Menopause and perimenopause are a natural part of life, happening when periods change and eventually stop due to lower hormone levels, and they usually affect women between 45 and 55 though they can happen earlier. The NHS is clear that this affects anyone who has periods.

The symptom people expect is hot flushes. The symptoms that actually disrupt life most often are the ones nobody warned them about: broken sleep, mood changes, memory and concentration problems. Those are frequently attributed to stress, overwork or getting older, and treated as personal failings rather than as a recognised part of the same process.

Key takeaways

  • It usually happens between 45 and 55, but can happen earlier.
  • A change to periods is usually the first sign of perimenopause, becoming more or less frequent, heavier or lighter.
  • Symptoms go well beyond hot flushes, including sleep problems, mood changes, poor memory and brain fog, weight gain and vaginal symptoms.
  • The symptoms compound each other. Mood and memory problems feel worse when sleep is already disrupted by night sweats.
  • Oestrogen is the main type of HRT, available as tablets, patches, spray or gel.
  • If you have not had a hysterectomy, progestogen is essential alongside oestrogen to protect the womb.
  • Local oestrogen treats vaginal and urinary symptoms as a cream or pessary.
  • Testosterone is used for low libido in some women, on specialist prescription.

What are the symptoms, really?

A cluster that reaches well past hot flushes, and which often does not get recognised as one thing.

The NHS lists what to expect:

  • Changes to periods, usually the first sign of perimenopause. They may come more or less often, and bleeding may get heavier or lighter, until eventually they stop.
  • Hot flushes and night sweats, where the face, neck and chest suddenly feel very hot or cold. These can cause heavy sweating, palpitations, anxiety or dizziness, and can last several minutes, by day or night.
  • Sleep problems, difficulty getting to sleep or staying asleep, which the NHS notes may be worse if you also have night sweats.
  • Mood changes, poor memory and brain fog, including mood swings, low mood or depression, and problems with memory or concentration.
  • Weight gain, commonly around the stomach and upper body.
  • Vaginal problems, including dryness and soreness.

The compounding effect is worth naming, because the NHS points at it directly: mood and memory symptoms may feel worse if you have sleep problems and feel very tired. So a woman whose nights are broken by sweats is not experiencing three separate problems; she is experiencing one process with a chain of consequences.

Hot flushes deserve a local note. In a climate where feeling hot is unremarkable for half the year, and where air conditioning masks a lot, the distinctive character of a flush, sudden, internal, often with palpitations or anxiety, is what distinguishes it from simply being warm.

When should I talk to someone?

When symptoms are affecting your life, rather than when you think you have crossed some threshold.

The NHS framing is that if you have symptoms of perimenopause or menopause, you should talk to a doctor, nurse or pharmacist about HRT and the other options available. There is no requirement to have stopped having periods, and perimenopause can begin years before that.

The practical trigger to seek help is impact: sleep that is not restoring you, mood changes affecting relationships or work, memory problems you are covering for, or symptoms you have started planning your life around.

One reason to raise it explicitly rather than wait: several menopause symptoms overlap with other treatable conditions. Fatigue, low mood, weight change and poor concentration are also how thyroid disease presents, which is covered in thyroid problems, and both are diagnosed by taking the whole picture rather than one symptom.

What does HRT actually consist of?

Oestrogen as the main component, with progestogen alongside it for most women, and the delivery route chosen to suit you.

Oestrogen is the main type of HRT and can help manage symptoms. It can be taken as tablets, or used as patches, spray or gel. That range matters, because the route affects convenience and suitability, and a woman who cannot take one form may do well on another.

Progestogen is the part most often misunderstood. The NHS states it directly: if you are taking oestrogen and have not had a hysterectomy, it is important to take progestogen to protect your womb. This is not an optional addition or a second-line extra. It can be taken as tablets, as part of a combined patch, or as the hormonal coil.

The type of HRT you are offered depends on whether you still have periods, and on whether you have had your womb removed. That is why HRT is not a single product and why what suited a friend may not suit you.

Local oestrogen is used as a cream or pessary to treat vaginal dryness and soreness, or urinary symptoms, after the menopause. This is a distinct treatment from systemic HRT and is often the right answer when the vaginal and urinary symptoms are the main problem.

Testosterone gel or cream can help improve low libido for some women, and may be available on prescription from a menopause specialist. The NHS is careful to note that low libido around menopause has many possible causes, including relationship difficulties, how you feel about yourself, and physical discomfort. Treating it as purely hormonal can miss the actual reason.

What if HRT is not suitable for me?

There are other options, and the conversation is worth having rather than assuming the answer.

The NHS framing is to discuss HRT and other options available, which is deliberate. Some women cannot take HRT, some prefer not to, and some need particular symptoms addressed rather than the whole picture.

Non-hormonal approaches exist for hot flushes and for mood and sleep, and local vaginal treatment can be used in circumstances where systemic HRT is not appropriate. Whether any of these fits depends on your history, which is a clinical assessment rather than a search result.

Does living here change anything practical?

Mainly continuity of care and storage, both of which are ordinary problems with ordinary solutions.

Continuity. Many women here started HRT in another country. Treatment benefits from review, and formulations available locally may differ from the ones you began on. The reliable way to continue is by active ingredient and dose rather than by brand, which the ingredients index is built for.

Storage. Patches and gels are affected by heat like everything else, and most medicines here are licensed for storage below 25°C. That is covered in storing medicine in a Gulf summer.

Bone health. Falling oestrogen affects bone density, which is why postmenopausal osteoporosis is a recognised consequence rather than an unrelated condition. It is worth asking about at the same appointment.

Do and don’t

Do:

  • Raise symptoms when they affect your life, not when periods have stopped.
  • Mention sleep, mood and memory, not just hot flushes.
  • Take progestogen alongside oestrogen if you still have your womb.
  • Ask about local vaginal treatment if those are your main symptoms.
  • Match a continuing prescription by active ingredient and dose.
  • Ask about bone health at the same time.

Don’t:

  • Don’t assume symptoms must be stress or ageing.
  • Don’t take oestrogen alone without advice if you have not had a hysterectomy.
  • Don’t assume what suited someone else will suit you.
  • Don’t dismiss low libido as purely hormonal, or purely not.
  • Don’t stop HRT abruptly without discussing it.

Frequently asked questions

At what age does this start? Menopause usually affects women between 45 and 55, but it can happen earlier. Perimenopause, the period of changing hormones before periods stop, can begin several years before menopause itself.

Why is progestogen necessary? Because oestrogen alone stimulates the lining of the womb. The NHS states that if you are taking oestrogen and have not had a hysterectomy, it is important to take progestogen to protect your womb. Women who have had a hysterectomy generally do not need it.

Is HRT only tablets? No. Oestrogen can be taken as tablets or used as patches, spray or gel, and progestogen as tablets, a combined patch or the hormonal coil. Local oestrogen comes as a cream or pessary. The route is part of what is tailored to you.

Where to go next

The menopause and HRT and hormone therapy categories list what is stocked here, and menopausal vasomotor symptoms approaches it from the indication. The ingredients index is the reliable way to match a prescription started in another country.

MedicForce option: our hormone listings show active ingredient, dose and formulation, which are the three details needed to continue an existing HRT prescription accurately.