Perimenopause, often referred to as “second puberty,” is the period leading up to menopause, marked by fluctuating hormone levels that can result in changes in menstrual cycles. These changes may include lighter or heavier periods and variations in cycle length. Hormonal fluctuations can lead to unpredictable good and bad days, affecting your mood, cognitive function, and overall quality of life.

Menopause is officially diagnosed when you have not had a period for 12 consecutive months. In the United Kingdom, the average age of menopause is 51. However, hormonal changes start years before menopause, with progesterone levels declining before oestrogen. Perimenopausal symptoms can begin up to a decade before menopause itself.

Perimenopausal symptoms can vary widely among women, with each person experiencing a unique combination and duration of symptoms. Some may have only a few symptoms for a short period, while others may endure symptoms affecting various aspects of their health for many years or even decades.

Changes in Menstrual Patterns
Often the initial sign. Periods may become lighter or heavier, and the menstrual cycle may shorten or lengthen before finally stopping. Women using the Mirena coil or progestogen-only contraceptives may miss this clue, as they typically have no periods.

Hot Flushes and Night Sweats
These are the most common symptoms, affecting approximately 75% of women, with 25% experiencing severe cases. Night sweats can disrupt sleep, adding to the fatigue associated with this phase.

An increased awareness of your heartbeat, often associated with hot flushes and night sweats.

Muscle and Joint Pain 
As oestrogen, which has anti-inflammatory properties, decreases in the body, joint discomfort may intensify, and recovery time from injuries may lengthen.

Worsening Headaches/Migraines
Headaches can become more severe, frequent, or even develop for the first time in a woman’s life.

Low Mood
Often linked with deteriorating premenstrual syndrome, low mood can affect relationships at home and work.

Increased anxiety may lead to heightened concerns about work performance, excessive worry about health issues, and reduced self-confidence.

Brain Fog
This encompasses various symptoms, including poor concentration and memory, difficulty finding words, forgetfulness, and problems retaining information. Many women fear they may be experiencing early onset dementia.

Loss of Libido
A lack of interest in sex is frequently reported during this period. Decreased levels of oestrogen and testosterone can affect sexual arousal, receptiveness, and pleasure, causing distress.

Vaginal Dryness
Oestrogen plays a crucial role in maintaining vaginal lubrication and elasticity. As oestrogen levels drop, vaginal tissues may become thinner, drier, and less flexible, contributing to painful intercourse.

Urinary Issues
Oestrogen receptors in the bladder, vulva, and pelvic floor rely on oestrogen for normal bladder control and function. As oestrogen levels decrease, structural changes can lead to urinary frequency, urgency, and recurrent urinary tract infections.


This list is not exhaustive, as oestrogen receptors are distributed throughout the body, potentially causing a wide range of perimenopausal and menopausal symptoms.

If you are over 45, have noticed changes in your periods, and are experiencing some of the symptoms mentioned above, you are likely in the perimenopausal phase. Monitoring your symptoms and using a menopause symptom checker can help healthcare professionals diagnose perimenopause without the need for additional tests.

For individuals aged 40-45, the same applies, but healthcare professionals may consider conducting blood tests to rule out other causes of symptoms, such as anaemia or an underactive thyroid gland.

For those under 40, premature ovarian insufficiency may be a concern, impacting fertility and long-term health. Blood tests are necessary to investigate further.

Achieving lifestyle changes can be challenging when you’re not feeling your best. Seeking help is not a sign of failure but an acknowledgment of your need for support. If perimenopausal symptoms significantly affect your quality of life, home, work, or relationships, consult a healthcare professional for personalised advice.

During perimenopause, when hormone levels fluctuate and decline, HRT aims to provide a consistent supply of hormones. HRT includes oestrogen, progesterone, and, sometimes, testosterone replacement:

HRT typically uses 17 beta-oestradiol, derived from yams, with a biological structure identical to the body’s oestrogen. It can be administered via patches, gels, sprays, or orally.

If you have a uterus and use oestrogen replacement, progestogen is necessary to prevent abnormal uterine lining thickening. The Mirena coil is a common choice, as it acts as an effective contraceptive while releasing progestogen to maintain a thin uterine lining. Alternatively, natural progesterone (e.g., Utrogestan in the UK) can be taken orally in capsule form.

Some women may experience persistent low libido, arousal, and sexual satisfaction issues, accompanied by fatigue and brain


Perimenopause presents an opportunity to re-evaluate lifestyle choices that can influence your long-term health and quality of life during post-menopausal years. Here are some recommendations:

Aim for a diverse diet, incorporating a variety of colourful foods. A calcium-rich diet supports bone health, and daily vitamin D supplements (10 micrograms) are essential. Calculate your dietary calcium intake using available resources.

Weight Management
Metabolism changes during perimenopause, and maintaining a healthy weight is crucial. Keep a food diary to understand your eating habits and monitor your intake, recording date, time, food description, quantity, any accompanying symptoms, and reasons for consumption.

Strive for at least 150 minutes of moderate-intensity exercise per week or 75 minutes of vigorous-intensity exercise weekly, preferably distributed throughout the week. Engage in strengthening activities for major muscle groups at least twice weekly. Regular exercise promotes mental health, reduces stress, lowers blood pressure, and decreases the risk of breast cancer.

Some women find that alcohol exacerbates hot flushes. Limit alcohol intake to 14 units per week, with at least two alcohol-free days.

Smoking can lead to an early menopause and more severe hot flushes and night sweats. Reduce cigarette consumption with the goal of quitting.

Stress Management
Prioritise self-care, as stress management is vital during this life phase. Explore relaxation techniques like yoga, meditation, nature walks, or spending time with loved ones.

Address sleep disturbances caused by night sweats, anxiety, itching, vaginal dryness, or nocturia. Aim for 7-8 hours of sleep per night, establish a routine, reduce caffeine intake, avoid alcohol, develop a bedtime routine, keep electronic devices out of the bedroom, and get up if unable to sleep after 10-15 minutes.

The perimenopause is the time before this where oestrogen levels start to alter.  Many people are surprised to learn that oestrogen levels start declining from the age of 35 and that in the build-up to the menopause the oestrogen we produce is variable.

It is like a monthly rollercoaster, with fluctuating hormone levels, where some months you produce a lot of oestrogen and other months you don’t. Due to these fluctuations performing blood tests of hormone levels are pointless, diagnosis should be on discussing symptoms with a menopausal expert.

Due to the complexities around reaching a proper diagnosis we always recommend talking to a qualified healthcare professional.

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.