Perimenopause is the transition leading up to menopause, during which hormone levels fluctuate and menstrual cycles gradually change.

For many women, perimenopause begins during their 40s, although the timing and experience vary from person to person. Some women notice changes to the timing, frequency or flow of their periods, while others first notice symptoms such as hot flushes, disrupted sleep or changes in mood.

Perimenopause can last for several years before menopause.

Menopause is the point in time when a woman has not had a menstrual period for 12 consecutive months.

The years leading up to menopause are known as perimenopause, and the years following menopause are referred to as post menopause.

For some women, symptoms associated with hormonal change can begin during perimenopause and continue for some time after periods have stopped.

Perimenopause is often identified by considering a woman's age, menstrual history, symptoms and overall health.

Many women first notice that their menstrual cycle is changing. Periods may become less predictable, closer together or further apart, or change in flow.

Other symptoms that may occur during the menopausal transition include:

• hot flushes or night sweats

• disrupted sleep

• changes in vaginal comfort, or sexual wellbeing

• changes in mood

• difficulties with concentration or memory

• changes in how well you feel able to cope with everyday demands.

Not every woman experiences the same symptoms, and not every symptom occurring during midlife is caused by perimenopause. A medical assessment can help determine whether hormonal changes may be contributing to the way you feel.

Perimenopause most commonly begins during a woman's 40s, although some women experience hormonal changes earlier or later.

The timing of menopause varies, and factors such as surgery or certain medical treatments can influence when menopause occurs.

If you are younger than expected for perimenopause and are experiencing symptoms or changes to your menstrual cycle, it may be important to consider other possible causes as part of your assessment.

Yes.

Perimenopause occurs before menopause, so most women experiencing perimenopause are still having periods.

One of the earliest signs can be a change in your usual menstrual pattern. However, some women experience other symptoms such as hot flushes before noticing significant changes to their cycle.

You do not need to wait until your periods have stopped before seeking advice if symptoms are affecting your quality of life.

The experience of perimenopause and menopause varies considerably between women.

Some of the more recognisable symptoms associated with hormonal change include:

• hot flushes

• night sweats

• disrupted sleep

• vaginal dryness or discomfort

• changes in bladder symptoms

• changes in sexual wellbeing.

Some women also notice changes in mood, concentration, memory or their ability to cope with everyday demands.

These symptoms can have other causes, however. A careful assessment considers your symptoms in the context of your age, menstrual history, medical history and overall health.

Hormonal changes during perimenopause can contribute to changes in mood, sleep, concentration and wellbeing.

However, symptoms such as anxiety, fatigue and brain fog are common and can have many possible causes.

Rather than assuming that these symptoms are caused by hormones alone, your doctor will consider your stage of life, menstrual history, other symptoms and overall health. Sometimes hormonal changes are an important contributing factor; in other situations, further assessment or investigation may be appropriate.

For many women over 45, hormone blood tests are not routinely required to diagnose perimenopause.

Hormone levels fluctuate during the menopausal transition and a single blood test may not accurately reflect what is happening over time.

Your doctor will consider your age, menstrual pattern and symptoms when assessing whether you may be experiencing perimenopause.

Blood tests may sometimes be appropriate depending on your age, symptoms and individual circumstances, particularly if there are other possible explanations for the symptoms you are experiencing.

A menopause consultation provides an opportunity to discuss the changes you have been experiencing and how they are affecting your health and quality of life.

Your doctor may discuss:

• changes to your menstrual cycle

• symptoms such as hot flushes or disrupted sleep

• mood and emotional wellbeing

• sexual and vaginal health

• your medical and family history

• lifestyle and other factors affecting your health

• whether other health concerns should be considered.

Together, you can discuss the treatment and management options that are appropriate for your individual circumstances.

Treatment depends on your symptoms, stage of life, medical history and personal preferences.

Options may include hormonal contraceptives, menopausal hormone therapy (MHT), non-hormonal treatments, vaginal therapies and lifestyle approaches.

Your doctor can discuss the potential benefits and risks of different treatments and help you decide which options may be appropriate for you.

There is no single approach that is right for every woman.

Menopausal hormone therapy can be an effective treatment for many women, but it is not appropriate for everyone.

Whether MHT is suitable depends on factors including your symptoms, age, stage of menopause and medical history.

Your doctor will discuss your individual circumstances and help you understand the potential benefits and risks of treatment.

If a woman has previous significant medical conditions such as blood clots (eg deep vein thrombosis or pulmonary embolism) or a history of cancer, they will commonly require discussion about additional specialist advice and input into their management plan. 

No.

You do not need to wait until your symptoms become severe or until your periods have stopped before discussing perimenopause or menopause with a doctor.

If changes associated with the menopausal transition are affecting your sleep, work, relationships, physical comfort or overall quality of life, it may be helpful to seek advice.

You do not need to know whether your symptoms are related to perimenopause before booking an appointment.

Perimenopause can cause significant changes and can affect women in different ways. However, many symptoms that occur during midlife - including fatigue, anxiety, poor sleep, changes in mood and difficulties with concentration - can also have other contributing factors.

Part of a menopause consultation is considering your symptoms in the context of your age, menstrual history, medical history and overall health, rather than assuming that hormones are the explanation for every change.

A thoughtful assessment can help determine whether hormonal changes may be contributing to the way you feel, whether other factors should also be considered, and what options are available to support your health and wellbeing.