Perimenopause and Menopause: Symptoms and Diagnosis

Perimenopause and menopause are natural stages of life, 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.

Let’s clarify the definitions:

• Perimenopause is the time leading up to a natural menopause – when periods become different (lighter, heavier, closer together, further apart) and menopausal symptoms start to happen.
• Menopause (for women 45 years or older) is the day one year after the last natural menstrual period. The average age in the UK is 51, but this age varies between different cultures
• Postmenopause is the time after menopause. As the average life expectancy of a woman in the UK is now 82, women can spend, on average, 30 years of their lives after menopause.
• Surgical menopause is the day the ovaries are removed during an operation (before a woman has gone through her menopause)
• Induced or iatrogenic menopause (may be permanent or temporary )and is when periods stop because the ovarian function is affected by chemotherapy, radiotherapy, or hormone blockers.
• Early menopause is when menopause happens between the ages of 40-45 years
• Premature ovarian insufficiency (POI) is when menopause occurs before the age of 40 years

What are the symptoms of perimenopause and menopause?

Not every woman will experience all of them and symptoms can vary significantly. 80% of women experience symptoms and for 25%, the symptoms are significant enough to affect their quality of life.

Common symptoms include:

Vasomotor Symptoms

• Hot flushes
• Night sweats
• Feeling suddenly overheated
• Chills after hot flushes
• Affects 75% of women
• Think: what brings these on? Stress? Caffeine?

Sleep Symptoms

• Difficulty falling asleep
• Waking during the night
• Poor quality sleep
• Early morning waking
• Affects 40-60% of women.
• Think: Do you snore? Could you have obstructive sleep apnoea affecting your sleep?
• Think: Do you have restless legs? This is associated with a low ferritin level.

Psychological and Cognitive Symptoms

• Anxiety
• Low mood
• Mood swings
• Irritability
• Loss of feelings of joy
• Loss of confidence
• Brain fog
• Poor concentration
• Poor memory

Physical Symptoms

• Fatigue/tiredness
• Joint and muscle aches
• Headaches
• Palpitations
• Light headedness
• Weight changes and change in body shape
• Dry itchy skin
• Feeling of things crawling under the skin

Genitourinary Symptoms

• Vulval and vaginal 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
• Urine infections

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

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 perimenopause diagnosed?

This is diagnosed when symptoms start to happen and when periods start to change (lighter, heavier, closer together, further apart). This usually happens in the early 40’s but it can be earlier.

How Is menopause diagnosed?

For women aged over 45

• Menopause is the day one year after your last natural menstrual period

• Blood tests are not usually needed but might be required if another medical condition needs to be excluded.

For 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.
• If for 3-4 months your periods become irregular, or your periods stop, this is the time to speak with your Dr, even if you have no symptoms. Blood tests are required to diagnose menopause under the age of 45.

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.

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.

Menopause matters 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, the brain, skin, vaginal and vulval tissues, the bladder.

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 and fractures. Have a look at the Royal Osteoporosis Society to read about ways to protect your bones.

Cardiovascular Health

The risk of cardiovascular disease increases after menopause. Blood cholesterol rises. Insulin resistance rises. There is a change in the way body fat is stored (more around the waist) – this type of fat is inflammatory and can increase risk of heart and blood vessel disease, and of type 2 diabetes.

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. Read our article about this.

What can help relieve symptoms?

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

Hormone Replacement Therapy (HRT)

HRT gives back the hormones that decline during menopause. For many women, HRT is the most effective treatment for:

• Hot flushes and night sweats, sleep problems, mood symptoms, vaginal, vulva and bladder symptoms and joint and muscle aches and pains.

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 and vulval dryness and soreness, discomfort during sex
• Bladder symptoms like increased need to pass urine, recurrent urinary tract infections and urge to pass urine

Many women can use vaginal oestrogen alongside systemic HRT. Don’t forget good vulval health care, non-hormonal moisturizers and non-hormonal lubricants during sex.

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)
• Prescription non-hormonal medications – there are lots of options which are suitable to relieve hot flushes and night sweats for women who choose not to, or are unable to take hormone therapy.

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. 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.

References

British Menopause Society

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.