Menopause is typically confirmed when you have experienced 12 consecutive months without a menstrual period.

Perimenopause is the transitional stage before menopause which can be years, during which hormonal changes occur and menstrual cycles may become irregular. If you’re experiencing symptoms include changes in the normal pattern of periods, hot flushes, night sweats, vaginal atrophy, reduced libido, joint pains, difficulty sleeping, mood changes or other menopausal symptoms, it could indicate perimenopause. No one test or sign is enough to determine if you’ve entered perimenopause. We are able to tell if you are in perimenopause or menopause based on your age, symptoms (use the LGP Menopause Symptoms Checker) and how often you have periods.

To confirm the diagnosis we will evaluate your symptoms, discuss your medical history, and may order tests or hormone level assessments if necessary. This will help provide a clear understanding of your hormonal status and guide appropriate management options.

Perimenopause symptoms, are they different from menopause?

Yes, perimenopause symptoms can be different from menopause symptoms. Perimenopause is the transitional phase leading up to menopause, during which hormonal fluctuations occur. During perimenopause, you may experience irregular menstrual cycles, changes in the frequency and flow of your periods, and symptoms such as hot flushes, night sweats, mood swings, vaginal dryness, and sleep disturbances.

Menopause, on the other hand, is the point when it has been at least one year since your last menstrual period. At this stage, menstrual periods have ceased, and symptoms like hot flashes and night sweats may continue but usually become less frequent over time. It’s important to note that perimenopause and menopause are part of the same natural biological process, but they represent different stages with their own characteristic symptoms.

Is premenopausal the same as perimenopausal?

No, premenopausal and perimenopausal are not the same. Premenopausal refers to the period of time before menopause when a woman’s menstrual cycles are still regular, and she is still ovulating. Perimenopause, on the other hand, is the transitional phase leading up to menopause. During perimenopause, hormonal changes occur, and menstrual cycles may become irregular, with symptoms such as hot flashes, mood swings, and changes in menstrual flow. It is a gradual process that can last for several years before menopause is reached.

Menopause affects every woman differently. You may have no symptoms at all, or they might be brief and short-lived. For some women they are severe and distressing. Hormones affect every cell in our body so when they are fluctuating leading up to the menopause (perimenopause), this can cause symptoms all over our body, and may include ones you didn’t realise might be due to your hormones, until now. This is why the LGP Menopause Symptom Checker is a great and simple way to measure and track your symptoms.

Symptoms can be split into:

• vasomotor (hot flushes, night sweats),
• psychological (mood changes, difficulty sleeping, lack of interest in sex),
• physical ( joint and muscle pain,
• vaginal/bladder symptoms (dry vagina, frequent urine infections).

You can still get menopause symptoms if you have had a hysterectomy (an operation to remove your womb). Other natural changes as you age can be intensified by menopause. For example, you may lose some muscle strength and have a higher risk of conditions such as osteoporosis and heart disease but these conditions are silent so you will not feel any symptoms. Hence we can assess your risk and screen you to give you an individualised plan to manage your health going forward.

No, vaginal atrophy is not exactly the same as vaginal dryness, although they are related. Vaginal atrophy is a term used to describe the thinning, inflammation, and drying of the vaginal walls that can occur during menopause. It is one of the genitourinary symptoms of menopause (GSM), which refers to various changes in the genital and urinary areas due to hormonal changes.

Vaginal dryness, on the other hand, specifically refers to the lack of moisture and lubrication in the vaginal area. Vaginal atrophy can contribute to vaginal dryness, but it also involves other changes such as decreased elasticity and increased vulnerability to irritation or pain during sexual activity. So, while vaginal dryness is one aspect of vaginal atrophy, the term “genitourinary symptoms of menopause” encompasses a broader range of changes that can affect the vaginal and urinary areas during menopause.

During perimenopause, hormone tests are generally not helpful because hormone levels fluctuate throughout the menstrual cycle, so you are unlikely to need tests. Also, if you are taking any hormonal treatments (for example, to treat heavy periods or contraception that affect your periods) it can be more difficult to know when you have reached menopause.

In women over 45, blood tests are not required to diagnose menopause and diagnosis is usually taken on symptoms alone.

You may be offered a blood test but only if:

• you are between 40 and 45 and have menopausal symptoms, including changes in your menstrual cycle (how often you have periods)
• you are under 40 and we suspect you are in menopause (also see premature menopause).

The blood test measures a hormone called FSH (follicle-stimulating hormone). FSH is found in
higher levels in menopause.

Some contraceptives affect your natural FSH levels. Therefore if we feel it it is necessary to take your FSH level

If you are taking a contraceptive containing oestrogen and progestogen (combined pill/ring/patch) we will ask you to stop the contraceptive for 6 weeks before we take the test
or high-dose progestogen (Depo injection) we will take just before your next injection when it is at its lowest level.

For some women of any age, it may make sense to test for other causes of symptoms that can mimic perimenopause, such as thyroid disease so it is important to discuss your symptoms, your menstrual cycle so we can see what you may need.

For women who seek help for their menopausal symptoms, HRT (hormone replacement therapy) is the most commonly prescribed treatment. HRT helps to relieve symptoms by replacing oestrogen levels that naturally fall in menopause. You can take HRT as tablets or through a patch or gel on your skin.

Although the majority of women usually benefit from taking a type of HRT, this is only one part of treatment for the menopause. Some women choose not to take HRT or cannot take HRT due to medical reasons and so there are alternative treatments available. These will be discussed with you.

We will discuss everything from lifestyle changes and the risks and benefits of HRT, to general health advice which will help manage long-term risks of osteoporosis and heart disease creating a holistic menopause management plan specifically for your individual circumstances.

