NICE's Updated Draft Guidance Recommends Ziwig Endotest® While Evidence Is Gathered
Oct 14, 2026
Skip the phone queue - book your appointment in minutes, day or night.
Published on
18/10/2026
The LivingCare Group
Sooner than most people think. The NHS's first reason to contact a GP is that you think you have symptoms of menopause or perimenopause and want to know what your options are [3]. You do not have to wait until things feel bad enough to justify it. Wanting to understand what is happening to you is reason enough.
It is also common. Not all women have symptoms as they go through the menopause, but up to 80-90% have some, and 25% describe them as severe and debilitating [1].
Perimenopause is the lead-up to menopause and can occur over many years.
The timing is very varied: menopause usually affects women between the ages of 45 and 55, but it can happen earlier [2], and the British Menopause Society gives the average age of menopause in the UK as 51 [1].
Perimenopause can occur several years before the menopause, so will commonly start in your forties up to 10 years before your periods stop. The British Menopause Society describes the process as usually gradual, progressing over several years [1].
Whilst some women do not experience any symptoms, many women will notice symptoms that can be very debilitating and affect their ability to function normally at home and at work. Some of the commonest symptoms are listed below, although symptoms can be very varied and fluctuate from week to week due to wide swings in hormone levels.
Often women do not notice changes to their cycle and can put a missed period or change down to other factors such as stress.
Symptoms will commonly start gradually and can be mistaken for other conditions such as anxiety and depression or can be put down to problems at work or at home.
Other issues are occurring in a woman's life around the time of the perimenopause such as children growing up and leaving home, stress in the workplace and elderly parents needing more care, and women will often miss symptoms of the perimenopause.
As women approach the menopause it is common to experience worsening of their menopausal symptoms where perimenopause will become more obvious.
It is advisable to speak to your GP if: [3]
The first point sets no threshold at all - no severity test, nothing about it affecting your daily life. Wanting to know what your options are is reason enough to make the appointment.
Perimenopause is a clinical diagnosis made on symptoms alone with no specific test to diagnose whether a woman is perimenopausal.
The British Menopause Society says a diagnosis should follow careful history taking, based on a combination of menopausal symptoms and a change in menstrual cycle pattern, in women over 45 [1].
Below the age of 45, women can still be perimenopausal, but as there are health risks to going through an early menopause, we would normally recommend all of these women to seek medical help, advice and hormone testing.
Blood tests come with a caveat. For women over 45, the British Menopause Society says hormonal testing - FSH, or follicle stimulating hormone, one of the hormones that signals to the ovaries - is not helpful in diagnosing the perimenopause, because FSH levels can fluctuate from one month to another and may not give an accurate assessment [1]. Between 40 and 45, where early menopause is suspected, FSH may be useful alongside symptoms and cycle changes, although a single test may not be diagnostic [1].
In women under 45, FSH can however be used to determine whether a woman has gone through the menopause with 2 readings >25 taken 6 weeks apart being diagnostic.
Other blood tests can be helpful to determine whether there is any other medical cause for a woman's symptoms or whether there could be another hormonal imbalance such as in PCOS to cause periods to stop.
Many women seek help from their GPs around the time of the perimenopause but find that the limited time in a GP appointment is not always long enough to be able to discuss what is often a complex condition with many different hormonal and non-hormonal treatment options. Seeking help from a British Menopause Society accredited menopause specialist can be very helpful in the perimenopause and will ensure that any tests, treatment and general lifestyle advice is tailored to you as an individual.
LivingCare's Menopause and Perimenopause Management service runs at Thorpe Park Clinic in Leeds. A Women's Health Consultation is another route in, and both sit within our Women's Health department.
No GP referral is required and appointments can be booked via our private team, who will be able to advise you on the best course of action for you.
Can perimenopause start in your 30s or early 40s?
It can start earlier than the usual window. The NHS says menopause usually affects women between the ages of 45 and 55, but it can happen earlier [2]. Symptoms and cycle changes well before 45 are a reason to speak to a clinician rather than to wait and see - below 45 the way it is assessed changes, and below 40 it changes again [1].
Do I need a blood test to confirm perimenopause?
Usually not, if you are over 45. The British Menopause Society says a diagnosis should be reached through careful history taking, based on symptoms combined with a change in menstrual cycle pattern [1], and that FSH testing is not helpful in diagnosing the menopause for women over 45, because levels fluctuate month to month [1].
My periods have got heavier, not lighter. Is that part of it?
It is one of the NHS's own reasons to get in touch. Their guidance is to contact a GP if you still have periods but your bleeding pattern has changed and you are bleeding more than before [3]. Any vaginal bleeding after 12 months without a period is also on their list [3].
Do I need a GP referral to be seen privately?
No. LivingCare's women's health services are available self-pay, with no GP referral needed.
World Menopause Day falls on 18 October, and it is as good a prompt as any to stop putting off a conversation you have been circling for months. If your cycle has changed, or your sleep and mood have, LivingCare's Menopause and Perimenopause Management service is available privately at Thorpe Park Clinic in Leeds, as part of our Women's Health department. Self-pay, with no GP referral needed. Exceptional care, without the wait.
Book a menopause and perimenopause appointment in Leeds
Medically reviewed by: Dr Becky Harris, General Practitioner and Menopause Specialist. Last reviewed: 12/10/26.
This article is for general information and is not sponsored content.
