{
 "name": "Perimenopause check rules",
 "publisher": "Mobi Doctor (Mobidoctor Ltd)",
 "url": "https://www.mobidoctor.eu/perimenopause-test/",
 "version": "1.0",
 "dateModified": "2026-10-02",
 "licence": "CC BY 4.0",
 "licence_url": "https://creativecommons.org/licenses/by/4.0/",
 "cite_as": "Mobi Doctor, Perimenopause check rules, 2 Oct 2026.",
 "description": "The rules behind Mobi Doctor's free perimenopause self-check: how the bleeding pattern is read (STRAW+10), hormone-test advice by age, warning signs that need a doctor, and the 12-symptom checklist. Not a diagnostic tool.",
 "languages": [
  "en",
  "es",
  "nl"
 ],
 "staging": [
  {
   "id": "early",
   "condition": "Last period within 2 months; consecutive cycle lengths keep differing by 7 days or more",
   "reading": "Early menopausal transition (STRAW+10 stage -2)",
   "sources": [
    "straw10"
   ]
  },
  {
   "id": "late",
   "condition": "Last period 2-12 months ago, or a gap of 60 days or more in the past year",
   "reading": "Late menopausal transition (STRAW+10 stage -1)",
   "sources": [
    "straw10"
   ]
  },
  {
   "id": "post",
   "condition": "No period for more than 12 months (not explained by contraception, HRT or surgery)",
   "reading": "Postmenopause (12 months without a period)",
   "sources": [
    "straw10",
    "who-menopause"
   ]
  },
  {
   "id": "repro",
   "condition": "Last period within 2 months; cycle interval unchanged",
   "reading": "No change in cycle interval",
   "sources": [
    "straw10"
   ]
  },
  {
   "id": "unknown",
   "condition": "Last period within 2 months; cycle not tracked",
   "reading": "Cannot be staged from periods",
   "sources": [
    "straw10"
   ]
  },
  {
   "id": "hormonal",
   "condition": "Hormonal contraception or HRT",
   "reading": "Cannot be staged from periods",
   "sources": [
    "nice-ng23",
    "straw10"
   ]
  },
  {
   "id": "surgery",
   "condition": "Hysterectomy or endometrial ablation",
   "reading": "Cannot be staged from periods; doctors use symptoms and age",
   "sources": [
    "straw10",
    "nice-ng23"
   ]
  },
  {
   "id": "flag",
   "condition": "Any warning sign reported",
   "reading": "Not staged; see a doctor first",
   "sources": [
    "nhs-pmb",
    "nhs-imb",
    "nhs-heavy",
    "nice-ng12"
   ]
  }
 ],
 "test_advice_by_age": [
  {
   "age": "45 or over",
   "advice": "No blood test needed to identify perimenopause or menopause",
   "sources": [
    "nice-ng23",
    "ese-2025",
    "bms-tfc"
   ]
  },
  {
   "age": "40-44",
   "advice": "An FSH blood test may be considered if there are symptoms and the cycle has changed",
   "sources": [
    "nice-ng23",
    "ese-2025"
   ]
  },
  {
   "age": "under 40",
   "advice": "See a doctor: assessment for premature ovarian insufficiency includes blood tests",
   "sources": [
    "nice-ng23",
    "eshre-poi-2024"
   ]
  },
  {
   "age": "any, on combined contraception or high-dose progestogen",
   "advice": "FSH results are not reliable",
   "sources": [
    "nice-ng23",
    "fsrh-40"
   ]
  },
  {
   "age": "any",
   "advice": "Home urine FSH tests cannot confirm or rule out perimenopause and must not be used to stop contraception",
   "sources": [
    "fda-home",
    "rcog-home-2022"
   ]
  }
 ],
 "warning_signs": [
  {
   "id": "pmb",
   "sign": "Any bleeding or spotting after more than 12 months without periods",
   "action": "See a doctor; bleeding after menopause always needs checking",
   "sources": [
    "nhs-pmb",
    "nice-ng12"
   ]
  },
  {
   "id": "imb",
