Perimenopause is the transition leading up to menopause. Menopause is reached after 12 months without a menstrual period when no other cause is present.
What to know
Changing hormone levels can affect periods, temperature regulation, sleep, mood, vaginal and urinary health, and bone health.
Lifestyle measures, non-hormonal treatments and menopausal hormone therapy may help some people. Benefits and risks must be considered individually.
Key points
Hot flushes and sweatsThese can disrupt sleep and daily life.
Sleep and mood changesSeveral factors may contribute.
Vaginal and urinary symptomsDryness, discomfort or urinary changes may occur.
Bone and heart healthPreventive care remains important.
Signs and symptoms
Perimenopause can last several years. Symptoms may come and go, and another condition can sometimes cause similar changes.
Changing periods
Cycles may become shorter, longer, heavier, lighter or less predictable before periods stop.
Hot flushes and night sweats
Sudden heat, sweating and chills can disrupt sleep and daily activities.
Sleep, mood and thinking
Insomnia, low mood, anxiety, irritability or concentration difficulty may occur and deserve support.
Genitourinary symptoms
Vaginal dryness, pain with sex, urinary urgency or recurrent urinary infection can become more common.
Causes and contributing factors
Menopause occurs as ovarian follicle activity declines and estrogen and progesterone levels change. Natural menopause is diagnosed after 12 months without menstruation when no other cause explains it.
Natural transitionMost people experience menopause in midlife, with perimenopausal changes beforehand.
Surgery or treatmentRemoval of both ovaries, chemotherapy or pelvic radiotherapy may cause sudden or earlier menopause.
Primary ovarian insufficiencyLoss of ovarian function before age 40 requires assessment and has different health implications.
Not every symptom is menopauseThyroid disease, pregnancy, medicine effects, anaemia, sleep disorders and mental-health conditions can overlap.
How healthcare professionals assess it
Assessment is individual. Not every person needs every test, and results must be interpreted alongside symptoms, history and examination findings.
History first
Age, cycle pattern, symptoms, contraception, medicines and medical history often provide most of the information.
Pregnancy and other causes
Pregnancy testing or other investigations may be appropriate when periods change.
Testing selectively
Routine hormone tests are often unnecessary in typical midlife symptoms because levels fluctuate, but they may help in younger people or unclear cases.
Long-term health review
Blood pressure, cardiovascular risk, bone health, screening and sexual or urinary wellbeing should be considered.
Treatment and management
Treatment depends on the symptoms that matter, medical risks and personal preferences. Options include lifestyle measures, non-hormonal treatment and hormone therapy.
Flush management
Layered clothing, a cooler sleep environment and selected medicines may help. Identify individual triggers without blaming yourself.
Menopausal hormone therapy
Hormone therapy is effective for many symptoms but requires individual assessment of benefits, risks, dose, route and need for uterine protection.
Vaginal and urinary care
Moisturisers, lubricants and local vaginal estrogen or alternatives may help when medically appropriate.
Bone and heart health
Weight-bearing activity, adequate nutrition, smoking avoidance and indicated screening support long-term health.
Practical steps you can take
Track bleeding changes and symptoms before an appointment.
Use reliable contraception until pregnancy risk has passed according to clinical guidance.
Prioritise sleep routines, strength and weight-bearing movement, and adequate calcium and vitamin D intake.
Discuss pain with sex, urinary symptoms and mood openly; these are medical concerns.
Report any bleeding after 12 months without periods.
Questions to ask at an appointment
Writing questions down can make a consultation more useful, especially when symptoms are stressful or complex.
- Are my symptoms likely to be perimenopause, and do I need any tests?
- What hormonal and non-hormonal treatments suit my health history?
- Do I need contraception, bone assessment or cardiovascular-risk review?
- What should I do about vaginal dryness, painful sex or urinary symptoms?
Common questions
Is menopause a disease?
No. It is a normal life stage, but symptoms and longer-term health risks deserve appropriate care.
Can pregnancy still happen during perimenopause?
Yes. Ovulation becomes less predictable but can still occur until menopause is reached.
Is bleeding after menopause normal?
No. Any bleeding after 12 months without a period should be assessed promptly.
When to speak with a healthcare professional
Arrange an assessment if symptoms concern you, affect daily life, persist, worsen or are different from what is normal for you.
Bleeding occurs after 12 months without a periodContact a qualified healthcare professional for individual assessment.
Bleeding is very heavy, frequent or occurs after sexContact a qualified healthcare professional for individual assessment.
Symptoms significantly affect sleep, mood or daily activitiesContact a qualified healthcare professional for individual assessment.
This guide is educational. It does not diagnose a condition or replace care from a qualified healthcare professional.
Medical references
This guide was prepared from authoritative public-health and professional medical resources.
Have questions about this topic?
Discuss your symptoms, history and next steps privately with Dr. Benny.