You might have noticed that something just feels different lately. Your sleep isn’t as good as it used to be. You feel more anxious or irritable for no obvious reason. Your concentration isn’t what it was, and you find yourself more forgetful at work. Maybe your periods have changed – or maybe they haven’t at all – but something is definitely off.
If you’re in your late 30s to 40s, there’s a good chance these changes are due to perimenopause.
Perimenopause is the phase leading up to menopause when your hormone levels start to fluctuate and gradually decline. It’s not sudden – this phase can last several years. Because symptoms can feel very different from what people traditionally associate with ‘the menopause,’ many women don’t realise what’s happening.
Common symptoms include brain fog, low mood, poor sleep, joint aches, heart palpitations, reduced confidence, and changes in libido – all of which are recognised and treatable. You don’t have to wait until your periods stop to seek help. If this sounds familiar, it’s worth talking to someone who understands what you’re going through.”
Hormone fluctuations during perimenopause can affect many areas of health, which is why symptoms are so varied and sometimes surprising.
The following are recognised features of perimenopause and menopause. This list is not exhaustive – if something feels different and you are in your 40s or 50s, it is worth speaking to a specialist.
Many women are initially treated for depression or anxiety without consideration of hormonal causes. If you have been prescribed antidepressants and have not had a conversation about menopause, it may be worth raising this with your clinician.
Perimenopause is primarily a clinical diagnosis – meaning it is based on your symptoms and age, not on a single blood test. This can surprise many women, especially if a GP has told them that “normal” blood results mean nothing is wrong.
Hormone levels fluctuate significantly during perimenopause, so a single blood test can appear normal even when symptoms are significant. National guidance from NICE states that in women over 45, perimenopause should be diagnosed based on symptoms alone.
Blood tests can be useful in certain situations – for example, in younger women where perimenopause is less expected, or to rule out other causes such as thyroid problems or anaemia. At The York Clinic, we use blood tests when clinically helpful – not as a barrier to diagnosis or treatment.
Perimenopause is the transitional phase when hormone levels begin to fluctuate and gradually decline – typically starting in the early 40s, though sometimes earlier.
Menopause is the point at which a woman has not had a period for 12 consecutive months (for women over 50; for women under 50, it is typically two years without a period). The average age of menopause in the UK is 51, though it can happen earlier or later.
Post-menopause refers to all the years after menopause. Symptoms can occur during perimenopause, menopause, and post-menopause, and they do not automatically stop once periods have finished.
Post-menopause begins 12 months after your last period – and lasts for the rest of your life. For many women, it brings a sense of relief – the uncertainty of perimenopause is over, periods have stopped, and some of the more acute symptoms settle. For others, symptoms may continue for years, and new ones can appear that are not always recognised as menopause-related.
The key message about post-menopause is this – it is never too late to discuss your symptoms or explore treatment options. While the potential benefits may vary depending on age and individual circumstances, it can still be worthwhile to seek personalised advice.
Falling hormone levels continue to affect your body after menopause – impacting bones, heart, brain, skin, and bladder. Even in your 60s, 70s, or beyond, treatment options may help improve quality of life. If you have been told you are “too old” for HRT or have “missed the window,” this guidance may not reflect current evidence.
Many women notice changes in urinary and vaginal health after menopause – such as needing to urinate urgently, going more frequently, especially at night, discomfort or burning when passing urine, or recurrent urinary tract infections. Sexual changes are also common, including reduced sensation, lower arousal, difficulty achieving orgasm, vaginal dryness, decreased libido, subtle changes in genital tissue such as shrinking of the labia or clitoris, and vulval soreness – which is often mistaken for skin infections such as thrush. These changes are often caused by falling oestrogen levels, rather than being an inevitable part of ageing.
The good news is that these symptoms are treatable. Low-dose, localised vaginal oestrogen applied directly to the affected area is one of the safest and most effective options, helping to improve urinary comfort, sexual function, and overall quality of life. It is generally suitable for most women, including those who cannot take systemic HRT. Non-hormonal options are also available if preferred.
If you’ve been living with these symptoms, it’s worth seeking help. Many women discover that a single consultation can clarify what might help, even if symptoms have been ongoing for years. At The York Clinic, we assess your individual situation and work with you to find the approach that fits your needs – whether that’s localised oestrogen, systemic HRT started later, or non-hormonal treatments.
It’s never too late to explore your options.
