Menopause marks the natural end of a woman’s reproductive years, occurring when the ovaries gradually reduce oestrogen production and periods cease. Every woman experiences menopause differently, and it can be a concerning time.

Perimenopause is clinically a time when you may notice a change in your menstrual pattern. Once you’ve not had a period for over 12 months, we consider you to be post-menopausal. Other than menstrual changes, common symptoms can include:

• Hot flushes and night sweats
• Difficulty sleeping (insomnia)
• Poor memory or concentration
• Low mood, anxiety or depression
• Vaginal dryness or discomfort during sex
• Reduced libido

Perimenopause is the transitional phase leading up to menopause, when oestrogen and progesterone levels begin to fluctuate. This stage can start as early as your mid-30s through to your mid-50s, and may last from a few months to several years.

Typical perimenopausal symptoms include:

• Irregular or changing periods
• Hot flushes
• Vaginal dryness (vaginal atrophy)

During this stage, the ovaries begin producing less oestrogen, which can cause hormonal imbalance and associated symptoms. Although fertility is reduced, pregnancy remains possible, so contraception is recommended until you have been period-free for 12 consecutive months.

Declining oestrogen disrupts the balance with progesterone, leading to fluctuations in hormone levels that affect both physical and emotional wellbeing. These hormonal shifts can contribute to mood changes, sleep disturbance and irregular periods.

While hormonal fluctuations are normal during perimenopause, some symptoms require medical review to rule out other causes. You should seek advice if you experience:

• Pain or spotting during or after sex
• Spotting between periods
• Heavy bleeding or passing large clots
• Periods lasting significantly longer than usual
• Cycles occurring closer together than normal

We may recommend further investigations, such as a pelvic ultrasound of your womb and ovaries, to identify potential causes and ensure your wellbeing.

For most women, diagnosis is based on a combination of symptoms, age and menstrual history. However, if symptoms significantly affect your quality of life or if the cause is uncertain, we may recommend further evaluation or testing.

A formal diagnosis allows your doctor to tailor a precise treatment plan, ensuring you receive the most effective and appropriate care.

Measuring FSH levels is one of the ways to understand whether you may be approaching menopause. If levels are consistently high, this can be a helpful indicator. However, during perimenopause, your hormone levels will naturally fluctuate.

Other factors such as birth control, thyroid disorders or elevated prolactin may also influence results. Which is why a FSH test may not always give a clear answer. Your doctor will review your results alongside your symptoms, medical history and overall wellbeing to build a clearer understanding and guide you on the next steps.

If your symptoms affect your daily life, we can recommend a range of effective, evidence-based treatments. We’ll work with you to personalise a menopause treatment plan just for you. This may include: 

• HRT: Replacing declining oestrogen levels using tablets, patches, gels or implants.
• Consideration for onward referral for testosterone replacement
• Lubricants and moisturisers: To relieve vaginal dryness and discomfort.
• SSRIs: Antidepressant medications that can help with low mood or anxiety.
• Talking therapy: To support emotional wellbeing and resilience during this transition.

Our GPs take a holistic, patient-centred approach to provide guidance on nutrition, exercise and lifestyle changes that can help reduce menopausal symptoms and promote overall vitality.