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Perimenopause test: am I in perimenopause?

At 45 or over, you don't need a blood test: doctors recognise perimenopause from how your periods have changed and from your symptoms. This free 2-minute check reads both, shows what your answers match and what to ask a doctor.

12symptoms checked
51average age at menopause in Europe
42official sources
Read about:SymptomsTestsTreatmentPregnancy & contraceptionCare abroad

Medically reviewed by Dr. Chrysoula Liakou, MD, PhDSources checked 2 Oct 2026Page updated 2 Oct 2026

On this pageTake the checkIn briefHow this perimenopause test worksWhat is perimenopause?Perimenopause symptoms: the signs to look forIs there a perimenopause or menopause test?When to see a doctor about perimenopausePerimenopause treatment: what a doctor can discussCan you get pregnant during perimenopause?Perimenopause care in Ireland, Malta and across the EUQuestions people askThe data behind this checkAbout this pageSources

In brief

  • Perimenopause runs from the first changes until a year after your last period; menopause is confirmed after 12 months without a period.1
  • The average age at menopause in Ireland is 51, and it usually happens between 45 and 55.2
  • Over 45, hormone blood tests aren't needed: doctors go by your symptoms and how your periods have changed.3
  • HRT is the most effective treatment for hot flushes and night sweats.4
  • You can still get pregnant: use contraception until 2 years after your last period if under 50, or 1 year if 50 or over.5
  • Any bleeding after 12 months without a period needs checking: it is usually not serious, but it can be a sign of cancer.6

How this perimenopause test works

This perimenopause test (some call it a perimenopause quiz) asks about your age, your periods and 12 common symptoms. It takes about 2 minutes and gives you three readings: what your periods show, whether a hormone test makes sense at your age, and which symptoms bother you most.

1. Your periods, read with STRAW+10

Doctors stage the run-up to menopause with a system called STRAW+10. Cycles that keep varying in length by 7 days or more mark the early transition, and a gap of 60 days or more marks the late transition.7 Twelve months without a period confirms that the final period has happened.

2. A 12-symptom checklist

The checklist is our own, built from the symptoms NICE, the NHS and WHO describe, in four groups.8,1 It is not a validated questionnaire and has no clinical cut-off. The points simply add up your own ratings (0 to 3 per symptom, 36 at most) so you can compare over time.

3. Test advice by age

Whether a blood test helps depends mainly on your age: not needed over 45, sometimes considered at 40 to 45, and part of a proper check under 40.3

Warning signs come first

The check also asks about warning signs such as bleeding after menopause, which always needs checking.6 If you tick one, your result starts with advice to see a doctor.

Private by design

Your answers never leave your device. You can save a result in this browser to compare next time, and print or share a one-page summary for any doctor in Europe, in two languages if needed.

What is perimenopause?

Perimenopause is the transition when your ovaries wind down and oestrogen levels fall, often with symptoms starting.3 Menopause is your last period, confirmed only after 12 months in a row without one; WHO counts perimenopause from the first signs until a year after that last period.1 The years after it are called postmenopause.7 The HSE puts it simply: perimenopause is when you have symptoms before your periods have stopped completely.2

When does perimenopause start?

There is no fixed age. Most women reach menopause between 45 and 55, and the average age is about 51, both in Ireland and across Europe.2,3 Changes can begin well before that: the HSE says symptoms can start 7 to 10 years before your periods stop.9 Menopause between 40 and 45 is called early menopause, and before 40, premature ovarian insufficiency (POI).

How long does perimenopause last?

