Menopause is a natural stage of life, but the changes leading up to it can feel anything but predictable.
Periods may become irregular, sleep may suffer, and familiar moods or energy levels can shift. Some people experience symptoms that affect daily life; others notice very little. Knowing what may be happening, and where to find help, can make this transition easier to navigate.
Perimenopause and menopause: what’s the difference?
Perimenopause is the time when hormone levels begin to change and periods become irregular. Menopause is reached when you have gone 12 months without a period and are not using hormonal contraception. After that, the stage is called post-menopause.
Menopause usually happens between ages 45 and 55, though it can happen earlier. Early menopause occurs before 45; premature ovarian insufficiency can occur before 40. These changes may follow surgery to remove the ovaries, but sometimes there is no known cause. Menopause and perimenopause can affect anyone who has periods.
There is no routine test to confirm perimenopause or menopause. A doctor will usually consider your age and symptoms. If you think you may be experiencing these changes, a GP, nurse or pharmacist can help you understand your options.
Symptoms can look different for everyone
Symptoms may begin during perimenopause, continue through menopause or persist afterwards. Their effect varies: they may disrupt work, relationships and family life, or be barely noticeable. Ethnic background can influence symptoms, their severity and how long they last.
A change in periods is often an early sign. Bleeding may become heavier or lighter, and periods may arrive more or less often before stopping.
Hot flushes can bring a sudden feeling of heat or sometimes cold in the face, neck and chest. They may cause sweating, a racing heartbeat, anxiety or dizziness, and can happen at night as well as during the day. Night sweats can disturb sleep, leaving you tired, irritable or anxious.
Some people notice mood swings, low mood, anxiety, depression, memory lapses or difficulty concentrating. Poor sleep and fatigue may make these feelings harder to manage. Weight gain, often around the stomach and upper body, is also common.
Lower hormone levels can lead to vaginal dryness, itching, irritation or soreness, which may make sex uncomfortable. Urinary symptoms may include needing to pee more often, including at night, or a burning sensation that can feel like a urinary tract infection.
Other possible changes include headaches, muscle and joint aches, thinning hair, dry or itchy skin, reduced sex drive, sensitive teeth or gums, palpitations and bone loss.
Treatment is personal
If symptoms are affecting your life, talk with a healthcare professional about treatment. Hormone replacement therapy (HRT) is one option, and the type offered depends on your symptoms, whether you still have periods and whether you have had a hysterectomy.
Oestrogen is the main hormone used in HRT. It can be taken as a tablet or used as a patch, spray or gel. For vaginal dryness, soreness or some urinary symptoms, oestrogen may also be used locally as a cream, pessary or other treatment.
If you take oestrogen and still have your womb, you will usually need progestogen to protect the womb lining. It may come as tablets, a combined patch or a hormonal coil (IUS). Testosterone may be prescribed by a menopause specialist for some people with low sex drive, though libido can be affected by many things, including discomfort, relationships and how you feel about yourself.
If HRT is unsuitable, does not help or is not your preference, other treatments may be available. Depending on your symptoms, a clinician may discuss antidepressants, other medicines or cognitive behavioural therapy (CBT). A GP can help weigh up which options may suit you.
Everyday steps that may help
Rest, regular sleep routines, a balanced diet and regular exercise can support wellbeing during this transition. Calcium-rich foods such as milk, yoghurt and kale, alongside weight-bearing and strength-building exercise, can help protect bone health. Relaxation practices such as yoga, tai chi or meditation may help, as can talking with friends, family, colleagues or others going through similar changes.
For hot flushes and night sweats, try lightweight clothes, a cool bedroom, a fan, a cool shower or a cold drink. Stress, spicy food, caffeine, hot drinks, smoking and alcohol can be triggers for some people. Regular exercise and maintaining a healthy weight may also help. CBT can help some people manage flushes, mood changes or sleep problems.
Vaginal moisturisers and lubricants are available from pharmacies. If using condoms, choose a water-based lubricant because oil-based products can damage condoms. A pharmacist or doctor can explain other treatments, including vaginal oestrogen.
To support bone health, combine strength and weight-bearing exercise with a diet that includes calcium. Sunlight helps the body make vitamin D, and supplements may be appropriate; ask a healthcare professional for advice. HRT can also reduce osteoporosis risk.