   "sign": "Bleeding between periods",
   "action": "See a doctor",
   "sources": [
    "nhs-imb"
   ]
  },
  {
   "id": "pcb",
   "sign": "Bleeding after sex",
   "action": "See a doctor",
   "sources": [
    "nhs-imb"
   ]
  },
  {
   "id": "hmb",
   "sign": "Very heavy periods: soaking a pad or tampon every 1–2 hours, clots bigger than about 2.5 cm, or periods lasting more than 7 days",
   "action": "See a doctor; blood count",
   "sources": [
    "nhs-heavy",
    "nice-ng88"
   ]
  },
  {
   "id": "ovarian",
   "sign": "Bloating, feeling full quickly, or pain in your tummy or pelvis on more than 12 days a month",
   "action": "See a doctor, especially at 50 or over",
   "sources": [
    "nice-ng12"
   ]
  }
 ],
 "symptom_checklist": {
  "note": "Mobi Doctor's own checklist of 12 symptoms listed by NICE, the NHS and WHO, rated by how much each bothers the user. It is not a validated questionnaire and has no clinical cut-off scores; points (0-3 per symptom, maximum 36) only add up the user's own ratings for comparison over time.",
  "scale": {
   "0": "none",
   "1": "mild",
   "2": "moderate",
   "3": "severe"
  },
  "timeframe": "past 4 weeks",
  "groups": [
   {
    "id": "g1",
    "items": [
     "hot",
     "sweats",
     "sleep"
    ],
    "labels": {
     "en": "Hot flushes, sweats and sleep",
     "es": "Sofocos, sudores y sueño",
     "nl": "Opvliegers, zweten en slaap"
    }
   },
   {
    "id": "g2",
    "items": [
     "mood",
     "anx",
     "fog"
    ],
    "labels": {
     "en": "Mood and mind",
     "es": "Ánimo y mente",
     "nl": "Stemming en hoofd"
    }
   },
   {
    "id": "g3",
    "items": [
     "joints",
     "palp",
     "head"
    ],
    "labels": {
     "en": "Body",
     "es": "Cuerpo",
     "nl": "Lichaam"
    }
   },
   {
    "id": "g4",
    "items": [
     "vag",
     "libido",
     "bladder"
    ],
    "labels": {
     "en": "Intimate and bladder",
     "es": "Zona íntima y vejiga",
     "nl": "Intiem en blaas"
    }
   }
  ],
  "items": [
   {
    "id": "hot",
    "group": "g1",
    "labels": {
     "en": [
      "Hot flushes",
      "Sudden waves of heat in your face, neck or chest"
     ],
     "es": [
      "Sofocos",
      "Oleadas repentinas de calor en la cara, el cuello o el pecho"
     ],
     "nl": [
      "Opvliegers",
      "Plotselinge golven van warmte in je gezicht, hals of borst"
     ]
    }
   },
   {
    "id": "sweats",
    "group": "g1",
    "labels": {
     "en": [
      "Night sweats",
      "Waking up hot or soaked in sweat"
     ],
     "es": [
      "Sudores nocturnos",
      "Despertarte con calor o con el pijama empapado de sudor"
     ],
     "nl": [
      "Nachtzweten",
      "Wakker worden omdat je het heet hebt of nat bent van het zweet"
     ]
    }
   },
   {
    "id": "sleep",
    "group": "g1",
    "labels": {
     "en": [
      "Sleep problems",
      "Trouble getting to sleep or staying asleep"
     ],
     "es": [
      "Problemas de sueño",
      "Dificultad para conciliar el sueño o para mantenerlo"
     ],
     "nl": [
      "Slaapproblemen",
      "Moeite met inslapen of doorslapen"
     ]
    }
   },
   {
    "id": "mood",
    "group": "g2",
    "labels": {
     "en": [
      "Low mood",
      "Feeling down, tearful or flat"
     ],
     "es": [
      "Ánimo bajo",
      "Tristeza, ganas de llorar o falta de ilusión"
     ],
     "nl": [
      "Sombere stemming",
      "Je neerslachtig, huilerig of vlak voelen"
     ]
    }
   },
   {
    "id": "anx",
    "group": "g2",