Hormone Replacement Therapy (HRT) can have both positive effects and potential side effects. Some common side effects of HRT may include:

• Breast tenderness or swelling: Some women may experience increased breast sensitivity or swelling while on HRT.
• Spotting or breakthrough bleeding: HRT can cause irregular bleeding or spotting, especially during the early stages of treatment. This usually resolves over time.
• Nausea: Some women may experience mild nausea when starting HRT, although this side effect typically subsides.
• Headaches: HRT can occasionally trigger headaches or migraines in some women.
• Fluid retention: Some women may experience fluid retention, leading to bloating or swelling in the hands, feet, or ankles.
• Mood changes: HRT may influence mood in some individuals, causing changes such as irritability, mood swings, or mild depression. However, for many women, HRT can actually improve mood and overall well-being.
• Digestive issues: HRT can occasionally cause gastrointestinal symptoms like indigestion, bloating, or stomach discomfort.

It’s important to note that not all women will experience these side effects, and their severity and duration can vary. We will discuss potential side effects with you before starting HRT, as we will provide personalised advice and guidance based on your individual circumstances. Regular monitoring and follow-up with us can help address any concerns and ensure optimal treatment outcomes.

It is important to understand the benefits and risks when deciding whether to have hormone replacement therapy (HRT). Studies in the early 2000’s were published highlighting the potential risks and as a result, some women and doctors have been reluctant to use HRT. More recently published findings show that although not entirely risk free, it remains the most effective solution for the relief of menopausal symptoms and is also effective for the prevention of osteoporosis and in certain age groups provide protection against heart disease and possibly even dementia (further research needed).
So, recent evidence says that the risks of HRT are small and are usually outweighed by the benefits.

The risks are usually very small, and depend on the type of HRT you take, how long you take it and your own health risks.

Breast cancer risk

There is little or no change in the risk of breast cancer if you take oestrogen-only HRT.
Combined HRT (oestrogen and progestogen) may be associated with a small increased risk of developing breast cancer.

The increased risk is related to how long you take HRT, and it falls after you stop taking it.

Young women (under 51 years) taking HRT do not have a greater risk of breast cancer

Blood clots

The evidence shows that:

• Taking oral HRT (tablets) can very slightly increase your risk of blood clots
• There is no increased risk with transdermal HRT (patches or gels)

Heart disease and strokes

When HRT is started before the age of 60 years, it does not significantly increase the risk of cardiovascular disease (including heart disease and strokes) and may actually reduce your risk.

Taking HRT tablets is associated with a small increase in the risk of stroke, but the risk of stroke for women under age 60 is generally very low, so the overall risk is still small.

We will discuss your own personal risk as this will be depend on your own individual circumstances.

The term ‘bio-identical’ literally means the product has the same molecular structure as the hormones produced in the body;

Regulated bioidentical hormones (rBHRT) – these are what might be referred to as Body Identical HRT – they are hormones derived from plants and produced by pharmaceutical companies and undergo strictest testing and regulations. These regulated HRT products are the only products that are available on the NHS and mainstream scientific, clinical and regulatory bodies in women’s health advise. We will prescribe for you.

Compounded bioidentical hormones (cBHRT) are produced by a compounding pharmacy for private clinics and here the term ‘bio-identical hormone therapy’ is often misused and is widely marketed as a ‘natural’ alternative to conventional HRT. This type of HRT is not regulated with the rigorous licensing standards which apply to normal pharmaceutical products. There is no evidence to support this way of testing the compounds and no regulations to support their safety in the UK. A further limitation is that quite worryingly the transdermal (cream) micronised progesterone may not protect your uterine lining. Mainstream scientific, clinical and regulatory bodies in women’s health advise against the use of these products. Additionally, this costly practice of complex blood and saliva tests and the compounded products are significantly more expensive than the cost of private or NHS prescriptions. Paying more does not mean better. We do not prescribe these.

Testosterone is an important female hormone and levels naturally decline throughout a woman’s lifespan but particularly profound after a surgical and medical menopause and premature ovarian insufficiency. Testosterone deficiency can contribute to a reduction in your libido, sexual arousal but also a reduction in energy levels, cognitive function often described as ‘brain fog’ and joint pains. We can prescribe you testosterone if appropriate.

Sources of advice and support

• Menopause Matters
www.menopausematters.co.uk

An award winning, independent website providing up-to-date, accurate information about the menopause, menopausal symptoms and treatment options.

• The Menopause Exchange, 0208 420 7245
www.menopause-exchange.co.uk
The Menopause Exchange gives independent advice about the menopause, midlife and post-menopausal health

• Women’s Health Concern, 01628 890 199
www.womens-health-concern.org
Offer unbiased information – by telephone, email, printed factsheets, online and through symposia, seminars, meetings and our workshop Living and loving well beyond 40…!

• National Institute Clinical Evidence (NICE) for patients
www.nice.org.uk/guidance/ng23/ifp/chapter/menopause

• NHS Choices
Menopause – NHS

• Balance Menopause
Balance Menopause
Providing independentproviding evidence-based and unbiased information content and information

• Rock my Menopause
https://rockmymenopause.com/

Premature Ovarian Insufficiency (POI) or Premature Menopause

• The Daisy Network information and support to women diagnosed with Premature Ovarian Insufficiency (POI), also known as Premature Menopause.
https://www.daisynetwork.org/

• Fertility Friends – an online infertility community in the UK
www.fertilityfriends.co.uk

• The Infertility Network UK, 0800 008 7464
www.infertilitynetworkuk.com