Menopause and perimenopause: symptoms, diagnosis and support

The menopause is the point at which your ovaries stop releasing eggs and your periods stop for good. It is diagnosed once you have gone 12 consecutive months without a period. It is a natural part of ageing rather than an illness, though the hormonal changes behind it can affect how you feel for several years.

Perimenopause is the transitional phase leading up to the menopause, when levels of oestrogen and other hormones begin to fluctuate. Periods often become irregular and menopausal symptoms can appear while you are still having them. This phase may last a few months or several years before your periods stop completely.

When the menopause happens before the age of 45 it is described as early menopause, and before 40 as premature ovarian insufficiency (POI). If you would like to understand what is happening and what your options are, our broader gynaecology services include consultations covering the menopause and related women's health concerns.

Symptoms vary widely from one person to the next, and no two experiences are the same. They are driven mainly by falling oestrogen levels and can affect your body, mood and sleep. Many women notice changes to their periods first, followed by other symptoms over time.

On average, symptoms last around 7 to 9 years, although for some women they continue for longer and for others they are relatively brief. Vaginal dryness and urinary symptoms in particular may persist, or worsen, without treatment.

• Irregular periods, or bleeding that is heavier or lighter than usual
• Problems with memory and concentration, often called 'brain fog'
• Recurrent urinary symptoms, such as needing to pass urine more often

In the UK, the menopause usually happens between the ages of 45 and 55, with the average age being around 51. Perimenopause commonly begins in your mid-forties, though it can start earlier or later.

Around 1 in 100 women reach the menopause before the age of 40, known as premature ovarian insufficiency. This can occur naturally, or follow surgery to remove the ovaries, cancer treatment such as chemotherapy, or certain medical conditions. Early and premature menopause deserve particular attention, because the longer-term effects of low oestrogen on bone and heart health are relevant over more years of life.

For most women, the menopause is diagnosed from your symptoms and your age rather than from a blood test. NICE guidance (NG23) advises that if you are over 45 with typical symptoms, such as irregular periods and hot flushes, a diagnosis can usually be made without any testing.

Blood tests measuring follicle-stimulating hormone (FSH) may be considered if you are aged 40 to 45 with menopausal symptoms, or under 40 where premature menopause is suspected. A women's health GP appointment is often the most straightforward place to start, and can help rule out other causes of similar symptoms, such as thyroid problems, before deciding on next steps.

There is no need to simply put up with symptoms that affect your quality of life. A range of treatments can help, and the right approach depends on your symptoms, medical history and personal preferences. This information is intended for general educational purposes only and does not constitute medical advice — please consult a qualified healthcare professional for guidance specific to your circumstances.

Hormone replacement therapy (HRT) replaces the oestrogen your body no longer makes and is the most effective treatment for hot flushes, night sweats and many other symptoms. It is available as tablets, skin patches, gels or sprays, and women who still have a womb also take a progestogen to protect its lining. Low-dose vaginal oestrogen can be used specifically for vaginal dryness and urinary symptoms.

Non-hormonal options include lifestyle measures such as regular exercise, reducing caffeine and alcohol, and cognitive behavioural therapy (CBT), which has evidence for easing hot flushes and low mood. Certain non-hormonal medicines may also be considered for women who cannot take HRT or prefer not to. Our sister clinic runs a dedicated menopause service where all of these options can be discussed in detail and tailored to you.

It is worth seeking advice if menopausal symptoms are affecting your daily life, relationships or work, or if you are simply unsure whether what you are experiencing is the menopause. You should also seek advice if your periods stop before the age of 45, or if you have any bleeding after the menopause — postmenopausal bleeding always needs to be checked by a clinician.

You can start with your GP, or arrange to see a specialist female gynaecologist if you would prefer a more in-depth women's health consultation. Support is available at every stage, and effective treatment can make a real difference to how you feel.