Perimenopause and Menopause: How to Recognise the Symptoms and When to Seek Help
By Dr Daniel Gordon • 27, Dec 2025
Understanding Changes During Perimenopause and Menopause
Perimenopause and menopause are natural stages of life, but that doesn’t mean they’re always easy. For many women, this transition brings physical, emotional, and psychological changes that can feel confusing, unexpected, or overwhelming.
One of the most difficult aspects is that symptoms often begin years before periods stop completely. Many women don’t realise what’s happening, or assume their symptoms are due to stress or something they just have to tolerate.
I’ve written this article to explain what perimenopause and menopause are, the common symptoms to look out for, what you can do to support your health, and when it’s important to seek medical advice.
What is perimenopause?
Perimenopause is the transition phase leading up to menopause. It usually begins in the later part of a woman’s 40s.
During this time, oestrogen levels fluctuate rather than steadily decline. These hormonal changes are responsible for many of the symptoms women experience, often long before periods stop completely.
Periods may become irregular, heavier, lighter, closer together, or further apart. However, cycle changes are not always the first or most noticeable sign.
What is menopause?
Menopause is defined as the point when a woman has not had a menstrual period for 12 consecutive months. The average age is 51, but this varies widely.
After menopause, oestrogen levels remain low and more stable. Some symptoms may ease, while others can persist if not addressed.
Menopause is not a single moment, but part of a longer hormonal transition that affects many systems in the body.
Common symptoms of perimenopause and menopause
Symptoms vary significantly between women, both in type and severity. Some of the most common symptoms include:
Hot flushes and night sweats
Irregular periods
Sleep disturbance and insomnia
Fatigue and low energy
Mood changes, anxiety, or low mood
Brain fog, poor concentration, or memory changes
Weight gain and changes in body composition
Joint aches and muscle pain
Reduced libido and vaginal dryness
Palpitations or a sense of internal jitteriness
Symptoms may come and go, and their fluctuating nature can make them difficult to recognise.
Why symptoms are often missed or misunderstood
Perimenopause symptoms can overlap with many other conditions, including anxiety, depression, thyroid disorders, and chronic stress.
Women are often told their symptoms are “just stress” or “part of getting older”, which can delay diagnosis and treatment. This can be frustrating and invalidating, particularly when symptoms are affecting work, relationships, or confidence.
Recognising the pattern of symptoms over time is often key.
What you can do to support your health during this transition
Lifestyle measures play an important role in managing symptoms and supporting long-term health.
Regular exercise, particularly resistance and weight-bearing activity, helps protect muscle mass and bone density. A balanced diet with adequate protein, fibre, and healthy fats supports energy levels and metabolic health.
Sleep hygiene, stress management, and limiting alcohol can significantly reduce symptoms such as night sweats, anxiety, and poor sleep. Staying socially connected and prioritising emotional wellbeing also matter more than many women realise.
When menopause hormone therapy (HRT) may help
Menopause hormone replacement therapy, or HRT, can be very effective for many women during perimenopause and menopause. It is usually helpful for symptoms such as hot flushes, night sweats, poor sleep, low mood, anxiety, and brain fog.
HRT works by replacing oestrogen at safe, physiological levels, helping to stabilise hormonal fluctuations. For women who are suitable, it can significantly improve quality of life. HRT is not right for everyone, but many women who would benefit are never offered it due to outdated fears or misinformation.
To address this, I spoke with Dr Ellie Cannon, a GP and author of The Little Book of HRT, on my YouTube channel The Health Perspective. We discussed common concerns around HRT, including breast cancer and blood clots, and why lifestyle factors such as weight, inactivity, and smoking often carry greater health risks.
You can watch the full conversation here:
When to seek medical advice
You should consider speaking to a healthcare professional if menopausal symptoms are affecting your quality of life, sleep, work, or relationships.
Medical advice is particularly important if you experience heavy or prolonged bleeding, significant mood changes, palpitations, or symptoms that feel unusual or out of proportion.
You do not need to wait until symptoms feel “severe enough”. Early support can prevent years of unnecessary struggle.
A final word
Perimenopause and menopause are not conditions to be endured in silence. They are significant physiological transitions that deserve proper recognition, understanding, and care.
With the right information, support, and treatment, most women can feel well, confident, and in control during this stage of life. If something doesn’t feel right, trust your instincts and seek advice. You don’t have to manage this alone.
Disclaimer
This blog post provides general information only. It is not intended to provide instruction and you should not rely on this information to determine a diagnosis, prognosis or course of treatment. It should not be used in place of a professional consultation with a doctor.
The medical information is the personal opinion of the stated author(s). It is based on available evidence or, where no published evidence is available, on current medical opinion and practice.
Every effort is taken to ensure that the information contained in this website is accurate and complete. However, accuracy cannot be guaranteed – rapid advances in medicine may cause information contained here to become outdated, invalid or subject to debate.
The author(s) is/are not responsible for the results of your decisions resulting from the use of the information, including, but not limited to, your choosing to seek or not to seek professional medical care, or from choosing or not choosing specific treatment based on the information.
You should not disregard the advice of your physician or other qualified healthcare provider because of any information you read on this website. If you have any health care questions, please consult a relevant medical practitioner.
