Menopause and perimenopause: symptoms, how long they last and treatment

The NHS stresses that perimenopause and menopause are different for everyone. Some people have symptoms with a big effect on daily life, relationships and work, and others hardly notice any. The NHS also notes that ethnic background can affect symptoms, giving the example that women from a Black ethnic background are more likely to have hot flushes that are severe and continue for longer.

The symptom list the NHS gives is broad: changes to periods, hot flushes and night sweats, sleep problems, mood changes, poor memory and brain fog, weight gain (often around the stomach and upper body), vaginal dryness, burning, irritation or pain with sex, and more urinary tract infections. It goes on to include palpitations, loss of bone density that can lead to osteoporosis, urinary leakage, worse headaches and migraines, muscle aches and joint pains, hair thinning, dry or itchy skin, reduced sex drive and sensitive teeth or painful gums.

Symptoms do not follow a single script. The NHS says they can change over time, for example hot flushes and night sweats may improve and be replaced by low mood and anxiety, while joint pain and vaginal dryness may continue after menopause.

The NHS advises contacting your GP in the situations below, and says early advice can help reduce the effects of menopause and perimenopause on your health, relationships and work.

• 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 are bleeding more, not less, than before.

• You have not had a period for 12 months or more and you have any vaginal bleeding. The NHS says to see a GP even if it has only happened once, there is only a small amount of blood or spotting, or you have pink or brown discharge.

The NHS says perimenopause ends when you reach menopause, and menopause is when you have not had a period for 12 months. After that you are in postmenopause. Menopause itself is therefore a point in time, while the symptoms around it go on for longer.

The NHS says symptoms usually last for 7 to 9 years, sometimes longer, and that during this time they can change. For example, hot flushes and night sweats may improve for a while and be replaced by other symptoms, such as low mood and anxiety. Some symptoms, such as joint pain and vaginal dryness, can continue after menopause.

The NHS also notes that ethnic background can affect how severe symptoms are and how long they last. It gives the example that women from a Black ethnic background are more likely to have hot flushes that are severe and continue for longer.

The NHS describes menopause and perimenopause as a natural part of life that happens when periods change and eventually stop because of lower hormone levels. NHS inform explains that menopause happens when the ovaries stop producing as much oestrogen and no longer release an egg each month.

Perimenopause is the lead-in. NHS inform describes it as the time from the start of menopausal symptoms until after the last period, with periods usually becoming less frequent over a few months or years, sometimes more irregular, heavier or lighter, and sometimes stopping suddenly. Menopause itself is the point at which 12 months have passed with no period, and what follows is called postmenopause.

NHS inform adds that it is not only women who experience menopause: some transgender men, non-binary people and people with intersex variations may also go through it. It can also happen sooner and more abruptly after certain surgeries or cancer treatments, such as chemotherapy, radiotherapy or removal of the ovaries.

During perimenopause periods may be irregular, lighter or heavier. The NHS says taking hormone replacement therapy during perimenopause can make periods more regular, with some irregular bleeding or spotting that should settle within 6 months; it advises talking to a GP if irregular or heavier bleeding or spotting continues beyond that.

Hormonal contraception can mask the picture. The NHS says some types, such as the progestogen-only pill, hormonal coil, implant and injection, can make periods irregular or stop them, which makes it harder to tell whether you have reached menopause. It also says the combined pill causes monthly bleeds for as long as it is taken and is not recommended from age 50, because the risks generally outweigh the benefits, and that a GP may suggest progestogen-only contraception instead. The NHS says HRT is not contraception.

One kind of bleeding should never be left. If you have not had a period for more than 12 months and then have any vaginal bleeding, the NHS says to see a GP, even if it only happened once, is a small amount, or is pink or brown discharge. It explains that postmenopausal bleeding is not usually serious but can be a sign of cancer, which may be easier to treat if found early.

The NHS advises speaking to a doctor, nurse or pharmacist about hormone replacement therapy (HRT) and other options. It explains that oestrogen is the main type of HRT and can be given as tablets, patches, spray or gel, with a cream or pessary sometimes used for vaginal dryness or urinary symptoms. If you still have a womb, progestogen is needed with oestrogen to protect it, as tablets, as part of a combined patch or through the hormonal coil. For some people with low libido, testosterone gel or cream may be considered, and the NHS says it may be available on prescription from a menopause specialist. This page is information only; prescribing choices belong to your clinician.

