Menopause & perimenopause

Navigating the menopause transition with clarity

What changes, what's commonly reported, and which treatment options exist. Whether a treatment is suitable depends on your personal medical history and needs a professional assessment.

Published 15 January 2026 · Latest verified educational update

Silhouette of a woman in a yoga pose at sunset — stock lifestyle photo, not a patient

Definitions

Three stages, explained

Select a stage to read how it is defined.

Perimenopause

The transition before the final period, when ovarian hormone levels fluctuate. It often starts in the 40s and can last several years. Periods may become irregular, heavier or lighter. Symptoms can start while periods are still regular. Pregnancy remains possible, so contraception may still be needed — discuss options with a clinician.

Commonly reported symptoms

Experiences vary widely. Some people have few symptoms; others find them significantly disruptive. Similar symptoms can have other causes, such as thyroid conditions, anaemia or depression.

Vasomotor

Hot flushes and night sweats

Sleep

Difficulty falling or staying asleep, often linked to night sweats

Mood & mind

Low mood, anxiety, irritability, “brain fog”, reduced concentration

Genitourinary

Vaginal dryness, discomfort with sex, urinary urgency or recurrent UTIs

Body

Joint and muscle aches, headaches, palpitations, skin and hair changes

Cycle

Irregular, heavier or lighter periods during perimenopause

Sleep & mood considerations

Night sweats, anxiety and changing hormone levels can all affect sleep. Consistent sleep routines, a cool bedroom and limiting alcohol and late caffeine are commonly recommended general measures.

Cognitive behavioural therapy (CBT) is recommended in NICE's menopause guideline as an option to help with some symptoms, including low mood and anxiety linked to menopause. Persistent low mood, hopelessness or thoughts of self-harm need prompt professional support — contact a clinician or a crisis line.

✓ Guideline-supported

Bone & heart health

Estrogen helps maintain bone density, so bone loss accelerates around menopause, raising osteoporosis risk. Weight-bearing and muscle-strengthening activity, adequate calcium and vitamin D, not smoking and limiting alcohol support bone health.

Cardiovascular risk rises after menopause. Knowing your blood pressure, cholesterol and blood sugar, and discussing your personal risk with a clinician, is a practical step.

✓ Established evidence

Treatment options

An overview — not a prescription

We do not provide dosages, schedules or individual recommendations. Suitability depends on age, time since menopause, symptoms, and personal and family history.

Hormonal

Menopausal hormone therapy (MHT / HRT)

Replaces estrogen, usually with a progestogen for people who have a uterus to protect the womb lining. Major guidelines describe it as the most effective treatment for hot flushes and night sweats, and it helps prevent bone loss.

Risks and benefits vary with type, dose, route (for example, transdermal vs oral estrogen) and timing. Guidance from The Menopause Society describes a generally favourable benefit–risk balance for many people under 60 or within 10 years of menopause without contraindications. It may not be suitable for people with certain cancers, clotting history or other conditions.

Local hormonal

Vaginal estrogen

Low-dose estrogen applied locally to treat vaginal dryness and some urinary symptoms. Absorption into the body is low. Non-hormonal vaginal moisturisers and lubricants are also options.

Non-hormonal

Non-hormonal prescription options

For people who cannot or prefer not to use hormones, clinicians may discuss options such as certain SSRIs/SNRIs, gabapentin, or fezolinetant (a neurokinin-3 receptor antagonist approved in some countries, including by the US FDA in 2023). Availability and suitability vary.

Psychological

CBT & supportive approaches

CBT has evidence for helping people manage how hot flushes, sleep difficulties and mood affect daily life. Many herbal and “bioidentical” compounded products lack robust evidence of safety and effectiveness — tell your clinician about any supplements you use.

Questions to discuss with a clinician

Could my symptoms be related to perimenopause, or might something else be involved?
Are tests helpful in my situation, or is a diagnosis based on symptoms and age?
What are the benefits and risks of hormone therapy for me specifically?
What non-hormonal options are suitable given my medical history?
Do I still need contraception, and for how long?
Should I have my bone health or cardiovascular risk assessed?
How and when should we review my treatment?

Current clinical guidance & sources

Guidance changes over time. Always check the source's current version. Related guides: NHS menopause guide · The Menopause Society · ACOG perimenopause