It varies. European endocrinologists say perimenopause may last 2 to 4 years, while WHO says it can last several years.3,1 Symptoms can outlast it: the NHS says they usually last 7 to 9 years, sometimes longer.10 In the US SWAN study, frequent hot flushes and night sweats lasted a median of 7.4 years in total, 4.5 of them after the last period.11

The stages at a glance

Doctors divide the transition into stages by what happens to your periods.7

Stages of the menopausal transition, based on STRAW+10
StageWhat happens to your periodsTypical length
Late reproductive yearsStill regular; cycles may get a little shorterVaries
Early transition (early perimenopause)Cycle length keeps varying by 7 days or moreVaries
Late transition (late perimenopause)Gaps of 60 days or more; hot flushes likelyAbout 1 to 3 years
Final period (menopause)Confirmed once 12 months have passed without a periodA single point in time
Early postmenopauseNo periods; hormone levels settleAbout 5 to 8 years

After a hysterectomy or endometrial ablation, bleeding can't show your stage.7 Doctors then go by the type and combination of your symptoms, and NICE notes that menopause can also be harder to identify while you take hormonal treatment.8

Perimenopause symptoms: the signs to look for

Symptoms range from minor to severe and can last for a short or a long time.8 The first sign is usually a change in your periods: in how regular they are and how heavy.1

A menopause symptoms checklist, in four groups

  • Hot flushes, sweats and sleep: sudden waves of heat in your face, neck and chest, night sweats, and trouble sleeping.
  • Mood and mind: low mood, anxiety and mood changes, and trouble with memory and concentration, often called brain fog.
  • Body: joint and muscle pain, headaches or migraines that are worse than usual, and palpitations, which can come with hot flushes.
  • Intimate and bladder: vaginal dryness, pain during sex, lower sex drive, leaks and repeated urine infections.

NICE, WHO and the NHS describe symptoms in groups like these.8,1,10

Can symptoms start before your periods change?

Yes. In the US SWAN study, women whose frequent hot flushes began while their periods were still regular, or early in the transition, had them for longest: a median of more than 11.8 years.11 Hot flushes are likely in the late transition, when gaps between periods reach 60 days or more.7

What are the 34 symptoms of perimenopause?

You may have seen lists of “34 symptoms” online. They don't come from NICE, the NHS or WHO, which describe a shorter set of symptom groups instead.8,10,1

Other conditions that can feel similar

Thyroid disease can cause sweating, mood swings, anxiety or low mood, lower sex drive and irregular periods, so doctors are advised to have a low threshold for checking thyroid function at this age.12 European guidance also asks doctors to consider other diagnoses when cycle changes or menopause-like symptoms appear in women of reproductive age.3

Is there a perimenopause or menopause test?

There's no single test that proves you are in perimenopause. At 45 or over, if you're otherwise healthy, doctors recognise it without lab tests when hot flushes or night sweats have recently started and your cycle has changed in any way.8

How to test for perimenopause at different ages

  • 45 or over: no hormone tests needed. European endocrinologists say testing is not necessary over 45, and NICE advises against using AMH, inhibin, oestradiol, antral follicle count or ovarian volume to identify perimenopause at this age.3,8
  • 40 to 45: a doctor may consider a blood test for FSH (follicle-stimulating hormone), ideally on days 2 to 5 of your cycle or after more than 40 days without a period.3
  • Under 40: irregular periods, trouble getting pregnant or hot flushes call for blood tests to check for POI.3,13

Why a perimenopause blood test can mislead

FSH rises and falls through the cycle and across the transition, so one normal reading doesn't rule perimenopause out.14 NICE also advises against using FSH to identify menopause while you use combined hormonal contraception or high-dose progestogen.8

Home menopause tests and saliva tests

Home menopause tests check FSH in urine. The US Food and Drug Administration says they can't detect perimenopause or menopause, and that you should never stop contraception because of the result.15 The Royal College of Obstetricians and Gynaecologists recommends against using them.14 There is also no evidence that repeated saliva tests help to monitor compounded hormone treatment.16

What a doctor actually does

Expect questions rather than lab forms: about your periods, your symptoms and how much they affect your life. In Ireland, the HSE says your GP can usually confirm menopause from your symptoms and may suggest a blood test to check your hormone levels.2 A doctor may also look for other causes, such as thyroid problems.12

