Perimenopause and menopause

Perimenopause and menopause are natural life stages that can cause wide-ranging physical, psychological and hormonal symptoms. Many women experience changes years before their final period, often without realising that symptoms may be linked to hormonal transition rather than a new illness.

This page provides GP-reviewed information on perimenopause and menopause, including common symptoms, how they are assessed, available treatment options and when to seek medical advice.

These articles are intended as educational sources, not diagnostic nor taking place of a proper medical assessment. If you need help, please book an appointment with one of our GP’s.

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What is perimenopause?

Perimenopause is the transitional phase leading up to menopause. It can begin in the early to mid-40s, and sometimes earlier, and may last several years.

During perimenopause, ovarian hormone production becomes more variable. Oestrogen and progesterone levels fluctuate rather than steadily decline, which explains why symptoms can feel unpredictable or cyclical.

Women in perimenopause may still have periods, but cycles often become irregular, heavier, lighter or more erratic.

What is menopause?

Menopause is defined as the point at which a woman has not had a menstrual period for 12 consecutive months, without another medical cause. The average age of menopause in the UK is around 51.

After menopause, oestrogen levels remain consistently low. Symptoms may persist for several years, although their pattern often changes over time.

Common symptoms of perimenopause and menopause

Symptoms vary widely between individuals. Some women experience mild disruption, while others find symptoms significantly affect quality of life.

Common symptoms include:

irregular periods or changes in menstrual flow
hot flushes and night sweats
sleep disturbance or insomnia
low mood, anxiety or irritability
brain fog, poor concentration or memory changes
fatigue and low energy
joint or muscle aches
headaches or migraines
palpitations
vaginal dryness or discomfort during sex
reduced libido
urinary frequency or recurrent urinary symptoms
weight gain or changes in body composition

Symptoms may fluctuate month to month, particularly during perimenopause.

When symptoms may be mistaken for other conditions

Perimenopause and menopause symptoms are often misattributed to other causes, especially when periods are still occurring.

Women may present to a GP with:

anxiety or panic symptoms
low mood or depression
unexplained fatigue
sleep problems
joint pain or stiffness
palpitations or chest awareness
recurrent urinary symptoms

A careful history helps distinguish hormonal transition from other medical conditions that may need investigation.

Treatment options for perimenopause and menopause

Management is individualised and depends on symptom severity, medical history and personal preference.

Options may include:

Hormone replacement therapy (HRT)

HRT replaces oestrogen and, where appropriate, progesterone. It can significantly improve hot flushes, sleep disturbance, mood symptoms and vaginal dryness for many women.

A GP will assess suitability, risks and benefits before prescribing. HRT should be tailored for each individual depending on the current symptoms, stage of menopause/perimenopause and existing conditions.

Vaginal oestrogen

Local oestrogen treatments are effective for vaginal dryness, discomfort and urinary symptoms, with minimal systemic absorption.

Non-hormonal options

Some women prefer or require non-hormonal approaches. These may include:

lifestyle adjustments
sleep optimisation
cognitive behavioural strategies
selective medications for hot flushes or mood symptoms

Lifestyle measures

Lifestyle support is often an important part of management and may include:

regular physical activity
strength and resistance training
balanced nutrition
alcohol and caffeine moderation
sleep routine support
stress management

When to seek medical advice urgently

Medical advice should be sought promptly if you experience:

bleeding after menopause
very heavy or prolonged bleeding
bleeding between periods that is persistent
new pelvic pain
unexplained weight loss
severe or worsening mood symptoms

These symptoms require assessment to exclude other causes.

Menopause, cardiovascular health and bone health

The hormonal changes that occur during perimenopause and menopause can have longer-term effects on heart health and bone strength, particularly due to declining oestrogen levels.

Cardiovascular health after menopause

Oestrogen has a protective effect on the cardiovascular system. After menopause, changes in hormone levels may contribute to:

increases in LDL (bad) cholesterol
changes in blood vessel flexibility
increased blood pressure
shifts in body fat distribution

As a result, cardiovascular risk gradually increases after menopause. This does not mean heart disease is inevitable, but it highlights the importance of proactive health monitoring.

A GP may discuss:

In some cases, hormone replacement therapy (HRT) may form part of a broader cardiovascular risk discussion, depending on age, timing, symptoms and individual risk factors.

Bone health and osteoporosis

Oestrogen plays a key role in maintaining bone density. After menopause, bone loss can accelerate, increasing the risk of osteopenia and osteoporosis over time.

Factors that may increase bone health risk include:

early menopause
family history of osteoporosis
low body weight
smoking
long-term steroid use
low calcium or vitamin D levels

A GP may discuss:

lifestyle measures such as weight-bearing exercise
calcium and vitamin D intake
bone health blood tests
referral for bone density scanning (DEXA) where appropriate

Early awareness allows preventative strategies to be put in place before fractures occur.

A preventative health approach

Perimenopause and menopause can be an opportunity to take a preventative, whole-health approach, focusing on cardiovascular health, bone strength, metabolic health and long-term wellbeing alongside symptom management.