is not contraception. Pregnancy is still possible in about 2 to 3 per cent of women aged 45 to 49 using nothing.
It may well be. The risk of new depression during the transition is around 30 per cent, and around 60 per cent with a previous history. Oestrogen improves mood during the transition, though not after menopause.
Evidence
Where this information comes from
Every figure on this page is taken from the sources below. All of them are free to read, so you can check them yourself.
This page is general medical information and does not replace a personal consultation. Trial results are averages across large groups, not a prediction for any one person.