Perimenopause Clinical Navigator Atrium Medical
Perimenopause does not always begin with hot flashes. Changes in periods, sleep, mood, concentration, sexual health, urinary symptoms, and the way your body feels can appear gradually and in combinations that are easy to miss.
This tool looks at the pattern clinically: where you may be in the menopausal transition, which symptoms fit the pattern, and which other explanations deserve attention.
Clinically reviewed by Shilpa Paradkar Singh, MD | Updated October 2026
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Step 1 of 4: Age and reproductive context25%
Age and reproductive context
Cycle pattern is the backbone of reproductive staging. Age adds context, especially when major cycle changes occur earlier than expected.
Your age47
35455565
Do any of these make your periods hard to interpret?
No
Natural cycles, uterus present
Hormonal contraception
Pill, patch, ring, implant, or hormonal IUD that changes bleeding
Hysterectomy, ovaries retained
Bleeding cannot be used to stage the transition
Both ovaries removed
Surgical menopause rather than a natural transition
Current cycle pattern
Still regular and similar to my usual pattern
Persistently more variable or unpredictable
Cycles often differ by about a week or more from one cycle to the next
I have gone 60 days or more without a period in the past year
But less than 12 months
No natural period for 12 months or more
Bleeding changes (select any that apply)
Much heavier or longer bleeding than usual
Spotting or bleeding between expected periods
Cycle changes are common in the menopausal transition, but abnormal bleeding should not automatically be attributed to hormones.
Sleep, mood and cognition
These symptoms are common during the menopausal transition, but they are not specific to it. This section measures symptom burden and clinical context rather than pretending every sleep or mood change proves a hormonal cause.
Sleep changes (select all that apply)
Difficulty falling asleep
Waking during the night or too early and having trouble falling back asleep
Waking overheated or sweaty
Unrested despite enough hours of sleep
Mood and cognitive changes (select all that apply)
New or increased irritability
New or increased anxiety or sense of dread
Low mood or emotional flatness
Brain fog, word-finding difficulty, or reduced concentration
Reduced motivation or drive
Mood-treatment context
No
No antidepressant or anti-anxiety medication suggested for these symptoms
Yes
A clinician suggested or prescribed one for these symptoms
Physical and genitourinary symptoms
Some symptoms are much more informative about menopausal stage than others. This page includes hallmark features associated with clinician-confirmed perimenopause in a 2025 U.S. study.
Hot flashes and night sweats
None
Occasional
Present, but not frequent
Frequent
Most days or nights
Severe
Regularly disrupting sleep or daily life
Body and physical changes (select all that apply)
Weight shifting toward the abdomen despite no major lifestyle change
New joint achiness or stiffness
Skin or hair texture or thickness changes
New episodes of heart pounding or palpitations
Genitourinary and sexual symptoms (select all that apply)
Vaginal dryness
Pain or discomfort with penetration
Frequent urination or new urinary urgency
Recurrent urinary tract infections
Reduced libido or change in sexual response
Clinical context
Good menopause care means recognizing a hormonal pattern without blaming every symptom on hormones. These questions identify common reasons the interpretation may need to widen.
Thyroid history
No known thyroid condition
Diagnosed thyroid condition
Hypothyroidism, Hashimoto's, hyperthyroidism, nodules, or other thyroid disease
Not sure
Blood clot or clotting-risk history
No known clotting risk
Prior blood clot
DVT, pulmonary embolism, or another blood clot
Known clotting disorder
Thrombophilia or strong family history of blood clots
Higher-risk factor or not sure
Smoking, inflammatory disease, recent major surgery, immobilization, active cancer, or uncertain history
This does not decide whether hormone therapy is right or wrong. It flags that route, dose, personal risk, and specialist coordination may matter.
Prior evaluation
I have not raised this with a physician yet
I was told my hormone labs were normal
I was diagnosed with perimenopause or menopause
I am currently on hormone therapy
Estrogen, progesterone, testosterone, or a combination
What matters most to you right now?
Understanding what is happening to my body
Getting symptom relief
Finding a physician who will take this seriously
Understanding whether hormone therapy is right for me
Your perimenopause clinical assessment
An evidence-informed pattern assessment, not a diagnosis or probability calculator.
What your answers suggest
Reproductive stage
Hallmark pattern
Research-informed symptom index
Atrium Perimenopause Evidence Index (APEI)
0.0 / 10
0510
Limited signalCompatibleStrong pattern
APEI is a 0-to-10 Atrium-developed index based on the relative symptom associations reported by Cunningham et al. 2025. It is not a disease probability. Cycle-based reproductive staging is handled separately using STRAW+10.
Why your index is here
Other symptom domains you reported
Save or share your results
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How this assessment was built
Clinical sources and methodology
- Harlow SD et al. Executive summary of the Stages of Reproductive Aging Workshop + 10. Menopause. 2012;19(4):387-395. STRAW+10 supplies the cycle-based staging logic used here. PubMed
- Cunningham AC et al. Perimenopause symptoms, severity, and healthcare seeking in women in the US. npj Women's Health. 2025;3:12. APEI uses the relative reported symptom associations for hot flashes, vaginal dryness, pain with penetration, palpitations, and frequent urination, then linearly rescales the combined symptom score to 0-10. Cycle criteria are kept separate in the STRAW+10 stage output. The resulting APEI is an Atrium-developed educational index, not a validated probability model. DOI
- Aras SG, Grant AD, Konhilas JP. Clustering of more than 145,000 symptom logs reveals distinct pre, peri, and menopausal phenotypes. Scientific Reports. 2025;15:640. DOI
- NICE NG23. Menopause: identification and management. Current guidance supports clinical diagnosis in otherwise healthy people age 45 or older with typical symptoms and cautions against using a single FSH result as a gatekeeper. Guideline
- ASRM Evidence-Based Guideline: Premature Ovarian Insufficiency. Used for the age-under-40 and early-menopause flags. Guideline
- U.S. Food and Drug Administration. FDA initiated removal of broad menopausal hormone-therapy boxed-warning language in November 2025; the first revised product labels were approved in February 2026. FDA
- Sobel TH, Shen W. Transdermal estrogen therapy in menopausal women at increased risk for thrombotic events: a scoping review. Menopause. 2022;29(4):483-490. Used for the clotting-risk flag and route-of-estrogen education. PubMed
- ACOG Committee Opinion No. 556. Postmenopausal estrogen therapy route of administration and risk of venous thromboembolism. Used for oral-versus-transdermal route context. ACOG
- The North American Menopause Society. The 2022 hormone therapy position statement. Used for individualized route, dose, duration, timing, and risk-profile context. PubMed
This tool is for educational purposes only and does not diagnose perimenopause, menopause, thyroid disease, abnormal uterine bleeding, or premature ovarian insufficiency. The Atrium Perimenopause Evidence Index (APEI) is an educational synthesis of published symptom-association research, rescaled to a 0-to-10 index for readability. APEI has not itself been prospectively validated as a diagnostic instrument. Your assessment inputs are processed locally in your browser and are not submitted to Atrium. Feedback: info@atriummednyc.com
