Menopause and perimenopause are a natural part of life. 

This happens when your periods change and eventually stop due to lower hormone levels. It usually affects women and anyone who has periods between 45 and 55, but it can happen earlier.  

Menopause is caused by a fall in hormone levels and usually affects women and those who have periods between the ages of 45 and 55, but it can happen earlier. 

What's the difference between perimenopause and menopause? 

  • Perimenopause happens when your periods become irregular. Perimenopause ends when menopause begins. 

  • Menopause is when your periods stop altogether (not having a period for 12 months without the aid of hormonal contraception) 

Symptoms of perimenopause and menopause:

Changes to your period

One of the first signs of perimenopause is usually a change to your periods. They may happen more often or less often, and bleeding may get heavier or lighter. Eventually, you stop having periods altogether. 

Hot flushes and night sweats 

Hot flushes are when your face, neck and chest suddenly feel very hot or cold. It can make you sweat a lot, cause palpitations or anxiety, or make you feel dizzy. It can happen during the day or night (night sweats) and last for several minutes. 

Sleep problems 

Not being able to get to sleep or stay asleep can affect your daily life. It can make you feel irritable, stressed and anxious. Sleep problems may be worse if you also have night sweats. 

Mood changes 

You may have mood swings, low mood or depression. You may also notice problems with your memory or concentration. These symptoms may feel worse if you have sleep problems and feel very tired. 

Weight gain 

Weight gain during perimenopause and menopause is common. It often happens around the stomach and upper body. 

Vaginal problems 

You may get symptoms such as dryness, a burning feeling, irritation or itching in and around the vagina. These symptoms can also make sex feel painful. 

Menopause and perimenopause may affect you in other ways, including: 

  • a faster, slower or more noticeable heartbeat (palpitations) 

  • weakening bones (loss of bone density), which can lead to osteoporosis 

  • feeling the need to pee more or not being able to control when you pee (urinary incontinence) 

  • headaches and migraines that are worse than usual 

  • muscle aches and joint pains 

  • hair thinning or hair loss 

  • skin changes, including dry and itchy skin 

  • reduced sex drive (loss of libido) 

  • sensitive teeth, painful gums or other mouth problems 

When to see your GP 

  • you think you have symptoms of menopause or perimenopause and want to know what your options are 

  • you have symptoms like a fast heartbeat (palpitations) 

  • you still have periods, but your bleeding pattern has changed and you're bleeding more, not less, than before 

  • you have not had a period for 12 months or more, and you have any vaginal bleeding 

  • early advice can help reduce the effects of menopause and perimenopause on your health, relationships and work. 

Treatment 

Hormonal replacement therapy (HRT)  

If you have symptoms of perimenopause or menopause, talk to a doctor, nurse or pharmacist about HRT and other options available. 

The type of HRT you're offered will depend on whether you still have periods or not, or if you have had your womb removed. 

Oestrogen 

Oestrogen is the main type of HRT and can help manage your symptoms. It can be taken as tablets or used as patches, spray or gel. 

It's sometimes used as a cream or pessary to treat vaginal dryness and soreness, or urinary symptoms, after the menopause. 

Progestogen 

If you're taking oestrogen and have not had a hysterectomy, it's important to take progestogen to protect your womb. 

Progestogen can be taken as tablets, as part of a combined patch or as the hormonal coil (intrauterine system, or IUS). 

Testosterone 

Testosterone gel or cream can help to improve low libido (sex drive) for some. There are many reasons why you may have low libido around the menopause, including relationship difficulties, how you feel about yourself, and physical discomfort. You may be able to get testosterone on prescription from a menopause specialist. 

Ways to manage perimenopause and menopause symptoms: 

  • try to get plenty of rest, including keeping to regular sleep routines 

  • try to eat a healthy, balanced diet 

  • eat calcium-rich food like milk, yoghurt and kale, if you can, to keep your bones healthy 

  • exercise regularly, with focus on weight-bearing exercises to build strength as this can help protect against weakening bones 

  • try relaxing things such as yoga, tai chi or meditation 

  • talk to other people going through the same thing, like family, friends or colleagues 

  • talk to a doctor before taking herbal supplements or complementary medicines 

  • talk to a doctor about hormonal contraception if you need to – HRT is not contraception 

Commonly asked questions:

'Isn't menopause only something that happens to people in their 50s?' 

Some people naturally experience menopause earlier than others, beginning with perimenopause symptoms as early as their 30s or 40s.  Some people may also experience a surgical menopause if they have had their ovaries removed. Without the hormones the ovaries produce, they experience a sudden menopause. 

'Does going through menopause mean your sex life is over?' 

It is true that the change in hormones during the perimenopause, menopause and post-menopause can cause tiredness, a lower libido (desire to have sex), the clitoris to lose sensation, and the vagina to become dryer and less easy to arouse leading to painful penetrative sex.  However, menopause can also lead to an increase in libido: 

  • No longer worry about becoming pregnant (you can still get pregnant during the perimenopause, so you need to continue to use contraception during this time)  

  • Become more confident and care less about what they look like or what other people think   

  • Prioritise themselves during this stage of their life and put more emphasis on their pleasure 

If you want to have sex, there are many ways of managing the changes the menopause brings so you can continue to have a healthy and happy sex life:   

  • Talk to your partner(s) about difficulties you’re experiencing   

  • Use lube – Your best friend for helping with vaginal dryness  

  • Explore other types of sex – Sex isn’t just penetrative sex, you can explore arousal and intimacy in other ways and by incorporating sex toys  

  • Oestrogen creams – This can be prescribed by your GP to help with vaginal dryness which can help with sex as well as daily life  

  • Manage stress – Often libido is linked to stress levels and by incorporating exercise or reducing stress in your life, you may find your libido increases