What Is the Perimenopause?
Perimenopause means “around the menopause” and is the time when the ovaries start producing less oestrogen and progesterone. It usually starts around the 40s and symptoms can vary and change over time. It lasts on average 7-9 years.
Symptoms can interrupt work, home life and daily activities. If you’re unsure how to manage your symptoms or need treatment, our UK-registered GPs at Dr.Online UK can help. Early advice can reduce the effects of perimenopause on your health, relationships and work.
What Are the Common Symptoms of Perimenopause?
Menstrual changes: Periods may become shorter, longer, heavier, lighter, or spaced further apart.
Vasomotor symptoms: Sudden hot flushes and night sweats are very common.
Sleep issues: Insomnia or mid-sleep waking.
Mood and cognitive shifts: Irritability, anxiety, depression, and “brain fog” (memory or concentration trouble), reduced libido.
Physical changes: Vaginal dryness, joint pain, fatigue, and weight gain.
How Is Perimenopause Diagnosed?
For most people aged 45 or over, perimenopause can usually be diagnosed from your symptoms and changes to your periods. Routine blood tests are generally not needed.
During an online GP consultation, we can:
- Assess symptoms.
- Advise if blood tests are recommended.
- Provide treatment advice or prescriptions if needed.
NB. You may need in-person assessment if the diagnosis is unclear and a physical examination is required.
When to Seek Urgent Medical Attention
If you have gone 12 months without a period and then experience any vaginal bleeding, even a small amount of spotting or pink/brown discharge, you should contact your GP for assessment.
What Are the Treatment and Management Options?
Self-Care and Home Management
Implementing or maintaining a healthy lifestyle can improve menopause symptoms.
- Healthy diet (low in saturated fat and salt and rich in calcium and vitamin D).
- Stopping smoking.
- Reducing alcohol intake.
- Regular physical activity to maintain muscle mass and strength.
- For hot flushes and night sweats, regular exercise, weight loss (if applicable), wearing lighter clothing/layers of clothing, turning down central heating, sleeping in a cooler room, using fans, reducing stress, and avoiding possible triggers (such as spicy foods, caffeine, smoking, and alcohol) may be helpful.
- For sleep disturbances, avoiding exercise late in the day and implementing sleep hygiene measures may help.
- For low mood and anxiety, adequate sleep, regular physical activity, and relaxation techniques may help.
- For cognitive symptoms, regular physical activity and good sleep hygiene may help.
Hormone Replacement Therapy (HRT)
HRT replaces hormones that reduced during perimenopause and menopause.
It is particularly effective for symptoms such as:
- Vasomotor symptoms
- Sleep problems
- Mood disturbance
- Vaginal symptoms
HRT can also help protect against bone loss and osteoporosis.
What Type of HRT Might I Need?
If you still have your womb, you will usually need oestrogen plus a progestogen.
If you have had a hysterectomy, you may be able to use oestrogen only HRT.
Oestrogen can be given as tablets, patches, gel or spray. There are different ways of taking progestogen too. Testosterone replacement may also be appropriate.
Your Dr.Online GP can help you decide what is appropriate based on your symptoms, medical history and preferences.
Treatment from a GP
A GP can help with:
- Confirming the diagnosis
- Advice on when symptoms may indicate complications
- Recommendation for further treatment such as lifestyle changes, counselling/CBT, non-hormonal medicines, vaginal dryness treatments, contraception and HRT
- In depth discussion about the risks/benefits of HRT therapy.
When Referral Is Needed
You may need further assessment by a menopause expert if you have a condition that may be affected by HRT, or there is uncertainty about the best treatment option.
How Dr.Online UK Can Help
We offer:
- Same-day online GP appointments
- Expert assessment and guidance
- Private prescriptions (when appropriate)
- Fit notes or referral letters
- Clear advice on whether you need in-person care
