Perimenopause: symptoms, how long it lasts and treatment options

The NHS says perimenopause and menopause are different for everyone. You may get symptoms that have a big impact on relationships, social life, family life and work, or you may hardly have any symptoms at all. NHS inform says most women will experience menopausal symptoms, some few or none, and for some they can be quite severe.

The NHS says ethnic background can affect symptoms, how severe they are and how long they last. For example, it says women from a Black ethnic background are more likely to have hot flushes that are severe and continue longer.

NHS inform describes perimenopause as the time from the start of menopausal symptoms until after a woman has experienced her last period. Periods usually start to become less frequent over a few months or years before they stop altogether. They might be more irregular and become heavier or lighter, and for some women they can stop suddenly.

Menopause is when you have not had a period for 12 months, and after this you are postmenopausal. NHS inform explains that menopause happens when the ovaries stop producing as much oestrogen and no longer release an egg each month. Perimenopause and menopause are a natural part of life.

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

NHS inform says perimenopause and menopause usually occur between 45 and 55 years of age as oestrogen levels drop, although it can start earlier, and that in the UK the average age to reach menopause is 51. It suggests looking at your family history, because it is likely to be a similar age to when your mother or older sisters started theirs.

NHS inform also says menopause can occur due to certain surgeries or cancer treatments, and that premature or early menopause can occur at any age and in many cases there is no clear cause. If you notice changes earlier than the usual age, speak to a GP.

The NHS says if you have symptoms you can talk to a doctor, nurse or pharmacist about HRT and other options. The type of HRT you are offered depends on whether you still have periods or have had your womb removed.

NICE says that healthcare professionals should discuss treatment options with you, including the benefits and risks. NICE also says to consider menopause-specific cognitive behavioural therapy (CBT) for hot flushes and night sweats, in addition to HRT or for people who cannot or prefer not to take it.

The NHS says during perimenopause your periods may become irregular, lighter or heavier. If you take HRT you may have some irregular bleeding or spotting that should settle within 6 months, and you should talk to your GP if it continues after 6 months.

Contact a GP if you still have periods but your bleeding pattern has changed and you are bleeding more, not less, than before, or if you have not had a period for 12 months or more and have any vaginal bleeding. The NHS says postmenopausal bleeding is not usually serious but can be a sign of cancer, and should be checked even if it has only happened once.

The NHS says it is possible to get pregnant during perimenopause, so you still need contraception for 1 year after your final period if you are 50 or over, and for 2 years if you are aged 40 to 49. It says that hormonal contraception can make it harder to tell if you have reached perimenopause or menopause, and that the combined pill is not recommended from age 50 as the risks generally outweigh the benefits. HRT is not contraception.

The NHS says eating well, exercising and looking after your mental wellbeing can help with symptoms, and also helps you keep as well as possible in the future.

• Try to eat a healthy, balanced diet.

• Eat calcium-rich food such as milk, yoghurt and kale to keep bones healthy.

• Exercise regularly, with a focus on weight-bearing exercise to help protect against weakening bones.

• Get plenty of rest and keep to regular sleep routines.

• Try relaxing activities such as yoga, tai chi or meditation.

• Do not smoke, as this can make symptoms worse, and try not to drink more than the recommended alcohol limit.

• Talk to a doctor before taking herbal supplements or complementary medicines.

• For hot flushes, the NHS suggests lightweight clothing, a cool bedroom, a cool shower or cold drink, and avoiding triggers such as spicy food, caffeine, hot drinks, smoking and alcohol.

The NHS says to contact your GP if you think you have symptoms of menopause or perimenopause and want to know your options, if you have symptoms such as a fast heartbeat (palpitations), if you still have periods but are bleeding more than before, or if you have not had a period for 12 months and have any vaginal bleeding. It says early advice can help reduce the effects on your health, relationships and work.

NICE says perimenopause can be identified without laboratory tests in otherwise healthy people aged 45 or over who have recently started vasomotor symptoms and changes in their menstrual cycle, and advises against using tests such as anti-Müllerian hormone or oestradiol to identify perimenopause in people aged 45 or over.

On the NHS, menopause care usually starts with a GP, practice nurse or pharmacist, and the NHS notes that testosterone may be available on prescription from a menopause specialist. NICE guidance sets out what should be discussed and offered.

Some people choose a private menopause consultation for longer appointments or quicker access to specialist advice. Whichever route you take, it is reasonable to ask for the benefits and risks of each treatment to be explained, and to keep your GP informed of any prescription.