Is it perimenopause? What to discuss at your appointment
English translation of the French article published by SaHera.
The first step is to describe what is changing for you, then discuss it with a healthcare professional. The word “perimenopause” can open a useful conversation. It does not replace an assessment of your situation.
Perimenopause: a transition that begins before periods stop
Natural menopause is recognised after twelve consecutive months without menstruation, when there is no other cause. Perimenopause refers to the transition around the final menstrual period: according to the World Health Organization, it begins with the first signs and ends one year after the last menstrual period. It may last several years. You may therefore still have periods during this transition. WHO, 16 October 2024.
This milestone cannot tell you in advance when your final period will occur. It helps identify a stage; it does not predict your individual experience precisely.
What changes might you notice?
Periods that come closer together or further apart may be an early clue. Some women also notice hot flushes, night sweats, disrupted sleep, changes in mood or concentration, or vaginal dryness. Experiences vary: symptoms may be subtle or have a substantial effect on daily life. NHS, reviewed 19 May 2026.
To prepare for the conversation, focus on what is different from your usual experience. Is it new? When did it start? What bothers you most? You do not need to recognise yourself in an entire list to ask questions.
Can a blood test provide the answer?
Not always. In an otherwise healthy person aged 45 or over, the onset of hot flushes or sweats alongside changes in the menstrual cycle may allow clinical identification without routine hormone testing. NICE recommendations describe situations in which testing the hormone FSH may be considered, including between ages 40 and 45 with symptoms and cycle changes, or before age 40 when menopause is suspected. NICE NG23, recommendations 1.3.1 and 1.3.6, updated 15 April 2026.
Hormone levels can fluctuate during the transition. A single result therefore does not tell the whole story. Depending on the symptoms, tests may also help investigate another explanation. The Canadian clinical review by Lega and colleagues includes pregnancy and certain thyroid disorders among the causes to consider when periods are absent. CMAJ, 31 July 2023, diagnosis section.
A useful question to ask is: “What are we trying to find out with this test, and what would the result change for me?”
What if my periods are already absent or affected by treatment?
Hormonal contraception can change bleeding patterns and make these signs harder to interpret. After a hysterectomy, the absence of periods cannot, on its own, establish the timing of the transition. Assessment then takes symptoms and medical context into account. NICE, recommendations 1.3.1–1.3.2.
Pregnancy remains possible during perimenopause. If you use contraception, discuss when it would be appropriate to adjust or stop it; irregular cycles alone do not mean contraception is no longer needed. WHO, 16 October 2024.
When should you discuss it at an appointment?
You can seek advice whenever you want to understand your symptoms or learn about your options. Also mention bleeding that is heavier than usual for you. NHS, reviewed 19 May 2026.
Bleeding after menopause warrants assessment, even if it is light or happens only once. There may be several causes; do not automatically assume your periods have returned. NHS, “Postmenopausal bleeding”, reviewed 22 May 2023.
In Quebec, if you do not know where to seek help for abnormal vaginal bleeding, the government recommends consulting a healthcare professional or contacting Info-Santé 811. Government of Quebec, “Symptoms” section (French). This resource describes signs that should be assessed; having these signs does not in itself mean a cancer diagnosis.
Prepare for your appointment with a few notes
You can use a notebook or a note on your phone. Here is a simple structure for your observations:
What has changed: period dates if you know them, changes in bleeding, sleep or other symptoms.
When it began: approximate onset, frequency and how it has evolved.
The effect on your life: rest, work, activities or intimacy.
Your context: contraception, medicines, supplements and relevant medical history.
Your priority: what you would most like to understand or improve first.
These notes support the conversation. They are neither a test nor a requirement for getting help. If you are short of time, one sentence is enough to begin: “Here is what has changed and what concerns me most.”
Before your next appointment, write down the change that concerns you most and the question you would like answered.
Transparency and sources
This content was prepared for the SaHera blog. It provides general information and does not recommend any product. It does not replace a consultation tailored to your situation.
The French article records its source consultation date as 19 September 2026: WHO (2024), NICE NG23 (2026 update), NHS symptoms (2026 review), CMAJ (2023), NHS postmenopausal bleeding (2023 review), and the Government of Quebec (review date not recorded). Links appear beside the relevant passages. This English translation preserves the information and source references of that article.