When to see a doctor about perimenopause

See a doctor soon if you have

  • Bleeding after 12 months without a period, even a little or only once. It is usually not serious, but it can be a sign of cancer.6 At 55 or over, NICE recommends an urgent suspected-cancer referral.17
  • Bleeding between periods or after sex.18
  • Very heavy periods: changing a pad or tampon every 1 to 2 hours, clots larger than about 2.5 cm, or periods lasting more than 7 days.19 NICE advises a full blood count for all women with heavy periods.20
  • Bloating, feeling full quickly, or tummy or pelvic pain on more than 12 days a month, especially at 50 or over.17

Also talk to a doctor if

  • You're under 40 and your periods have changed or stopped, or you have hot flushes: this needs checking for POI.3
  • You're 40 to 45: menopause at this age is early, and the balance of benefits and risks of treatment differs from later menopause.8
  • Your symptoms make work, sleep or relationships harder. The HSE says to talk to your GP if you're finding your symptoms difficult.9

If your mood is very low or you're thinking about harming yourself, call Samaritans free on 116 123 in Ireland or the Mental Health Helpline on 1579 in Malta, both day or night.21,22 In an emergency, call 112: Mobi Doctor must not be used in a medical emergency.

Who to see first

In Ireland, start with your GP, who may refer you to a specialist menopause clinic.2 In Malta, start with a GP at a health centre or privately: the public Menopause Clinic at Mater Dei Hospital takes new patients on a GP's referral.23 Elsewhere in the EU, see the table under care abroad.

Want to talk your result through with a doctor?

Mobi Doctor connects you with a licensed EU-registered doctor over video, usually within 15 minutes, daily 7am–11pm CET.

See available timesMenopause: what we treat

Perimenopause treatment: what a doctor can discuss

Not everyone needs treatment. If symptoms bother you, a doctor can talk through the options and decide with you what suits you.

HRT (hormone replacement therapy)

HRT, also called menopausal hormone therapy (MHT), is the most effective treatment for hot flushes and night sweats, and NICE advises offering it for them.4,8 In Ireland, the HSE calls it the main medicine treatment for menopause and perimenopause symptoms.24 Combined HRT (oestrogen plus a progestogen) is used if you have a womb, oestrogen-only HRT if you don't, and oestrogen comes as tablets or through the skin as patches, gels or sprays.

Benefits and risks

  • Breast cancer: combined HRT raises the risk, more with longer use; the risk falls after stopping, but some extra risk lasts at least 10 years. Oestrogen-only HRT causes very little or no increase.8 UK regulator (MHRA) figures: 63 in 1,000 women aged 50 to 69 who never use HRT are diagnosed with breast cancer; 5 years of HRT adds about 5 (oestrogen-only), 14 (sequential combined) or 20 (continuous combined) cases per 1,000, roughly double that with 10 years.25
  • Blood clots: the risk rises with HRT tablets, but not with patches, gels or sprays.8
  • Stroke: the baseline risk under 60 is very low; it rises with oral oestrogen and is unlikely to rise with oestrogen through the skin.8
  • Heart disease and dementia: HRT doesn't increase coronary heart disease risk, and dementia risk might rise only with combined HRT started at 65 or over.8 HRT should not be used to prevent heart disease or dementia.4

Advice differs between countries: Malta's Ministry for Health page, for example, describes HRT for short-term relief of symptoms or for early menopause.26 Your doctor will weigh your own benefits and risks with you.

Vaginal oestrogen

For vaginal dryness, pain during sex and urinary symptoms, vaginal oestrogen works locally: only a minimal amount reaches the bloodstream and serious side effects are very rare.8 It can be used alongside HRT, and symptoms often return when it's stopped, though it can be restarted. The NHS adds that it doesn't increase breast cancer risk, but it won't help hot flushes.27

Non-hormonal medicines and CBT

Two non-hormonal medicines for moderate to severe hot flushes are authorised in the EU: fezolinetant since 7 December 2023 and elinzanetant since 17 November 2025.28,29 NICE advises against routinely offering SSRI or SNRI antidepressants or clonidine as a first treatment for hot flushes alone.8

Menopause-specific CBT, a talking therapy, is an option for hot flushes, alongside HRT or instead of it.8 For low mood that began with other menopause symptoms and isn't clinical depression, NICE suggests considering HRT, and CBT when low mood comes with hot flushes.

