Perimenopause symptoms: how do you know if you're in it?

The most common perimenopause symptoms are changes in your periods, hot flashes and night sweats, poor sleep, mood changes and brain fog [1][2]. Perimenopause often starts in your mid- to late 40s, though some women notice it in their 30s [3]. If you’re over 45 and your periods are changing along with symptoms like these, perimenopause is a likely explanation, and your doctor can help you confirm it.

I see many people who have had some of these symptoms for a year or two before anyone mentioned the word perimenopause. Below I go through the signs, the age it usually starts, what tests can and can’t show, and what we can do with the information.

What is perimenopause?

Perimenopause is the time before your last period. Your ovaries gradually make less estrogen and progesterone, and the levels go up and down along the way [2]. Menopause itself is a single point in time: when you’ve gone 12 months in a row without a period [3].

In Sweden, most women have their last period at 51 or 52. The range is wide, from about 45 to 57 [2]. Perimenopause can go on for several years before that, about four years on average and sometimes up to ten [3].

If your periods stop before 45, that is called early menopause. Before 40, it is called premature menopause [4]. Both are worth talking to your doctor about.

Common perimenopause symptoms

Perimenopause can look very different from one person to the next. The NHS lists a wide range of possible symptoms [1]. The ones I hear about most often:

• Changes in your periods. They can come more or less often, and be heavier or lighter than before. Irregular periods are often one of the first signs [1][2]. You can read more in perimenopause and your periods.
• Hot flashes and night sweats [1][2]. More on this in perimenopause night sweats.
• Sleep problems. Waking at 3 or 4 in the morning, or sleep that no longer feels restful [1]. See perimenopause insomnia.
• Mood changes. Low mood, worry, a shorter fuse [1]. See perimenopause anxiety.
• Brain fog and poor memory [1]. See perimenopause brain fog.
• Weight gain, mainly around the stomach and upper body [1].

Other signs on the NHS list include:

• palpitations
• headaches or migraines that are worse than usual
• muscle aches and joint pain
• vaginal dryness, and urinary symptoms that feel like a UTI
• dry, itchy skin and thinning hair
• lower sex drive [1]

Symptoms can change over time. They usually last 7 to 9 years, sometimes longer, and some carry on after menopause [1].

How do I know if I’m in perimenopause?

There is no single sign that settles it. What usually tells the story is a pattern: your age, your cycle and a mix of symptoms over a period of time.

A blood test rarely answers the question on its own. Hormone levels vary so much in perimenopause that one sample can look normal on a day when you feel far from normal [2]. If you’re 40 to 45, your doctor may still order a blood test. Under 40, blood tests can help check for premature menopause [5].

Some symptoms overlap with other conditions, too. Tiredness, weight gain, low mood, trouble concentrating and irregular or heavy periods can also come from an underactive thyroid, for example [6]. That’s one reason why new symptoms are worth checking with your doctor, even if perimenopause seems like the obvious answer.

A symptom diary helps

I often suggest writing down your symptoms for 4 to 6 weeks. Keep it short:

• the days you bleed, and how much
• how you slept, and what time you woke
• hot flashes or night sweats
• mood, energy and focus, on a scale from 1 to 5
• anything else that stands out, like headaches or joint pain

This gives you something concrete to bring to your vårdcentral (local primary care clinic) or gynecologist. It also makes it easier to see patterns, for example that sleep gets worse in the days before a period.

How I work with perimenopause symptoms

At your first visit, we go through your whole story: your cycle, sleep, stress, food, digestion and what you’ve already tried. The visit is 60 minutes, at Kommendörsgatan in Östermalm or online, in English or Swedish. We look at your symptom diary together if you have one.

After the visit, you get a written plan. It can include advice on food, sleep and stress, Chinese and Western herbs, supplements and acupuncture, mainly Japanese style. If it makes sense, we add lab tests, both functional and conventional, as a basis for your plan and for your conversations with your doctor.

I work in parallel with your doctor, whether or not you take HRT. The decision about hormone therapy is one you make with your doctor. You’ll find more on how I work in this phase on my perimenopause page, and all visit options on prices.

When to see a doctor

Contact your vårdcentral or 1177 (Sweden’s public health information service) if you have:

• bleeding more than a year after your last period, even once and even if it’s only spotting [1][2]
• periods that are much heavier than before, or bleeding changes that worry you [1][2]
• palpitations [1]
• symptoms of menopause before the age of 45 [5]
• new, severe or unclear symptoms, or low mood that doesn’t lift

If you have chest pain, severe sudden symptoms or thoughts of not wanting to live, call 112.

Sources

1. NHS. Symptoms of menopause and perimenopause (accessed 2026). https://www.nhs.uk/conditions/menopause/symptoms/
2. 1177. Klimakteriet (accessed 2026). https://www.1177.se/liv--halsa/sa-fungerar-kroppen/klimakteriet/
3. Office on Women’s Health, U.S. Department of Health and Human Services. Menopause basics (accessed 2026). https://www.womenshealth.gov/menopause/menopause-basics
4. NHS. Early menopause (accessed 2026). https://www.nhs.uk/conditions/early-menopause/
5. nidirect (Northern Ireland government, health information). Menopause (accessed 2026). https://www.nidirect.gov.uk/conditions/menopause
6. NHS. Underactive thyroid (hypothyroidism): symptoms (accessed 2026). https://www.nhs.uk/conditions/underactive-thyroid-hypothyroidism/symptoms/