Health Insights · Women's Health
Menopause and perimenopause: symptoms, HRT and staying well
Perimenopause often begins in the mid-forties, several years before periods stop, and the symptoms are frequently attributed to stress, thyroid problems or depression instead. Treatment decisions were skewed for two decades by a misreported study, and the picture now is considerably more reassuring than most people were told.
Arrange assessment promptly for
- any bleeding after 12 months without a period — this always needs investigating urgently
- bleeding between periods, or after sex
- periods becoming very heavy, prolonged, or coming more often than every 21 days
- unexplained weight loss, abdominal bloating or pelvic pain
- menopausal symptoms under the age of 45, and particularly under 40
Postmenopausal bleeding is the symptom that must never be put down to hormones without being investigated. Menopause before 40 — premature ovarian insufficiency — needs diagnosing and treating, because the long-term bone and heart consequences of going untreated are significant.
It is not only hot flushes
- changes to periods — usually the first sign, becoming irregular, heavier or lighter
- hot flushes and night sweats, disturbed sleep, and fatigue that sleep does not fix
- low mood, anxiety, irritability, and a distinct loss of confidence
- brain fog, difficulty concentrating, and word-finding problems
- joint and muscle aches, headaches, palpitations
- vaginal dryness, discomfort during sex, urinary urgency and recurrent urine infections
- reduced libido, and skin and hair changes
Many women are treated for depression or referred for other investigations before anyone asks about periods. If you are in your forties with several of these together, perimenopause is worth considering first.
Blood tests are usually not needed
Over the age of 45, menopause is diagnosed from symptoms — hormone levels fluctuate so much in perimenopause that a single test is often misleading and can be falsely reassuring. Testing is appropriate under 45, and particularly under 40. Do not let a normal blood test at 47 close the conversation.
HRT: the honest position
Hormone replacement therapy is the most effective treatment for hot flushes, night sweats and many other symptoms. For most women starting it under the age of 60, or within ten years of their last period, the benefits outweigh the risks.
- Oestrogen through the skin — patch, gel or spray — does not carry the small clot risk associated with tablets, and is preferred for many women.
- If you still have a womb you also need a progestogen to protect the lining.
- The breast cancer risk is real but small and depends on the type and duration. For context, it is of a similar order to the effect of drinking a couple of units of alcohol a day or being overweight. It is not increased by oestrogen-only HRT in women without a womb.
- HRT reduces the risk of osteoporosis and fractures, and started early does not increase heart disease risk.
- There is no arbitrary time limit. Continuing is a decision reviewed periodically, not something to be stopped at five years by rule.
Vaginal and urinary symptoms
These affect the majority of women, worsen over time without treatment, and are the symptoms women are least likely to raise. Vaginal oestrogen — a cream, pessary or ring — is highly effective, works locally with negligible absorption, can be used long term, can be used alongside systemic HRT, and is suitable for most women including many who cannot take other hormones. It also substantially reduces recurrent urine infections.
If HRT is not for you
- Cognitive behavioural therapy has good evidence for flushes, sleep and mood.
- Certain non-hormonal prescription medicines reduce flushes, and a newer class specifically licensed for vasomotor symptoms is now available.
- Regular exercise, particularly weight-bearing and resistance work, protects bone and helps mood and sleep.
- Reducing alcohol, caffeine and spicy food helps flushes for some; layered clothing and a cool bedroom help more.
- Isoflavones and black cohosh have weak and inconsistent evidence, and interact with some medicines — tell us if you take them.
You can still get pregnant
Fertility falls but does not vanish. Contraception is needed for two years after your last period if you are under 50, and one year if you are over 50. HRT is not contraception. This catches people out every year.
Book an appointment if you think you may be perimenopausal, you want to discuss HRT or review what you are on, you have vaginal or urinary symptoms, or you need a bone health assessment. We offer women's health consultations and blood testing 7 days a week, and arrange DEXA scanning through our CQC-registered partners.
Private menopause and HRT care in London
Perimenopause and menopause affect sleep, mood, periods and much more, and the right support makes a real difference. Our private women’s health clinic in London — or a private GP in East London to begin — offers unhurried assessment, discussion of HRT and non-hormonal options, and blood tests where they add value. Care is individualised and reviewed over time. Menopause care is provided at our private menopause service in Whitechapel, East London, with patients travelling from Canary Wharf, the City and Aldgate.
Menopause and perimenopause: symptoms, HRT and specialist care
Do I need blood tests to diagnose menopause?
Often not — in women over 45 the diagnosis is usually made on symptoms. Blood tests can help in younger women or unclear cases.
Can I start HRT privately?
Yes — after an assessment of your symptoms, history and any risks, we discuss whether HRT is suitable and which type fits you.
Can I get a same-day menopause appointment?
Yes — same-day private appointments are available most days at our Whitechapel clinic, no referral needed.
What if HRT is not right for me?
We also discuss non-hormonal treatments and lifestyle approaches, and review your plan over time.
Where can I get private menopause care near me in East London?
Our private menopause clinic in London at Whitechapel, near Canary Wharf, offers assessment, HRT and follow-up without a referral.
Do I need blood tests before starting HRT?
Not always, but a same-day private GP can arrange private blood tests in London where helpful and discuss the right HRT for you.
Women's health appointments, 7 days a week
Unhurried consultations and same-week reviews on Whitechapel Road.