Perimenopause and Menopause: Symptoms, Diagnosis and treatment

Perimenopause and menopause are natural stages of life that every woman will experience. However, the journey is different for everyone. Some women have very few symptoms, while others find that menopause has a significant impact on their physical health, emotional wellbeing, relationships and quality of life.

Understanding what is happening to your body can help you feel more informed and confident about seeking support and finding the right treatment.

What Is Menopause?

Menopause occurs when the ovaries stop releasing eggs and produce lower levels of hormones, particularly oestrogen and progesterone.

A woman over the age of 45 years is considered to have reached menopause when she has not had a period for 12 consecutive months and there is no other medical explanation for her periods stopping.

In the UK, the average age of menopause is around 51, although it can occur earlier or later (45-55 years).

Menopause, for women over the age of 45, itself is a single day, one year after the last natural menstrual period.

In the years before menopause (the perimenopause) and after the years after menopause (post menopause) symptoms can occur.

What Is Perimenopause?

Perimenopause is the stage leading up to menopause when hormone levels begin to fluctuate.

This transition can last several years and often starts in a woman’s 40s, although it can begin earlier.

During perimenopause, the ovaries continue to work but hormone production becomes less predictable. As a result, women may experience symptoms even while they are still having periods.

Periods may become:

• More frequent
• Less frequent
• Heavier
• Lighter
• Longer
• Shorter

Some women notice symptoms before their periods change significantly.

What Are the Symptoms of Perimenopause and Menopause?

Not every woman will experience all of them and symptoms can vary significantly.

Common symptoms include:

Vasomotor Symptoms

• Hot flushes
• Night sweats
• Feeling suddenly overheated
• Chills after hot flushes

Sleep Symptoms

• Difficulty falling asleep
• Waking during the night
• Poor quality sleep
• Early morning waking

Psychological and Cognitive Symptoms

• Anxiety
• Low mood
• Mood swings
• Irritability
• More emotional
• Loss of confidence
• Brain fog
• Poor concentration
• Poor memroy

Physical Symptoms

• Fatigue
• Joint and muscle aches
• Headaches/migraine
• Palpitations
• Dizziness
• Weight changes and change in body shape
• Dry itchy skin
• Thinning dry hair

Genitourinary Symptoms

• Genital dryness
• Decreased lubrication during sex
• Discomfort or pain during sex
• Bleeding after sex
• Decreased arousal, orgasm, desire
• Irritation, burning, or itching of the vulva or vagina
• Urinary frequency and urgency

These symptoms can affect work, relationships, exercise, sleep and overall quality of life.

Different symptoms

• Tinnitus
• Restless legs
• Increased allergies
• Digestive symptoms

Do these symptoms stop after the menopause?

Symptoms commonly last 4-7 years, but for some women they continue well after the menopause.

How Is Menopause Diagnosed?

For women aged over 45, menopause and perimenopause are diagnosed based on symptoms and changes in menstrual patterns assessing:

• Your symptoms
• Changes in your periods
• Your medical and family history
• Your medication including anything you take over the counter
• Any complementary and alternative treatments you use
• Your lifestyle

Blood tests may be needed on an individual basis, particularly if another medical condition needs to be excluded.

What about women under the age of 45?

For women under the age of 45, menopause is diagnosed in a different way. You do not need one whole year without a period to diagnose menopause if you are under the age of 45 years..

Some women experience menopause younger than 45 naturally, or as a result of medical treatment or surgery. Let’s talk about premature ovarian insufficiency (POI) and early menopause.

Premature Ovarian Insufficiency (POI)

Premature Ovarian Insufficiency (POI) is a condition where the ovaries stop functioning normally before the age of 40 years.

If your periods stop or become irregular for 4 months AND blood tests show a high level of follicle stimulating hormone (FSH) this can be diagnosed.

POI affects 3.7% of women before the age of 40.

It is important to make this diagnosis so it can be managed correctly with hormonal treatment.

Current guidelines state all women <40 years old with POI should be offered HRT at least until age 51 (average age of menopause), unless there are contraindications to treatment such as a personal history of hormone dependant cancer.

Early Menopause

Early menopause occurs between the ages of 40 and 45, and affects 12% of women.

If your periods stop or become irregular for 4 months AND blood tests show two high levels of follicle stimulating hormone (FSH) levels 4-6 weeks apart this can be diagnosed.

Early menopause affects 12% of women between the age of 40-45 years.

It is important to make this diagnosis so it can be managed correctly with hormonal treatment.

