Understanding Perimenopause: Common Symptoms and When to Seek Support
Perimenopause is the stage before menopause when changing ovarian hormone levels begin to affect menstrual cycles and other aspects of health. It is a natural life stage, but symptoms can be disruptive, unpredictable and difficult to recognise. Understanding what may be happening can make it easier to seek appropriate advice and find effective ways to manage symptoms.
Menopause is reached when you have had no menstrual period for 12 consecutive months, provided there is no other explanation. In the UK, it commonly occurs between the ages of 45 and 55, although every person’s experience is different. Perimenopause may begin several years earlier and can continue for varying lengths of time.
What happens during perimenopause?
During perimenopause, levels of oestrogen and other reproductive hormones fluctuate rather than declining in a smooth, predictable way. Ovulation may become less regular, periods can change and symptoms may come and go. It is still possible to become pregnant during perimenopause, because ovulation can occur even when periods are irregular.
Symptoms are not limited to menstrual changes. Some people have several symptoms, while others notice only one or two. Symptoms can also be influenced by sleep, stress, existing health conditions, medicines and lifestyle factors.
Common symptoms of perimenopause
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Changes to periods: periods may become heavier, lighter, longer, shorter, more frequent or less frequent. You may also notice spotting or missed periods.
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Hot flushes and night sweats: a sudden feeling of heat, sweating, flushing or chills can occur during the day or at night. Night sweats may disturb sleep.
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Sleep problems: difficulty falling asleep, waking during the night or waking earlier than usual may occur, sometimes because of night sweats.
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Mood changes: anxiety, irritability, low mood, tearfulness or feeling less able to cope can be associated with hormonal changes, poor sleep and the demands of this stage of life.
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Difficulty concentrating: some people describe forgetfulness, “brain fog” or difficulty finding words. Persistent or severe cognitive changes should be assessed rather than automatically attributed to perimenopause.
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Palpitations: awareness of your heartbeat can occur, although new, persistent or concerning palpitations need medical assessment to exclude other causes.
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Headaches or migraines: existing migraines may change, and some people experience more frequent headaches.
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Muscle and joint aches: new aches, stiffness or reduced exercise tolerance may be noticed.
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Genitourinary symptoms: vaginal dryness, discomfort during sex, reduced sexual desire, vulval irritation, urinary urgency or recurrent urinary tract infections can occur as oestrogen levels change.
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Skin and hair changes: skin may feel drier, and some people notice changes in hair texture or growth.
Many of these symptoms have causes other than perimenopause. For example, thyroid problems, anaemia, medication effects, depression, anxiety and sleep disorders can cause similar difficulties. A healthcare professional can help consider the wider picture.
When should you seek support?
You do not need to wait until symptoms become severe before asking for help. Consider arranging an assessment if symptoms are affecting your sleep, relationships, work, exercise, mood or general quality of life. It can be useful to keep a record of periods, symptoms, medicines and any factors that make symptoms better or worse.
Speak to a healthcare professional if bleeding is unusually heavy, lasts longer than expected, occurs between periods, happens after sex or returns after 12 months without periods. These symptoms are often caused by something treatable, but they should be assessed. Seek prompt medical advice for severe pelvic pain, dizziness, fainting or bleeding that is difficult to control.
Support is particularly important if menopause-related symptoms begin before the age of 45. Menopause before 40 is known as premature menopause, while menopause between 40 and 44 is often described as early menopause. These situations may require assessment for other causes and discussion of the possible effects on bone, heart and reproductive health.
If you experience chest pain, severe breathlessness, sudden weakness, confusion or a severe allergic reaction, seek emergency help. If you are experiencing thoughts of suicide or feel unable to keep yourself safe, contact urgent mental health support, NHS 111 or emergency services immediately.
How is perimenopause assessed?
For people aged 45 or over with typical symptoms, perimenopause is often identified from the symptoms and changes in periods. Hormone blood tests are not routinely needed because hormone levels fluctuate and a single result may not reflect what is happening over time. A clinician may recommend tests when symptoms are unusual, the diagnosis is uncertain, or there may be another medical explanation.
For people under 45, particularly those under 40, further assessment may be appropriate. Your healthcare professional may ask about your medical history, family history, contraception, pregnancy possibility, medicines and any previous surgery or treatment that could affect ovarian function.
Managing symptoms and treatment options
Helpful changes may include keeping the bedroom cool, wearing breathable layers, reducing triggers such as alcohol if they worsen flushes, maintaining regular physical activity and following a balanced diet. Protecting sleep, using relaxation techniques and seeking support for stress can also help. These steps may improve wellbeing, although they do not replace medical treatment when symptoms are troublesome.
Hormone replacement therapy, or HRT, may be suitable for many people with perimenopause symptoms. It can help with hot flushes, night sweats and other symptoms, and may also provide benefits for vaginal symptoms and bone health. The most appropriate type depends on factors such as whether you have a womb, your bleeding pattern, your medical history and your personal preferences.
HRT is not suitable for everyone and should be discussed with a qualified healthcare professional. If you still have periods, or it has been less than 12 months since your last period, a form of HRT that protects the womb is usually needed when oestrogen is prescribed. HRT is not contraception, so you may still need suitable contraception during perimenopause.
Non-hormonal treatments, vaginal oestrogen, psychological therapies and other prescribed medicines may also be considered, depending on your symptoms and health history. Do not stop prescribed medicines or start supplements marketed for menopause without checking that they are safe and appropriate for you.
How a women’s health consultation can help
A women’s health consultation can provide a confidential opportunity to discuss symptoms, period changes, contraception, treatment options and any concerns about your health. A pharmacist can help you understand which symptoms may fit with perimenopause, identify when further medical assessment is needed and advise on suitable next steps.
Before your appointment, consider noting when your symptoms started, how they affect daily life, the date and pattern of your periods, current medicines, allergies and any relevant medical or family history. This information can help make the consultation more useful.
Book your women’s health consultation
If you are experiencing possible perimenopause symptoms or would like advice about your options, book a women’s health consultation with Cattedown Pharmacy for clear, confidential support.