What is perimenopause?
Perimenopause is the transition before periods stop completely. Hormone levels rise and fall unpredictably, causing symptoms such as hot flushes, sleep problems, mood changes, heavier periods or irregular cycles.
When does menopause happen?
When the ovaries have stopped releasing eggs and hormones decline permanently. Sometimes defined as 12 months without a period – this marks the end of menstrual cycles.
In the UK, the average age is 51.
How long do symptoms last?
Symptoms vary from person to person. Some settle within a few years, while others continue for longer without treatment.
Do I need blood tests to diagnose menopause?
Most women do not need blood tests after age 45. Diagnosis is usually based on symptoms and period changes.
Will HRT help my symptoms?
For most women, yes. HRT is the most effective treatment for hot flushes, night sweats, mood changes, vaginal dryness, low libido and joint pain.
Is HRT safe?
For most healthy women under 60, the benefits of HRT outweigh the risks. The safest combination is transdermal oestrogen (patch, gel or spray) plus body-identical progesterone if you still have a womb.
Can I take HRT if I still have periods?
Yes. Many women start HRT during perimenopause.
Can I still get pregnant?
Yes. Use contraception until menopause is confirmed.
Common Concerns
“My symptoms seem too severe – is this normal?”
Many women experience symptoms that affect work, sleep, confidence and relationships. You are not alone, and effective help is available.
“I’m worried about weight gain.”
Weight changes are common due to hormonal shifts, reduced muscle mass and sleep disruption. Small, consistent lifestyle changes – and sometimes HRT – can help.
“I don’t feel like myself.”
Mood swings, anxiety and low motivation are common in perimenopause and often improve with the right treatment and support.
“I don’t want to take medication.”
HRT is one option. Lifestyle changes, non-hormonal medications and vaginal therapies can also help.
Practical Tips for Everyday Support
1. Look after sleep
- Keep the bedroom cool
- Reduce evening screen time
- Try calming routines before bed
- Limit caffeine after midday
2. Move your body regularly
- Aim for strength training twice weekly
- Add brisk walking or other cardio
- Increase daily steps where possible
3. Support your mood
- Mindfulness or relaxation exercises
- Talking therapies or coaching
- Regular social connection
4. Nourish yourself well
- Mediterranean-style meals
- Plenty of vegetables, whole grains and protein
- Reduce sugar and ultra-processed foods
5. Stay hydrated
- 6–8 glasses of water a day
- Reduce alcohol if it worsens flushes or sleep
6. Protect your pelvic and sexual health
- Use vaginal moisturisers regularly
- Vaginal oestrogen if you have dryness or discomfort
- Pelvic floor exercises
Myths & Facts About Menopause and HRT
Myth 1: “Everyone gains weight in menopause.”
Fact: Weight can shift during menopause, but it is not inevitable. Exercise (especially strength training), good sleep and nutrition help maintain a healthy weight.
Myth 2: “HRT causes breast cancer.”
Fact: Most modern HRT has a very low risk. Body-identical progesterone and transdermal oestrogen have one of the safest profiles. Being overweight, drinking alcohol and inactivity carry higher risks.
Myth 3: “Menopause only causes hot flushes.”
Fact: Symptoms can include mood changes, joint pain, sleep issues, heart palpitations, brain fog, vaginal dryness, bladder symptoms and reduced libido.
Myth 4: “You must stop HRT by age 60.”
Fact: Many women safely continue HRT beyond 60 if benefits outweigh risks. Decisions should be individual.
Myth 5: “You can’t take HRT if you have migraines.”
Fact: Transdermal oestrogen is safe for many women with migraines and may improve symptoms.
Myth 6: “HRT is not natural.”
Fact: Body-identical HRT (micronised progesterone and 17-β-oestradiol) is chemically identical to hormones produced by the ovaries.
Myth 7: “You must wait until your periods stop to start HRT.”
Fact: You can start HRT in perimenopause when symptoms begin.
Summary
Menopause is a natural life stage, but symptoms can have a real impact. With clear information, personalised treatment and practical daily strategies, most women see a significant improvement in their wellbeing. If you have questions or worries, specialist support is available.