It is recommended that early menopause is managed in the same ways as POI.

Surgical Menopause

Surgical menopause occurs when both ovaries are removed during surgery before a woman has gone through the menopause.

The day that the ovaries are removed is the day of menopause (you do not ‘go through menopause’ again).

Unlike natural menopause, hormone levels fall suddenly. Symptoms can therefore develop rapidly and may be more severe.

Current guidelines state all women <45 years old undergoing surgical menopause should be offered HRT at least until age 51 (average age of menopause), unless there are contraindications to treatment such as a personal history of hormone dependant cancer. Women aged 45 and older can also discuss use of HRT.

Medical Menopause

Medical menopause occurs when treatments stop the ovaries from functioning.

This may happen following:

• Chemotherapy
• Pelvic radiotherapy
• Ovarian suppression injections
• Certain treatments for endometriosis
• Some cancer treatments

Women experiencing POI, early menopause, surgical menopause or medical menopause often benefit from specialist menopause support and may require different treatment approaches. It is really important to ask for help.

Why Does Menopause Matter Beyond Symptoms?

Menopause is not just about hot flushes and night sweats.

Oestrogen affects many tissues throughout the body, including:

• Bones
• Blood vessels
• Muscles
• Joints
• Brain
• Skin
• Vaginal tissues
• Bladder tissues

Declining hormone levels can therefore affect long-term health as well as day-to-day wellbeing.

Bone Health

After menopause, bone loss accelerates. This can increase the risk of:

• Osteopenia
• Osteoporosis
• Fractures

Cardiovascular Health

The risk of cardiovascular disease increases after menopause.

Maintaining a healthy lifestyle becomes particularly important during midlife and beyond.

Musculoskeletal Health

Many women experience:

• Joint pain
• Muscle aches
• Reduced muscle strength
• Stiffness

These symptoms are now recognised as part of Musculoskeletal Syndrome of Menopause.

Bladder and intimate health

80% of women experience the bladder, vaginal and vulval symptoms in the section above, called Genitourinary Syndrome of the menopause.

What Treatments Are Available?

Treatment depends on your symptoms, medical history and personal preferences.

Hormone Replacement Therapy (HRT)

HRT replaces hormones that decline during menopause.

For many women, HRT is the most effective treatment for:

• Hot flushes
• Night sweats
• Sleep disturbance
• Mood symptoms
• Vaginal symptoms
• Joint aches
• Menopause-related quality of life issues

For women with an intact uterus, a progestogen is usually required alongside oestrogen to protect the lining of the womb.

HRT is not suitable for all women and some women prefer not to use hormonal treatments.

Low dose localised vaginal and vulval oestrogen

Vaginal oestrogen works locally within the vaginal and bladder tissues and can help improve:

• Vaginal dryness
• Discomfort during sex
• Recurrent urinary tract infections
• Urinary urgency
• Bladder symptoms

Many women can use vaginal oestrogen alongside systemic HRT.

Non-Hormonal Treatments to relieve hot flushes and night sweats

Some women choose not to use HRT or may be unable to do so.

Alternative options may include:

• Cognitive behavioural therapy (CBT)
• Lifestyle changes
• Prescription non-hormonal medications such as fezolinetant, low dose antidepressant medication, Oxybutynin or Gabapentin
• Specialist menopause support

Alternative and Complementary Therapies

Many women are interested in natural, complementary or alternative approaches to managing menopause symptoms. While some women find these helpful, it is important to remember that the evidence supporting their effectiveness varies and they should not be considered a replacement for medical advice or evidence-based treatments.

Herbal Remedies

A number of herbal products are marketed for menopause symptoms, including:

• Black cohosh
• Red clover
• Sage
• Soy isoflavones
• St John’s wort

Some women report symptom improvement, particularly for hot flushes, but research findings are mixed. The quality and strength of herbal products can vary significantly and some may interact with prescription medications.

For example, St John’s wort can affect the effectiveness of many medicines, including contraceptives, antidepressants and blood-thinning medications.

Phytoestrogens

Phytoestrogens are naturally occurring plant compounds that have weak oestrogen-like effects.

They are found in foods such as:

• Soy products
• Tofu
• Edamame beans
• Chickpeas
• Lentils
• Flaxseeds

Some women find that increasing phytoestrogen-rich foods in their diet helps with mild menopause symptoms, although the effects are generally much weaker than those seen with HRT.

Supplements

Some women choose to take supplements during menopause.

