First symptoms of menopause: when does it start and what do you notice?

It often starts with something small. You suddenly sleep worse, you are shorter-tempered than usual, or your period comes a week early and then a week late. Nothing to worry about, you think, until it keeps happening. For many women, these are the first, inconspicuous signs that menopause has begun.

What I find frustrating about this early phase is that no one tells you in advance how vague it can be. You feel different, but you have no words for what is happening. Let us find those words together.

When does menopause usually start?

Perimenopause, the run-up phase in which you notice the first complaints, begins for most women between 40 and 50. According to Thuisarts, average menopause falls around age 51, and the symptomatic period before it can easily last four to seven years. If it begins before 40, we call it early menopause, and it is wise to discuss that with your GP.

The early signals you can recognise

Not everyone gets the same complaints, and the order differs from woman to woman. These are the most common first signs.

The common thread: fluctuating oestradiol. It is not the slow decline but the up-and-down swing of this hormone that explains why you feel fine one week and as if nothing is right the next.

Is it really menopause? Other causes to rule out

Here I want to be honest: not every bout of fatigue or low mood around 45 is down to your hormones. Complaints that resemble menopause can have another cause. An underactive thyroid causes fatigue, weight gain and mood complaints. Anaemia from a low ferritin causes tiredness and breathlessness. That is why, with persistent complaints, it can be sensible to also have your TSH measured.

When does a test add something?

In this early phase, a hormone test is usually not a reliable way to "prove menopause", because your values vary day to day. The NHG guideline for GPs stresses that the diagnosis rests mainly on your complaints and cycle. Still, testing can be valuable to rule out other causes or to get a broader picture, for example with a women's hormone panel. Always discuss what is sensible for you with your doctor.

What you can already do now

• Keep a symptom diary. Note your cycle, sleep and mood. Patterns become visible and help your doctor.
• Be gentle with yourself. Irritability and forgetfulness are not a character flaw, but fit fluctuating hormones.
• Seek movement and routine. Enough sleep, exercise and relaxation soften many complaints, even if they do not cure menopause.
• Raise the alarm if in doubt. If complaints begin before 40, or are so severe they affect your daily life, see your GP.

How long do the first complaints last?

This varies greatly. For some women it stays at a few erratic cycles; for others the complaints build over years. On average menopause lasts around four to seven years, but hot flushes can persist even longer in some women. So it is not a matter of gritting your teeth and it is over, but of learning to live with a phase that lasts a while.

It helps to know that the severity of complaints does not always track the stage. You can have heavy hot flushes early in perimenopause, or only late. That is why your own observations are more valuable than a chart telling you what you are "supposed" to feel.

The nature of your complaints can also shift over time. Where the first years often revolve around an erratic cycle and hot flushes, other things sometimes come to the fore later, such as vaginal dryness or attention to your bones. So it is not a fixed list you tick off in one go, but a changing picture that moves with you.

When do you see your GP?

Not every complaint calls for an appointment, but there are signals where it is wise to go. According to Thuisarts, these include heavy or irregular bleeding, bleeding after menopause, or complaints that significantly affect your daily functioning. Also if you wonder whether hormone therapy is right for you, your GP is the right starting point. Do not be embarrassed to come with "vague" complaints: those are exactly part of it, and your doctor hears them more often than you think.

You are at the start, not the end

The first symptoms of menopause feel confusing because they are so undefined. But recognising them gives you a grip: you now know that what you feel belongs somewhere, and that you can do something about it. Read more on recognising your phase via our guide to perimenopause, or read about mood swings in perimenopause.