For people who cannot or prefer not to take HRT, the NHS describes non-hormonal options. Antidepressants may be offered for low mood or anxiety caused by menopause, and for hot flushes and night sweats it mentions cognitive behavioural therapy (CBT) and, if that does not help, clonidine or an antidepressant. It says herbal remedies and complementary medicines such as red clover and black cohosh have very little evidence on how well they work or how safe they are, and some may cause serious side effects with other medicines.

NHS inform lists HRT, vaginal oestrogen, lubricants or moisturisers, CBT, a healthy diet and exercise, and supplements such as vitamin B6 and vitamin D among the options discussed with a clinician. The NHS says that HRT can also reduce the risk of osteoporosis.

The NHS does not set out a special menopause diet. Its advice is to try to eat a healthy, balanced diet, which it says can help with symptoms during perimenopause and menopause and help you keep as well as possible in the future. NHS inform also lists a healthy, balanced diet and regular exercise among the options to discuss with a healthcare professional.

For bone health, the NHS suggests eating calcium-rich food like milk, yoghurt and kale, and a diet that includes plenty of fruit and vegetables. Weakening of the bones (loss of bone density, which can lead to osteoporosis) is one of the possible effects of menopause. The NHS also suggests getting some sunlight on your skin, which triggers vitamin D production, and taking vitamin D supplements. NHS inform lists supplements such as vitamin B6 and vitamin D among the options a clinician may discuss.

For hot flushes and night sweats, the NHS suggests regular exercise and avoiding personal triggers such as spicy food, caffeine, hot drinks, smoking and alcohol, and keeping to a healthy weight. It says weight gain during perimenopause and menopause is common, often around the stomach and upper body. It advises not smoking, which can make menopause symptoms worse, and keeping within the recommended alcohol limit, which may affect your symptoms.

The NHS says to talk to a doctor before taking herbal supplements or complementary medicines. Remedies such as red clover and black cohosh are sometimes sold for menopause symptoms, but there is very little evidence on how well they work or how safe they are.

The NHS lists lifestyle steps: regular sleep routines, a balanced diet with calcium-rich foods such as milk, yoghurt and kale, regular exercise with a focus on weight-bearing activity for bone health, relaxing activities such as yoga, tai chi or meditation, and talking with others going through the same thing. It advises not smoking and keeping alcohol within recommended limits, and talking to a doctor before herbal supplements.

For hot flushes it suggests lightweight clothing, a cool bedroom, a cool shower, fan or cold drink, stress reduction and avoiding triggers such as spicy food, caffeine, hot drinks, smoking and alcohol. For vaginal dryness it points to moisturisers and lubricants from a pharmacy and warns against oil-based lubricants with condoms. For bone health it adds sunlight on the skin and vitamin D supplements.

• Keep to regular sleep routines.

• Eat a balanced diet with calcium-rich foods.

• Do weight-bearing and strength exercise.

• Try CBT, relaxation or other talking support for low mood and anxiety.

• Keep a cool bedroom and avoid personal flush triggers.

For most people over 45, menopause is recognised from the symptoms and the pattern of periods. NHS inform notes that your family history can offer a clue to timing, since it is likely to be a similar age to when your mother or older sisters went through it. The NICE guideline NG23 covers identifying and managing menopause, including for people with premature ovarian insufficiency.

The NHS early menopause page says that if you are under 45 and having menopause symptoms, a GP may sometimes do blood tests. The NHS defines early menopause as periods stopping before the age of 45 and premature menopause as before 40, and says family history, starting periods early, smoking and being underweight make it more likely, as do radiotherapy, chemotherapy, some hormone medicines and surgery to remove the ovaries.

Most menopause care starts with a GP, practice nurse or pharmacist. The NHS says that if treatments and lifestyle changes do not help, you can be referred to a specialist menopause centre, and it points to the British Menopause Society website for finding an NHS or private menopause specialist. Some people choose a private menopause consultation for longer appointments or access to specialist prescribing.

Whichever route you take, it is reasonable to ask which symptoms the plan targets, what a review will look at, how long a treatment would be tried, and what to do about bleeding. The NHS notes that early advice can reduce the effects of menopause on health, relationships and work. NHS inform adds that menopause is a normal time in a woman's life and support should be available at work.