The first symptom of perimenopause. As ovulation becomes more unpredictable, you may skip some periods and experience a heavier period as the lining of the uterus (endometrium) has had more time to build up.

A ‘hot flush’ is a common symptom of a feeling of warmth, usually most intense over the face, neck, and chest. Some women experience profuse sweating. The intensity, length, and frequency of hot flushes can vary and disrupt sleep. Sleep disruption can also be caused by low levels of progesterone, which begin to drop during the perimenopause.

You may feel irritable, anxious, angry, or frustrated. The causes of these symptoms are frequently multifactorial and include hormone changes, disturbed sleep, and hot flushes. Earlier experiences of mood changes may predispose to mood changes around perimenopause.

When oestrogen levels decline, vaginal tissues become thinner and more easily irritated, making intercourse painful. Low oestrogen may also leave you more vulnerable to urinary or vaginal infections. The thinner vaginal tissues contribute to passing urine more frequently and an urgent need to pass urine.

During perimenopause, ovarian function declines. As ovulation becomes less regular, your ability to conceive decreases. However, as long as you are having periods, pregnancy is still possible. Therefore, if you wish to avoid pregnancy, contraception should be considered.

During perimenopause, sexual arousal and desire may change due to a change in hormones. Stress can also impact a woman's libido.

The risk of significantly decreased bone mineral density occurs close to the last period and in the early postmenopausal years. Oestrogen levels decline, and you begin to lose bone more quickly as bone breakdown occurs at a faster rate than bone production. This increases your risk of osteoporosis, a disease that causes bones to become weak and brittle.

A decline in oestrogen is associated with a rise in total cholesterol levels due to higher amounts of low-density lipoprotein (LDL), the ‘bad’ cholesterol, and another blood lipid (fat) known as triglyceride. Over time, this can increase the risk of heart disease in women.

Some women do not realise they are experiencing perimenopause and may not understand what is causing their symptoms. They could also be having regular periods and experiencing perimenopause. Talk to your doctor if you feel you are experiencing any of the perimenopausal symptoms listed.