Hormone Health

What is the menopause & perimenopause?

We are born with our lifetime’s worth of eggs and follicles in our ovaries; they reduce over our lifetime and reduce in number with age until (a) we have none left, (b) we stop ovulating and (c) stop having periods.

The menopause is defined as not having had a period for a year or a surgical menopause if you’ve had your ovaries removed.

The perimenopause is ill defined but can be up to 10 years before menopause, when your hormone levels start imperceptibly changing.

How do I know if I am perimenopausal, menopausal or post-menopausal?

Menopause is like looking at a box of chocolates and realising you have eaten them all; suddenly you realise that you have not had a period for a year and yes that’s it!  Post menopause begins after that year. The perimenopause is the gradual build up to this point and often the hardest for women to recognise and therefore address in themselves.

What might the symptoms be?

Many women get symptoms in their early 40s. These symptoms will often include:

  • difficulty sleeping or staying asleep,
  • increasing anxiety,
  • back and joint pains,
  • palpitations,
  • headaches or worsening migraines,
  • plantar fasciitis,
  • new or increasing allergies,
  • dry skin,
  • brain fog,
  • hair and/or nail changes.


Women are often misdiagnosed with fibromyalgia, chronic fatigue syndromes, anxiety, depression and have rheumatology referrals with little-to-no findings. Some women think they are developing brain fog, poor memory, poor concentration and losing words. Worsening symptoms with irritability, low mood, mood swings and panic attacks are also common as part of the perimenopause.

Some women sail through the menopause without symptoms so they don’t feel the need for HRT or have pushed through it. What we need to look at in these women is the long term health implications of an oestrogen deficiency particularly on bone health and osteoporosis. But also with cardiovascular protection. HRT is unique, as it reduces all-cause mortality and cardiovascular disease when we initiate it in women under 60yrs or less then 10yrs since menopause.

At all stages women can experience reduced sex drive, painful sex, vaginal irritation and body image changes.

Some women do not experience symptoms like vaginal dryness and atrophy or urinary symptoms until 10 years after the menopause. These can still be treated.

Some women may present with recurrent urine infections that are inconclusive when tested, but may in fact in part be due to reduced oestrogen levels.

Bladder frequency, urgency and leakage can all be impacted by decreasing oestrogen and might be helped with treatment, not just a pad.

What next?

Book an appointment with us at the Hormone Health Clinic and we can provide advice and support on what you may need and what would be suitable for you. We will send you a medical history questionnaire, a symptom survey and then book an up to hour long appointment to discuss all this with you and outline your choices.