“Bioidentical” hormones and supplements

NICE says the effectiveness and safety of unregulated hormone preparations are unknown.8 The Endocrine Society sees no reason to routinely prescribe custom-compounded “bioidentical” hormones.16 For hot flushes, The Menopause Society in the US does not recommend supplements or herbal remedies.30

Can you get pregnant during perimenopause?

Yes. Fertility falls with age and natural pregnancy is rare after 50, but you still need contraception until menopause if you want to avoid pregnancy.31 Keep using it until 2 years after your last period if you're under 50, or 1 year after it if you're 50 or over.5

Menopause can only be confirmed in hindsight, after a year without periods, so you can't know in advance which period will be your last.31 In general, contraception can be stopped at 55, as natural pregnancy after that age is exceptionally rare.

  • HRT is not contraception. If you may still be perimenopausal, or you're not sure, you need contraception alongside it.31
  • Hormone levels can't time this for you. They aren't reliable on combined contraception or HRT; a doctor uses FSH only in specific cases, such as women over 50 on progestogen-only contraception.31
  • Home tests are no guide. Never stop contraception because of a home menopause test.15

A missed period can also mean pregnancy, so take a pregnancy test if there's any chance. For your options, read about contraception.

Perimenopause care in Ireland, Malta and across the EU

In Ireland, your GP is the first stop, and since 1 June 2025 prescribed HRT has been free at pharmacies taking part in the free HRT scheme.9,32 Malta's Ministry for Health also uses the term HRT.26

If you live elsewhere in the EU

Who you see first, and what HRT is called, vary by country:

First contact and local names for HRT in some EU countries
CountryUsually see firstHRT is often called
Spain (Madrid region)Family doctor, or the midwife (matrona) at your health centreTHS (terapia hormonal sustitutiva)33
PortugalYour own doctor (médico assistente)Terapia de reposição hormonal34
FranceGP (médecin traitant), gynaecologist or midwife (sage-femme)THM (traitement hormonal de la ménopause)35
ItalyFamily doctor (medico di famiglia) or gynaecologistTOS (terapia ormonale sostitutiva)36
GermanyGynaecologist (Frauenarzt or Frauenärztin)37MHT (menopausale Hormontherapie) in the draft national guideline38
NetherlandsGP (huisarts) or gynaecologistHormoontherapie39

Using your prescription in another EU country

A prescription from a doctor in one EU country is valid in all the others, but it is dispensed under the rules of the country where you collect it.40 Ask for the common (generic) name, form, strength and dose on it, not just the brand, and for a paper copy if you'll use it abroad. Pharmacists follow national rules, which can include swapping to a generic.41 Some medicines are not authorised or available in every EU country.

MyHealth@EU lets EU citizens collect medicines in another EU country through the online transfer of their e-prescription.42 If you rely on a particular patch, gel or tablet, check our Medicine Shortage Tracker and Travel Health pages before you travel.

Talking to a doctor while you're away

Mobi Doctor connects you with a licensed EU-registered doctor over video, usually within 15 minutes, daily 7am–11pm CET. The doctor may suggest options and decides with you whether any treatment is right. See available times or read Menopause: what we treat.

Questions people ask

How do I know if I'm in perimenopause?

Usually from two things: changes to your periods and new symptoms such as hot flushes or night sweats. At 45 or over, NICE says doctors can recognise perimenopause without tests in otherwise healthy women when hot flushes have recently started and your cycle has changed in any way.8 If you're under 45, see a doctor so other causes and early menopause can be checked.3

What are the first signs of perimenopause?

