Is This Perimenopause? Four Questions Many Women Ask

Perhaps your periods have become unpredictable.

You are waking at 3am, forgetting familiar words, feeling anxious for no obvious reason or struggling to find the energy you once relied on.

You may have started wondering:

Is this perimenopause, or could something else be going on?

It is a sensible question.

Perimenopause can affect your sleep, mood, memory, concentration, energy, periods, joints, temperature regulation and much more. Symptoms vary considerably between women and can change over time, which is one reason the transition can feel so confusing.

Understanding what may be happening is an important first step. You deserve to feel listened to, to have other possible causes considered and to know what support is available.

Here are clear answers to four of the questions women ask most often.

How do I know if this is perimenopause or something else?

Perimenopause usually begins with a combination of symptoms and changes to your menstrual cycle.

Your periods may become:

• More or less frequent
• Heavier or lighter
• Longer or shorter
• Less predictable than before

You might also notice hot flushes, disrupted sleep, night sweats, anxiety, low mood, irritability, brain fog, headaches, palpitations, aching joints, vaginal dryness or changes in your sex drive.

You do not need to experience every symptom. You do not even need to experience hot flushes. For some women, changes in sleep, mood, cognition or energy are far more noticeable.

However, several health conditions can produce similar symptoms. Thyroid disorders, anaemia, vitamin deficiencies, medication side effects, sleep disorders and mental health conditions may all contribute to changes in energy, mood, concentration or menstrual patterns. NICE specifically advises healthcare professionals to be aware that symptoms of thyroid dysfunction can be mistaken for menopause.

It is also possible to be experiencing perimenopause and another health concern at the same time.

This is why it is worth speaking to your GP, particularly when symptoms are new, severe, rapidly worsening or affecting your ability to function and enjoy your life.

A useful starting point is to keep a simple record for a few weeks. Note:

• Changes to your periods
• Sleep quality
• Mood and anxiety
• Hot flushes or night sweats
• Headaches or palpitations
• Energy and concentration
• Vaginal or urinary symptoms
• Anything that appears to improve or aggravate your symptoms

This will not diagnose you, but it can help you describe the pattern more clearly during a medical appointment.

Please seek medical advice promptly if you are experiencing very heavy bleeding, bleeding after 12 months without a period, persistent palpitations or severe changes in your mental health. The NHS recommends that any bleeding after menopause is checked, even if it happens only once.

Do I need blood tests to confirm perimenopause?

Many women expect a hormone test to provide a definite answer.

Unfortunately, hormone levels can fluctuate significantly during perimenopause. A blood test taken on one particular day may therefore show a very different result from a test taken at another point in the same month.

For otherwise healthy women aged 45 or over who have menopause-associated symptoms, NICE recommends that perimenopause is usually identified from symptoms and menstrual changes rather than laboratory testing.

A “normal” hormone result does not necessarily rule out perimenopause.

There are circumstances in which blood tests may still be appropriate. A healthcare professional may consider follicle-stimulating hormone, commonly called FSH, testing when:

• You are aged 40 to 45 and have symptoms alongside a change in your menstrual cycle
• You are under 40 and menopause or premature ovarian insufficiency is suspected

Your GP may also recommend other investigations if your symptoms suggest another possible cause. These could include blood tests to assess thyroid function, anaemia or other aspects of your health. NICE makes clear that tests such as a full blood count or thyroid function test may be needed when a non-menopausal cause is suspected.

The aim is not simply to obtain a hormone number. It is to look at your symptoms, cycle history, age, medical history and wider health together.

Is hormone replacement therapy safe?

HRT can be an effective treatment for many symptoms of perimenopause and menopause, including hot flushes, night sweats, menopause-related sleep problems, vaginal dryness, anxiety and low mood. It can also help protect against osteoporosis.

Whether HRT is suitable for you depends on several factors, including:

• Your age
• Your symptoms
• Whether you still have your womb
• Your personal and family medical history
• Your risk of breast cancer or blood clots
• The type and route of HRT being considered

For many women under 60 who have troublesome menopause symptoms and are not at high risk of breast cancer or blood clots, the NHS states that the benefits of HRT are likely to outweigh the risks.

There is no single form of HRT.

Systemic HRT circulates around the body and may be provided through tablets, patches, gels or sprays. It is generally used when symptoms affect several parts of your physical or emotional health.

Local vaginal oestrogen is used specifically for vaginal and urinary symptoms such as dryness, soreness, discomfort during sex or recurring urinary problems. It is available in forms such as creams, pessaries or vaginal tablets.

The route matters. Oral HRT tablets can slightly increase the risk of blood clots, while oestrogen delivered through patches, gels or sprays does not increase that risk according to current NHS guidance. Combined HRT can slightly increase breast cancer risk, and that risk is influenced by the type of HRT and how long it is used.

Low-dose vaginal oestrogen has very little absorption into the rest of the body. NHS guidance states that it does not increase the risk of breast cancer or blood clots and can be used for longer periods. Women with a personal history of breast cancer should still discuss their individual circumstances with their medical team.

HRT is not the right choice for everyone, and you should never feel pushed either towards it or away from it.

There are also non-hormonal medicines, cognitive behavioural therapy and other forms of support available when HRT is unsuitable or simply not what you want.

A good consultation should give you the space to explore your symptoms, personal risk factors, preferences and the benefits and limitations of each option.

How long will perimenopause last?

This may be the most frustrating question because there is no precise timetable.

Menopause is reached when you have gone for 12 consecutive months without a period. The years leading up to that point are generally described as perimenopause. The stage after menopause is called postmenopause.

Current NHS information says that perimenopause and menopause symptoms commonly last for around seven to nine years, although they can continue for longer. The symptoms may also change during that time. Hot flushes may improve while other concerns, such as vaginal dryness, joint pain or changes in mood, continue or emerge later.

That does not mean you will feel the same way for seven to nine years.

Symptoms can come and go. Their intensity may change. Your health, stress levels, sleep, nutrition, movement, responsibilities and access to appropriate treatment can all influence how manageable life feels during this time.

You also do not have to wait until your periods stop before asking for support. HRT and other treatments can be considered during perimenopause while you are still having periods.

You do not have to work everything out alone

Many women spend months or years trying to push through because they are unsure whether their symptoms are “bad enough” to deserve support.

You do not need to reach a crisis point.

Medical care is important when you need assessment, diagnosis or treatment. Alongside that, you may also need help working out how to support yourself day to day.

That is where The SheVive Pathway™ can help.

The Pathway does not diagnose perimenopause or replace advice from your GP. It provides calm, gentle and sustainable support alongside any medical care or treatment you choose.

We begin by restoring calm and helping you understand what may be draining your physical, mental and emotional reserves. From there, we introduce realistic steps to support sleep, nutrition, movement, strength, boundaries and everyday wellbeing.

No complicated plan.

No expectation that you should overhaul your life while you are already exhausted.

Just practical support to help you rebuild the energy, head space and capacity to enjoy your life more fully.

Perimenopause can be an opportunity to pause and reassess what genuinely supports you. Before we ask more of ourselves, we restore calm and rebuild capacity.