Symptoms vary
Perimenopause may bring cycle changes, hot flushes, night sweats, sleep disturbance, mood changes, vaginal dryness, painful intercourse and urinary symptoms.
Thyroid disease, anaemia, sleep disorders, depression and medicines can overlap. Not every midlife symptom is hormonal.
Treatment is personal
Options include lifestyle measures, moisturisers or lubricants, non-hormonal medicines, local vaginal oestrogen and systemic hormone therapy.
Systemic hormones are not suitable for everyone. Age, time since menopause, uterus status, clotting, cardiovascular, liver and cancer history matter.
Use midlife visits for prevention
Review blood pressure, diabetes and lipid risk, cervical and breast screening, bone health, vaccines, exercise, nutrition, sleep and mental well-being.
Weight-bearing and resistance exercise support muscles and bones. Supplement doses should reflect diet and medical risk.
Understanding perimenopause and menopause
Perimenopause is the transition during which ovulation and hormone levels become less predictable. Periods may become closer, farther apart, heavier or lighter before stopping. Menopause is recognised after 12 months without menstruation when another cause does not explain it. Pregnancy remains possible during part of the transition, so contraception may still be relevant.
Hot flushes and night sweats are well known, but vaginal dryness, urinary urgency, painful intercourse, sleep disruption, joint symptoms and mood change may be equally important. New symptoms should not automatically be attributed to hormones. Thyroid disease, anaemia, depression, sleep apnoea, infection and medication effects can overlap and may need separate evaluation.
Hormone therapy and non-hormonal treatment
Systemic menopausal hormone therapy is effective for vasomotor symptoms in appropriately selected patients. The formulation and need for uterine protection depend on health history and whether the uterus is present. Breast cancer, clotting, cardiovascular, liver and unexplained bleeding histories affect suitability, making individual counselling essential.
Non-hormonal prescriptions and behavioural approaches can help some patients. Vaginal moisturisers, lubricants and local hormonal treatment address genital and urinary symptoms differently from systemic therapy. Review treatment periodically because priorities and risks change. Menopause care also creates an opportunity to address bone strength, cardiovascular risk, sleep, sexuality and preventive screening.
Bone, heart and metabolic health after menopause
Falling oestrogen contributes to bone loss, while age and other factors change cardiovascular risk. Review smoking, alcohol, blood pressure, diabetes, cholesterol, exercise, calcium intake and fracture history. Bone-density testing is based on age and risk rather than performed automatically for every symptom. Resistance, balance and weight-bearing activity support function, but supplements should be individualised because more calcium or vitamin D is not always better. Falls, height loss or a low-impact fracture should be discussed rather than accepted as normal ageing.
Questions patients commonly ask
How do I know I have reached menopause?+
For most people over the usual age range, menopause is identified after 12 months without a period. Hormone blood tests are not routinely necessary in every typical case.
Is bleeding after menopause normal?+
No. Even light spotting after menopause requires medical assessment to identify the cause and exclude important uterine or cervical disease.
Is hormone therapy safe for everyone?+
No. Benefits and risks depend on symptoms, age, time since menopause and medical history. A personalised discussion is required before prescribing.
Clinical references
This guide is informed by patient guidance from established public-health and professional medical bodies.