Usually a change in your periods, in how regular or how heavy they are.1 In doctors' staging, the early transition starts when your cycle length keeps varying by 7 days or more.7 Hot flushes can come with these changes, and in some women they start while periods are still regular.11

What age does perimenopause start?

There's no set age: changes can begin years before menopause, which most women reach between 45 and 55.1 The HSE says symptoms can start 7 to 10 years before your periods stop.9 Menopause before 40 is called premature ovarian insufficiency (POI) and needs a doctor's assessment with blood tests.13

How long does perimenopause last?

Usually a few years, but it varies. European endocrinologists say perimenopause may last 2 to 4 years.3 Its late stage, when gaps between periods reach 60 days or more, lasts about 1 to 3 years.7 Symptoms can carry on after your last period: the NHS says they usually last 7 to 9 years, sometimes longer.10

Is there a blood test for perimenopause?

Not one that can confirm it, and at 45 or over you don't need one. Hormone levels rise and fall during perimenopause, so a single result can mislead.14 European guidance says testing is unnecessary over 45; at 40 to 45 a doctor may consider an FSH test, and under 40 blood tests check for premature ovarian insufficiency.3

Do home menopause tests work?

Not for telling you whether you're in perimenopause. They measure FSH in urine, and the US Food and Drug Administration says they don't detect perimenopause or menopause and should never be used to stop contraception.15 The RCOG recommends against them, because FSH fluctuates and a negative result doesn't rule perimenopause out.14

Perimenopause vs menopause: what's the difference?

Perimenopause is the transition, when periods change and symptoms often start; menopause is the end point.3 Menopause is confirmed once you've had no period for 12 months in a row, and WHO counts perimenopause as ending a year after that final period.1 The years after it are postmenopause.7

What are the 34 symptoms of perimenopause?

There is no official list of 34 symptoms. Such lists circulate online, but NICE, the NHS and WHO describe a shorter set of symptom groups: period changes, hot flushes and night sweats, sleep problems, mood changes, joint and muscle pain, vaginal and bladder symptoms, and lower sex drive.8,10,1 Our checklist rates 12 symptoms from these groups.

Can you get pregnant during perimenopause?

Yes. Natural pregnancy becomes rare after 50, but you need contraception until menopause if you want to avoid it.31 Use it until 2 years after your last period if you're under 50, or 1 year after it if you're 50 or over.5 HRT is not contraception, so you still need it alongside HRT.

Want to talk your result through with a doctor?

Mobi Doctor connects you with a licensed EU-registered doctor over video, usually within 15 minutes, daily 7am–11pm CET.

See available timesTake the check

The data behind this check

Every rule the check uses — the cycle stages, the test advice by age, the warning signs and the 12-symptom checklist in English, Spanish and Dutch — as an open file with its sources. Free to reuse with a link to this page (CC BY 4.0).

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Cite as: Mobi Doctor, Perimenopause check rules, 2 Oct 2026.

About this page

Medically reviewed

Written by the Mobi Doctor medical content team. Every medical statement on this page is traced to a dated official source, listed under Sources, and was checked against it before publication.

Medically reviewed by Dr. Chrysoula Liakou, MD, PhD.

The symptom checklist is our own: the 12 symptoms NICE, the NHS and WHO list most often, rated by how much they bother you. It is not a validated questionnaire and gives no diagnosis.

Found something out of date? Use the contact page and we will check it against the source. Contact us

