In short
Perimenopause is the phase of changing cycles and symptoms before the last period, lasting about 4 years on average and starting at a median age of 47. Women over 45 are diagnosed from their cycle and symptoms. Hormone blood tests swing from week to week and often look normal.
Condition Overview
What is perimenopause?
Perimenopause is the menopausal transition, the years of irregular cycles and fluctuating hormones before the last period, plus the first year after it. Perimenopause starts at a median age of 47 and lasts about 4 years before the final period. The end point is menopause.
What are the stages of perimenopause?
Perimenopause has an early and a late stage, defined by the STRAW staging system (Fertility and Sterility, 2012).
| Stage | What changes |
|---|---|
| Early transition | Cycle length changes by 7 days or more, for example from 28 to 35 days |
| Late transition | Skipped periods and gaps of 60 days or more, usually 1 to 3 years before the last period |
| Final period | Confirmed after 12 months without a period |
What are the symptoms of perimenopause?
The symptoms of perimenopause are hot flushes, night sweats, broken sleep, mood swings and changing periods. Hot flushes affect about 40 percent of women in the early transition and 60 to 80 percent in the late transition. Difficulty sleeping affects 32 to 40 percent in the early and 38 to 46 percent in the late transition, about 1 in 3 rising to more than 1 in 3.
New depression is 2.5 times more likely during the transition than before it, most of all in women with earlier depression: hormonal mood changes.
How do periods change in perimenopause?
Periods in perimenopause usually become irregular and lighter, but some women bleed more heavily. Heavy bleeding occurs most often in the late transition, in women with obesity and in women with fibroids. Bleeding over 7 days, flooding, bleeding between periods or after sex is assessed, not assumed to be hormonal.
How is perimenopause diagnosed?
Perimenopause in women over 45 is diagnosed from a change in cycle length, with or without symptoms. A high FSH is not required. Between 40 and 45, pregnancy, raised prolactin and thyroid disease are excluded first. Under 40, irregular periods with menopause symptoms point to primary ovarian insufficiency, not perimenopause.
Why are hormone blood tests often normal in perimenopause?
Hormone blood tests are often normal because FSH and oestradiol swing widely from week to week during the transition. A sample on a good week looks premenopausal, and the next one looks postmenopausal. Changes in the bleeding pattern predicted the stage better than FSH in the SWAN study. Useful tests are thyroid function, a blood count with ferritin when periods are heavy, and a pregnancy test when relevant.
Can I get pregnant in perimenopause?
Yes, pregnancy is still possible in perimenopause, because many cycles are still ovulatory. Contraception continues until 12 months after the last period over 50, or 24 months under 50. Hormone replacement therapy is not contraception.
Perimenopause in Dubai and the UAE
How common is depression in perimenopause in the UAE?
In a UAE study of 279 women, 56.6 percent had at least mild depression and 10 percent severe depression, more than half and 1 in 10. Severe depression affected 16.7 percent of women in perimenopause against 4.3 percent after menopause, about 1 in 6 against 1 in 23 (Frontiers in Global Women’s Health, 2026).
Do women in the UAE recognise perimenopause?
In a Dubai study of 591 women, 82 percent had fair or poor knowledge of menopause and its treatment, about 8 in 10 (Menopause, 2021). A review of 15 studies from Arab countries found that fewer than 1 in 5 women used hormone therapy in 11 of the studies (Frontiers in Global Women’s Health, 2026).
Dr Felix treats within the scope of his Dubai Health Authority licence. When a case needs a specialist view, for example bleeding after menopause, a breast finding or severe depression, the decision is made together with a gynaecologist, breast specialist or psychiatrist.
How perimenopause is treated while periods continue: perimenopause treatment in Dubai. A first check: the menopause self-check.
When to See a Doctor
- Your cycle length or bleeding changed and new symptoms appeared with it.
- You wake at night or feel anxious and irritable in a way that follows your cycle.
- You have hot flushes or night sweats while still having periods.
- You were told your hormone tests are normal but your symptoms are clear.
- Bleeding between periods, after sex, or flooding with clots: assessment first.
- Periods stopping or becoming rare before 40: assessment for primary ovarian insufficiency.
- Thoughts of self-harm or hopelessness: urgent care the same day, not a routine appointment.
How Dr. Felix Assesses This
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1
Cycle and symptoms
How your cycle changed and which symptoms follow it, ideally with a menstrual calendar.
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2
History
Contraception, pregnancy wishes, migraine, clots, heart and breast history.
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3
Selective tests
Thyroid, blood count and ferritin with heavy periods, and hormone tests only under 45.
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4
Diagnosis and plan
Symptoms, bleeding and contraception decided together, with a review date.
Treatment Options
HRT Consultation
Four things, in order: whether your symptoms are menopausal, whether hormone therapy is safe for you, which preparation fits, and…
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HRT Patches and Oestrogen Gel in Dubai
HRT patches and oestrogen gel are transdermal estradiol, the same hormone the ovaries made before menopause, absorbed through the skin…
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HRT Tablets in Dubai
HRT tablets contain estradiol, alone or together with a progestogen in one combined tablet. Estradiol is body-identical, the same hormone…
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Non-Hormonal Menopause Treatment in Dubai
Non-hormonal treatment is for women with moderate to severe hot flushes who cannot take HRT or choose not to. Clinical…
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Why Early Treatment Can Matter
Recognising perimenopause early ends the search for other explanations and shortens the years of poor sleep and low mood. Heavy bleeding is treated before it causes iron deficiency, and contraception is settled rather than left uncertain.
Why Early Treatment Can Matter
Recognising perimenopause early ends the search for other explanations and shortens the years of poor sleep and low mood. Heavy bleeding is treated before it causes iron deficiency, and contraception is settled rather than left uncertain.
Sleep and mood
Symptoms are treated while periods continue.
Iron deficiency
Heavy bleeding is controlled before it causes anaemia.
One plan
Symptoms, bleeding and contraception in one consultation.
Cost & Consultation Investment
The cost of a perimenopause assessment covers the consultation with Dr Felix, the examination, any tests that change the plan and the written plan. Dr Felix explains the full cost before anything is done.
Frequently Asked Questions
No, not reliably. Over 45 perimenopause is diagnosed from the cycle and symptoms, because FSH and oestradiol swing from week to week.
Perimenopause lasts about 4 years on average before the last period, with a wide range between women.
Yes, hot flushes affect about 40 percent of women in the early transition, while periods still come.
The cost covers the consultation, examination, any necessary tests and the written plan. Dr Felix explains the full cost before anything is done.
Evidence
Where this information comes from
Every figure on this page is taken from the sources below. All of them are free to read, so you can check them yourself.
- Executive summary of the Stages of Reproductive Aging Workshop + 10 (STRAW+10)
- Menopause: identification and management (NG23)
- Depression in peri- and postmenopausal women in the UAE
- Women’s knowledge and awareness on menopause symptoms and its treatment options remains inadequate: a report from the United Arab Emirates
This page is general medical information and does not replace a personal consultation. Trial results are averages across large groups, not a prediction for any one person.