    "labels": {
     "en": [
      "Anxiety, irritability or mood swings",
      "Feeling on edge, short-tempered, or up and down"
     ],
     "es": [
      "Ansiedad, irritabilidad o cambios de humor",
      "Tensión, poca paciencia o altibajos de humor"
     ],
     "nl": [
      "Angst, prikkelbaarheid of stemmingswisselingen",
      "Gespannen, snel geïrriteerd, of je stemming gaat op en neer"
     ]
    }
   },
   {
    "id": "fog",
    "group": "g2",
    "labels": {
     "en": [
      "Brain fog",
      "Trouble concentrating or remembering things"
     ],
     "es": [
      "Niebla mental",
      "Dificultad para concentrarte o para recordar cosas"
     ],
     "nl": [
      "Brainfog",
      "Moeite met concentreren of dingen onthouden"
     ]
    }
   },
   {
    "id": "joints",
    "group": "g3",
    "labels": {
     "en": [
      "Joint or muscle pain",
      "Aches or stiffness in your joints or muscles"
     ],
     "es": [
      "Dolor articular o muscular",
      "Dolores o rigidez en las articulaciones o los músculos"
     ],
     "nl": [
      "Gewrichts- of spierpijn",
      "Pijn of stijfheid in je gewrichten of spieren"
     ]
    }
   },
   {
    "id": "palp",
    "group": "g3",
    "labels": {
     "en": [
      "Palpitations",
      "Your heart pounding, racing or fluttering"
     ],
     "es": [
      "Palpitaciones",
      "Notar el corazón latiendo fuerte, rápido o como un aleteo"
     ],
     "nl": [
      "Hartkloppingen",
      "Je hart bonst, jaagt of fladdert"
     ]
    }
   },
   {
    "id": "head",
    "group": "g3",
    "labels": {
     "en": [
      "Headaches or migraines",
      "New, or worse than usual"
     ],
     "es": [
      "Dolor de cabeza o migrañas",
      "Nuevos o peores que de costumbre"
     ],
     "nl": [
      "Hoofdpijn of migraine",
      "Nieuw, of erger dan normaal"
     ]
    }
   },
   {
    "id": "vag",
    "group": "g4",
    "labels": {
     "en": [
      "Vaginal dryness or discomfort",
      "Dryness, itching, burning, or pain during sex"
     ],
     "es": [
      "Sequedad o molestias vaginales",
      "Sequedad, picor, escozor o dolor en las relaciones sexuales"
     ],
     "nl": [
      "Droge vagina of vaginaal ongemak",
      "Droogheid, jeuk, branderigheid of pijn bij seks"
     ]
    }
   },
   {
    "id": "libido",
    "group": "g4",
    "labels": {
     "en": [
      "Lower sex drive",
      "Less interest in sex than is usual for you"
     ],
     "es": [
      "Menos deseo sexual",
      "Menos interés por el sexo de lo que es habitual en ti"
     ],
     "nl": [
      "Minder zin in seks",
      "Minder interesse in seks dan je van jezelf gewend bent"
     ]
    }
   },
   {
    "id": "bladder",
    "group": "g4",
    "labels": {
     "en": [
      "Bladder problems",
      "Needing to pee more often or urgently, leaks, or repeated urine infections"
     ],
     "es": [
      "Problemas de vejiga",
      "Orinar más a menudo o con urgencia, escapes de orina o infecciones de orina repetidas"
     ],
     "nl": [
      "Blaasklachten",
      "Vaker of plotseling moeten plassen, urineverlies of steeds terugkerende blaasontstekingen"
     ]
    }
   }
  ],
  "sources": [
   "nhs-symptoms",
   "nice-ng23",
   "who-menopause"
  ]
 },
 "sources": [
  {
   "id": "bms-tfc",
   "authority": "British Menopause Society",
   "title": "Menopause: identification and management – from NICE guideline to practice (Tool for Clinicians)",
