The early signs of perimenopause that are easy to miss

Perimenopause is the stage before menopause, when hormone levels start to change and periods become less predictable. For most women it starts in their 40s, and it can last several years.

Because the early signs are so varied, many women do not connect them to hormones at first.

Changes to your periods

Cycles may get shorter or longer, heavier or lighter, or become irregular. This is often the first clear sign, but not always.

Sleep and mood

Waking in the early hours, feeling more irritable or anxious than usual, or losing confidence are all common, and often come before hot flushes.

Memory and focus

Losing words mid-sentence or struggling to concentrate can be part of perimenopause. It is common and it usually improves.

When to talk to a doctor

If symptoms are affecting your work, relationships or sleep, it is worth a conversation. If you are over 45, you do not need a blood test to be diagnosed. A doctor can usually tell from your symptoms.

Heavy bleeding, bleeding between periods, or bleeding after sex should always be checked by a doctor.