Sources

  1. Menopause (fact sheet) — WHO (16 Oct 2024)
  2. Menopause — HSE
  3. Clinical practice guideline for evaluation and management of menopause and the perimenopause (Eur J Endocrinol 2025;193(4):G49–G81) — European Society of Endocrinology (13 Oct 2025)
  4. Updated menopause guidance includes discussion aid to support conversations about HRT — NICE (Nov 2024)
  5. About hormone replacement therapy (HRT) — NHS (reviewed 7 Feb 2023)
  6. Postmenopausal bleeding — NHS (reviewed 24 Sep 2026)
  7. Executive summary of the Stages of Reproductive Aging Workshop + 10 (STRAW+10). Menopause 2012;19(4):387–395 — Harlow SD et al. (2012)
  8. Menopause: identification and management (NG23) — NICE (updated 7 Nov 2024)
  9. Menopause symptoms — HSE
  10. Menopause and perimenopause: symptoms — NHS (reviewed 19 May 2026)
  11. Duration of menopausal vasomotor symptoms over the menopause transition (JAMA Intern Med 2015;175(4):531–539) — Avis NE et al. (SWAN) (2015)
  12. EMAS position statement: thyroid disease and menopause (Maturitas 2024;185:107991) — EMAS (2024)
  13. Evidence-based guideline: premature ovarian insufficiency (Hum Reprod Open 2024;hoae065) — ESHRE, ASRM, CRE, IMS (9 Dec 2024)
  14. RCOG recommends against using over-the-counter menopause tests — RCOG (10 Jun 2022)
  15. Menopause (home use tests) — US FDA (27 Sep 2018)
  16. Compounded bioidentical hormones in endocrinology practice (scientific statement) — Endocrine Society (Apr 2016)
  17. Suspected cancer: recognition and referral (NG12) — NICE (updated 15 Apr 2026)
  18. What causes bleeding between periods? — NHS (reviewed 13 Aug 2024)
  19. Heavy periods — NHS (reviewed 19 Sep 2024)
  20. Heavy menstrual bleeding: assessment and management (NG88) — NICE
  21. Contact a Samaritan (Ireland) — Samaritans
  22. National Suicide Prevention Strategy for Malta 2025–2030 — Ministry for Health, Malta (Mar 2025)
  23. Gynae outpatients and ante-natal clinic (incl. Menopause Clinic) — Mater Dei Hospital (Malta)
  24. Menopause treatment — HSE
  25. Hormone replacement therapy and risk of breast cancer (patient sheet) — MHRA (Aug 2019)
  26. Menopause — Sexual Health Malta (Ministry for Health)
  27. Types of hormone replacement therapy (HRT) — NHS (reviewed 9 Mar 2023)
  28. Veoza (fezolinetant): EPAR — European Medicines Agency (authorised 7 Dec 2023)
  29. Lynkuet (elinzanetant): EPAR — European Medicines Agency (authorised 17 Nov 2025)
  30. The 2023 nonhormone therapy position statement (Menopause 2023;30(6):573–590) — The Menopause Society (2023)
  31. Contraception for Women Aged Over 40 Years — FSRH / CoSRH (Aug 2017, amended May 2025)
  32. Free hormone replacement therapy (HRT) scheme — Citizens Information
  33. Menopausia — Comunidad de Madrid
  34. CHMT desmistifica a menopausa e alerta para importância da saúde feminina — Centro Hospitalar do Médio Tejo (SNS)
  35. Périménopause et ménopause : mode de vie et traitement — ameli.fr (Assurance Maladie)
  36. Terapia ormonale sostitutiva (TOS) — ISSalute (Istituto Superiore di Sanità)
  37. Wechseljahre — gesund.bund.de (Bundesministerium für Gesundheit)
  38. S3-Leitlinie Peri- und Postmenopause – Diagnostik und Interventionen (AWMF 015-062), Kurzfassung, Konsultationsfassung Juni 2026 — AWMF / DGGG, OEGGG, SGGG (Juni 2026 (Entwurf))
  39. Ik wil misschien hormoontherapie tegen opvliegers in de overgang — Thuisarts.nl (NHG)
  40. Prescriptions abroad — Your Europe (European Commission) (checked 9 Oct 2025)
  41. Directive 2011/24/EU on patients’ rights in cross-border healthcare, Article 11 — EU (2011)
  42. Electronic cross-border health services (MyHealth@EU) — European Commission

This check gives general information based on published guidance. It does not diagnose you and does not replace advice from a doctor who knows your situation.

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