Perimenopause and Menopause:  Understanding and Managing the Transition

During perimenopause, your ovaries gradually approach what is sometimes called ovarian failure, and hormone levels don’t fall in a straight line — they fluctuate for months or years before ceasing altogether. This is when you’re described as perimenopausal, and once you’ve gone 12 months without a period, you’re considered post-menopausal. Underneath this, your body experiences both oestrogen-decline and progesterone-decline, becoming oestrogen-deficient and hormone-deficient overall, which is why the effects can feel systemic and psychological — touching mood, sleep, bones, and more, not just your reproductive cycle.

A vasomotor symptom is the medical term for hot flushes and night sweats — sudden waves of heat that happen when hormonal changes trigger a temporary shift in how your body regulates temperature. These symptoms can range from mild to disruptive, and there are several ways to manage them, from HRT to lifestyle changes like layering clothing and avoiding triggers such as caffeine or alcohol.

Lower oestrogen can lead to vaginal atrophy — thinning and dryness of the vaginal tissue — which is part of a wider pattern sometimes called genitourinary atrophy, affecting the urogenital area more broadly. Some women also notice urinary incontinence as the genitourinary tissues change. Doctors can help manage symptoms with topical oestrogen, moisturisers, or lubricants, so it’s worth mentioning these changes even if they feel like an awkward topic to raise.

HRT works to oestrogen-replace and more broadly hormone-replace what your body is no longer producing. Tibolone is a synthetic alternative that has a similar effect to combined HRT. For women who prefer not to take hormones, phytoestrogen supplements — plant compounds like isoflavone found in soy — are sometimes used to symptom-manage mild symptoms, though the evidence for these is more limited than for HRT. Your GP can also help weigh up any metabolic factors, such as weight or cholesterol changes, when deciding what’s right for you.

Yes — falling oestrogen can affect more than reproductive symptoms. Some women notice low mood, depression and anxiety. Doctors may treat these where needed, and some find their mood can mood-stabilise again once hormone levels settle. Some women notice a cognitive-decline in memory or concentration (often described as “brain fog”), though this usually improves over time. Bone health matters too: without oestrogen, bone-density-decline can accelerate, raising fracture risk, so doctors may recommend calcium, vitamin D, weight-bearing exercise, or HRT to help bone-density-increase.