Common examples include:

• Vitamin D
• Calcium
• Magnesium
• Omega-3 fatty acids

These supplements may support overall health and wellbeing, particularly bone health, but they are not treatments for menopause itself. It is important to discuss use of any supplement with a healthcare professional, especially if you have underlying health conditions or take regular medication, as there may be an interaction.

A word of caution:

Natural does not always mean safe. Herbal remedies and supplements can cause side effects, interact with medications and may not be suitable for everyone.

If you are considering alternative or complementary therapies, it is a good idea to discuss them with a healthcare professional to ensure they are safe and appropriate for you.

Cognitive Behavioural Therapy (CBT)

Cognitive Behavioural Therapy is an evidence-based treatment that can help women manage the impact of menopause symptoms.

CBT may be particularly helpful for:

• Hot flushes and night sweats
• Anxiety
• Low mood
• Sleep problems
• Stress management

CBT does not alter hormone levels but can help improve coping strategies and quality of life.

Mindfulness, Yoga and Relaxation Techniques

Practices such as mindfulness, meditation, breathing exercises and yoga may help improve:

• Stress levels
• Anxiety
• Sleep quality
• General wellbeing

While these approaches may not directly reduce hormone-related symptoms, many women find them valuable as part of a holistic approach to menopause care.

Acupuncture

Some women report benefits from acupuncture for hot flushes and other menopause symptoms. However, research results are mixed and current evidence does not consistently show a clear benefit.

Lifestyle Measures That Can Help

Looking after your overall health can make a significant difference during menopause.

Exercise

Regular exercise helps support:

• Bone health
• Heart health
• Muscle strength
• Mental wellbeing
• Sleep

A combination of aerobic exercise and strength training is ideal.

Nutrition

Aim for a balanced diet rich in:

• Vegetables
• Fruit
• Wholegrains
• Lean protein
• Healthy fats
• Calcium-rich foods

Sleep

Prioritising sleep can improve many menopause symptoms, including fatigue, mood and cognitive function.

Smoking and Alcohol

Stopping smoking and moderating alcohol intake can improve both menopause symptoms and long-term health outcomes.

Managing stress

Managing stress is an important part of menopause care, as stress can worsen symptoms such as hot flushes, sleep problems, anxiety, brain fog and fatigue. Regular relaxation techniques, mindfulness, yoga, spending time in nature, social connections and making time for enjoyable activities can all help support emotional wellbeing during the menopause transition.

When Should You Seek Help?

Speak to a healthcare professional if:

• Symptoms are affecting your quality of life
• Your periods become irregular or stop unexpectedly under the age of 40 (you think you may have POI or early menopause)
• If you are planning to have your ovaries removed before you go through the menopause (a surgical menopause)
• If you have menopause after cancer treatment

You do not need to wait until symptoms become severe before seeking support.

Frequently Asked Questions

What is the difference between perimenopause and menopause?

Perimenopause is the transition leading up to menopause when hormone levels fluctuate. Menopause is reached once you have gone 12 months without a period (for women over the age of 45). Remember the diagnosis is made differently in women under the age of 45.

Do I need a blood test to diagnose menopause?

Most women over 45 do not require blood tests (unless there is uncertainty about the diagnosis, or to rule out other diagnoses). Diagnosis is usually based on symptoms and menstrual history. Under the age of 45, yes, blood tests are required to diagnosis early menopause or POI.

What age does perimenopause usually start?

The average age of menopause in the UK is around 51, although symptoms of perimenopause often begin several years earlier.

What is Premature Ovarian Insufficiency (POI)?

POI occurs when ovarian function is lost before the age of 40 and usually requires specialist assessment and management.

Can HRT help menopause symptoms?

For many women, HRT is the most effective treatment for menopause symptoms and can significantly improve quality of life.

The Bottom Line

Perimenopause and menopause are natural stages of life, but they can bring significant physical and emotional changes. Understanding what is happening to your body and knowing when to seek support can make a huge difference.

Whether you are experiencing natural menopause, POI, early menopause, surgical menopause or medical menopause, effective treatments and support are available. You do not have to struggle through symptoms alone.

References

British Menopause Society. Menopause Practice Standards (2026).

National Institute for Health and Care Excellence (NICE). Menopause: Identification and Management (NG23).

British Menopause Society. Recommendations on Hormone Replacement Therapy in Menopausal Women.

Last updated May 2026 Dr Carys Sonnenberg founder/director of Rowena Health, BMS registered Menopause Specialist and co-author of Women’s Health Made Easy.