   "url": "https://thebms.org.uk/wp-content/uploads/2026/09/09-NEW-BMS-TfC-NICE-Menopause-Menopause-identification-and-management-%E2%80%93-from-guideline-to-practice-SEPT2026-D.pdf",
   "date": "Sep 2026"
  },
  {
   "id": "ese-2025",
   "authority": "European Society of Endocrinology",
   "title": "Clinical practice guideline for evaluation and management of menopause and the perimenopause (Eur J Endocrinol 2025;193(4):G49–G81)",
   "url": "https://academic.oup.com/ejendo/article/193/4/G49/8281862",
   "date": "13 Oct 2025"
  },
  {
   "id": "eshre-poi-2024",
   "authority": "ESHRE, ASRM, CRE, IMS",
   "title": "Evidence-based guideline: premature ovarian insufficiency (Hum Reprod Open 2024;hoae065)",
   "url": "https://academic.oup.com/hropen/article/2024/4/hoae065/7918369",
   "date": "9 Dec 2024"
  },
  {
   "id": "fda-home",
   "authority": "US FDA",
   "title": "Menopause (home use tests)",
   "url": "https://www.fda.gov/medical-devices/home-use-tests/menopause",
   "date": "27 Sep 2018"
  },
  {
   "id": "fsrh-40",
   "authority": "FSRH / CoSRH",
   "title": "Contraception for Women Aged Over 40 Years",
   "url": "https://www.cosrh.org/Common/Uploaded%20files/documents/fsrh-guideline-contraception-for-women-aged-over-40-years.pdf",
   "date": "Aug 2017, amended May 2025"
  },
  {
   "id": "nhs-heavy",
   "authority": "NHS",
   "title": "Heavy periods",
   "url": "https://www.nhs.uk/conditions/heavy-periods/",
   "date": "reviewed 19 Sep 2024"
  },
  {
   "id": "nhs-imb",
   "authority": "NHS",
   "title": "What causes bleeding between periods?",
   "url": "https://www.nhs.uk/common-health-questions/womens-health/what-causes-bleeding-between-periods/",
   "date": "reviewed 13 Aug 2024"
  },
  {
   "id": "nhs-pmb",
   "authority": "NHS",
   "title": "Postmenopausal bleeding",
   "url": "https://www.nhs.uk/conditions/post-menopausal-bleeding/",
   "date": "reviewed 24 Sep 2026"
  },
  {
   "id": "nhs-symptoms",
   "authority": "NHS",
   "title": "Menopause and perimenopause: symptoms",
   "url": "https://www.nhs.uk/conditions/menopause-and-perimenopause/symptoms/",
   "date": "reviewed 19 May 2026"
  },
  {
   "id": "nice-ng12",
   "authority": "NICE",
   "title": "Suspected cancer: recognition and referral (NG12)",
   "url": "https://www.nice.org.uk/guidance/ng12/chapter/Recommendations-organised-by-site-of-cancer",
   "date": "updated 15 Apr 2026"
  },
  {
   "id": "nice-ng23",
   "authority": "NICE",
   "title": "Menopause: identification and management (NG23)",
   "url": "https://www.nice.org.uk/guidance/ng23/chapter/Recommendations",
   "date": "updated 7 Nov 2024"
  },
  {
   "id": "nice-ng88",
   "authority": "NICE",
   "title": "Heavy menstrual bleeding: assessment and management (NG88)",
   "url": "https://www.nice.org.uk/guidance/ng88/chapter/Recommendations",
   "date": ""
  },
  {
   "id": "rcog-home-2022",
   "authority": "RCOG",
   "title": "RCOG recommends against using over-the-counter menopause tests",
   "url": "https://www.rcog.org.uk/news/rcog-recommends-against-using-over-the-counter-menopause-tests/",
   "date": "10 Jun 2022"
  },
  {
   "id": "straw10",
   "authority": "Harlow SD et al.",
   "title": "Executive summary of the Stages of Reproductive Aging Workshop + 10 (STRAW+10). Menopause 2012;19(4):387–395",
   "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC3340903/",
   "date": "2012"
  },
  {
   "id": "who-menopause",
   "authority": "WHO",
   "title": "Menopause (fact sheet)",
   "url": "https://www.who.int/news-room/fact-sheets/detail/menopause",
   "date": "16 Oct 2024"
  }
 ]
}