What is Perimenopause

What is Perimenopause?

Perimenopause is the transitional phase leading up to menopause, when your body gradually begins to produce less oestrogen. It can start several years before menopause—often in your 40s, though sometimes earlier. Symptoms can last anywhere from a few months to over a decade.

During perimenopause, hormone levels (especially oestrogen and progesterone) fluctuate unpredictably. This can cause a wide range of physical, emotional, and cognitive symptoms. Some people experience only a few mild changes, while others notice many symptoms that can significantly affect daily life.

Did You Know There Are 34 Perimenopausal Symptoms?

Perimenopause is often associated with hot flashes and irregular periods—but there are actually many more possible symptoms. While not everyone will experience all of these, here are 34 commonly reported ones:

Menstrual & Reproductive Changes

  1. Irregular periods
  2. Heavier or lighter bleeding
  3. Shorter or longer cycles
  4. Spotting between periods
  5. Decreased fertility

Vasomotor Symptoms (Temperature Regulation)

  1. Hot flashes
  2. Night sweats
  3. Chills

Sleep Issues

  1. Difficulty falling asleep
  2. Waking during the night
  3. Insomnia

Emotional & Cognitive Symptoms

  1. Mood swings
  2. Anxiety
  3. Depression or low mood
  4. Irritability
  5. Brain fog (difficulty concentrating)
  6. Memory lapses

Physical Changes

  1. Fatigue
  2. Headaches
  3. Joint and muscle aches
  4. Weight gain (especially around the abdomen)
  5. Bloating
  6. Breast tenderness

Skin, Hair & Body Changes

  1. Dry skin
  2. Thinning hair
  3. Brittle nails

Sexual & Urinary Health

  1. Vaginal dryness
  2. Pain during sex
  3. Reduced libido (sex drive)
  4. Urinary urgency
  5. Increased urinary tract infections (UTIs)

Other Symptoms

  1. Heart palpitations
  2. Dizziness
  3. Tingling sensations (often in hands or feet)

Treatments for Perimenopause

While perimenopause is a natural stage of life, its symptoms can be very troublesome and there are lots strategies to help turn this potentially difficult stage of life into a positive experience. 

Hormone-Based Treatments

One of the most effective ways to manage perimenopausal symptoms is Hormone Replacement Therapy (HRT). This involves supplementing the body with oestrogen and usually progesterone to stabilise hormone levels.

HRT comes in different forms, including tablets, patches, gels, and sprays. We prescribe body identical as first line at the clinic to mimic your body’s own natural hormones. 

We can also offer Testosterone at the clinic which has been proved to improve libido but can also have some benefit on energy levels, brain fog, confidence and muscle strength. 

Non-Hormonal Medications

For those who cannot or prefer not to use hormones, there are alternatives:

  • Certain antidepressants have been show to reduce hot sweats, improve sleep and mood.
  • Certain medications to target specific issues such as migraines, poor sleep or anxiety
  • Clonidine which is a blood pressure medication which can help with hot sweats.
  • Herbal supplements such as black cohosh, red clover, ginseng and St Johns wart may offer some relief from symptoms. 

Lifestyle modifications

Simple daily habits can make a big difference:

  • Regular exercise – helps with mood, sleep, and weight management
  • Balanced diet – rich in calcium, vitamin D, whole foods and phytoestrogens such as tofu and soy.
  • Good sleep routine – consistent bedtime and limiting screen time
  • Reducing caffeine and alcohol – can help minimise hot sweats and anxiety
  • Mindfulness, yoga, or meditation

Vaginal Health Treatments

For symptoms like dryness or discomfort:

  • Vaginal moisturisers and lubricants
  • Local oestrogen treatments including creams, pessary’s and gels. 

Written by: Dr Rachel Tomlinson – Women’s Health Lead

 

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