Many women expect perimenopause to begin with hot flushes and periods simply stopping. In reality, the transition can be much less tidy.
It can start with changes that do not seem “hormonal”
Some women first notice sleep disruption, anxiety, reduced concentration, mood changes, headaches, palpitations, vaginal discomfort or a change in the way they tolerate stress. Periods may become heavier, lighter, closer together or further apart before eventually stopping.
Why symptoms can be confusing
Many of these symptoms overlap with thyroid disease, anaemia, depression, anxiety, medication effects and other medical conditions. That is why a consultation should consider the whole clinical picture rather than automatically labelling every midlife symptom as menopause.
Do hormone blood tests always help?
Not necessarily. Hormone levels can fluctuate significantly during perimenopause. In many women, age, menstrual pattern and symptom history are more useful than one isolated hormone result. Blood tests may still be appropriate when another condition is being considered or when the presentation is less typical.
What can treatment look like?
Management is individual. It may include lifestyle changes, targeted treatment for specific symptoms, non-hormonal options or menopausal hormone therapy where appropriate after considering personal risks and benefits.
Perimenopause is not simply a reproductive event. It can affect sleep, mental wellbeing, sexual health, urinary symptoms and day-to-day functioning, which is why primary care can be a useful place to start.