Perimenopause and menopause are a natural part of a woman’s life, but the experience can be very different from one person to another. For some women, symptoms are relatively mild. For others, hormonal changes can have a significant impact on sleep, mood, energy, relationships, work and overall quality of life.
There are now more treatment options available than ever before, from lifestyle changes and non-hormonal treatments to different types and forms of Hormone Replacement Therapy (HRT). With so many options – and individual medical histories to consider – knowing what is right for you is not always straightforward.
As a GP and Certified Menopause Specialist, my approach is to take the time to understand the whole picture and help each patient find an approach that is right for them.
What is the difference between perimenopause and menopause?
Menopause refers to the point when a woman’s periods stop as the ovaries lose their reproductive function. The average age of menopause in the UK is around 51.
However, symptoms often begin much earlier, during perimenopause – the transition leading up to menopause when hormone levels can fluctuate considerably. This stage can begin several years before periods stop completely.
These hormonal changes can affect many different systems within the body, which is why the experience of perimenopause and menopause can vary so widely between women.
What symptoms can occur?
Hot flushes and night sweats are perhaps the symptoms most readily associated with menopause, but hormonal changes can affect women in many different ways.
Symptoms may include:
- Hot flushes and night sweats
- Irregular or heavy periods
- Sleep disturbance
- Mood changes, anxiety or low mood
- Brain fog or difficulty concentrating
- Joint aches and muscle pain
- Increased headaches or migraines
- Vaginal dryness or recurrent urinary infections
- Low libido
Symptoms can develop gradually and are not always immediately recognised as being related to perimenopause, particularly when periods are still regular.
When should I seek advice?
There is no need to wait until symptoms become severe or your periods have stopped before seeking advice.
If changes to your sleep, mood, concentration, periods or physical wellbeing are beginning to affect everyday life, it can be helpful to talk through what you are experiencing and consider whether perimenopause or menopause may be contributing.
I often find that simply having the time to discuss the full range of symptoms is valuable, particularly when they have developed gradually or may initially appear unrelated.
How can a menopause specialist help?
While hormonal changes are something all women will experience, how those changes affect each of them – and how they responds to treatment – can vary considerably.
During a specialist menopause consultation, I take time to understand your symptoms alongside your medical and gynaecological history, lifestyle, family history and what matters most to you.
There are several different types and forms of hormonal and non-hormonal treatment available. Part of my role is to help you navigate those choices, understand the benefits and considerations of each, and find a treatment plan that is appropriate for you as an individual.
Depending on your individual circumstances, support may include:
- A women’s health check, including a gynaecological examination where appropriate
- Blood tests and referral for an ultrasound scan where clinically indicated*
- Advice on lifestyle changes that may improve symptoms
- Prescribing Hormone Replacement Therapy (HRT), including testosterone where appropriate
- Non-hormonal treatment options
- Advice around bone and cardiovascular health
- Assessment and advice around contraception and family planning
- Support with sleep, mood and cognitive symptoms
I also consider lifestyle as an important part of menopause care. Nutrition, physical activity, sleep and stress management can all influence health and wellbeing during midlife and can be considered alongside medical treatment.
What if my medical history makes menopause treatment more complicated?
For some women, deciding how best to manage menopause symptoms requires a little more consideration.
I see women with a wide range of medical histories and more complex needs, including those with:
- A personal or strong family history of breast cancer or other gynaecological cancers
- A history of migraine
- Previous venous thromboembolism
- Liver disease
- Endometriosis or fibroids
- ADHD or autism
- Previous side effects or intolerance to hormone treatment
- Heavy menstrual bleeding
- Progesterone sensitivity
- More complex mood or mental health concerns
Having one of these conditions does not necessarily mean that particular treatments cannot be considered. It does mean that your individual medical history, symptoms, risks and priorities need to be carefully assessed when deciding on the most appropriate approach.
This is one of the areas where a specialist menopause consultation can be particularly valuable.
What are the options for HRT?
Hormone Replacement Therapy replaces hormones – particularly oestrogen – that naturally decline during perimenopause and menopause.
There are many different types of HRT and several ways of taking it, including:
- Skin patches
- Gels or sprays applied to the skin
- Tablets
- Vaginal oestrogen creams, pessaries or rings
Some women require oestrogen alone, while others need a combination of oestrogen and progesterone. Testosterone may also be considered in certain circumstances.
There is no single form of HRT that is best for everyone. The most appropriate treatment will depend on factors including your symptoms, medical history, stage of menopause, lifestyle and personal preference.
For many women, HRT can be a safe and effective treatment for menopause symptoms. I discuss the potential benefits and risks with each patient so that we can make an informed decision together.
Do I need blood tests?
Not necessarily. In many women, perimenopause and menopause can be identified from symptoms and medical history without hormone testing.
There are circumstances where blood tests may be helpful, particularly in younger women, where symptoms are less clear or if we need to consider other possible medical causes.
Depending on your symptoms and medical history, I may also recommend a wider women’s health assessment or further investigation, including referral for an ultrasound scan where appropriate.*
What about contraception during perimenopause?
Although fertility declines during perimenopause, pregnancy can still occur while you are ovulating.
Contraception and menopause treatment therefore sometimes need to be considered together. During a consultation, we can review your current contraception and family planning needs alongside any treatment for menopause symptoms.
Why do I look beyond menopause symptoms?
Menopause care is not simply about treating the symptoms you are experiencing today.
Midlife is also an important time to consider longer-term health, particularly bone and cardiovascular health.
I take a holistic approach to menopause care, looking at these wider aspects of health alongside symptoms, lifestyle and treatment. My aim is to give women the information and support they need to make informed decisions about their health – both now and for the years ahead.
How can I book an appointment?
I offer specialist menopause consultations at Sloane Street Surgery Marlborough on Monday mornings, with appointments also available online via video consultation.
Initial menopause consultations are 30 minutes, giving us time to discuss your symptoms, medical history, concerns and priorities before considering the most appropriate next steps.
Book a menopause consultation online or call the team on 020 7245 9333 to find out more.
*Blood tests, ultrasound scans and other additional investigations incur an additional charge.
About the author
BSc (hons) MBChB (hons) MRCP MRCGP DFSRH PPMC
“The detective work of general practice — understanding what’s going on, finding answers and working together on the best way forward — is something I find incredibly rewarding. Being part of a patient’s journey towards better health and wellbeing is why I continue to love being a GP.”
I have worked in multi-racial and culturally diverse communities and gained experience across several specialist areas, giving me an extensive and well-rounded clinical background. I enjoy seeing patients of all ages and particularly value the breadth and variety that comes with general practice.
Alongside my GP work, I also have a specialist interest in women’s health and the menopause, and I am a Certified Menopause Specialist with the British Menopause Society. I provide evidence-based, individualised care to support women of all ages with hormonal changes from puberty through to the menopause and beyond, taking time to consider symptoms in the context of overall health, lifestyle, mental wellbeing and long-term risk. Ensuring women feel informed, confident and well supported is a central part of my clinical practice.
