Ovaries produce hormones such as oestrogen, progesterone and testosterone. We have oestrogen receptors in every part of our bodies, from our brain, heart, muscles, joints, vagina and bladder. We can experience symptoms when the amount of oestrogen in our bodies starts to decrease in the perimenopause, initially fluctuantly (up and down).

Majority of women will experience symptoms and 1 in 4 will report such significant symptoms which seriously affect their quality of life and their work life. These symptoms can last anything from 4 – 8 years and for some women, lasts well into their 60s. Some women will have no symptoms at all, their periods just stop.


Periods: Changes in the menstrual cycle is one of the earlier signs of perimenopause. Periods can become unpredictable: they can become heavier or lighter, they can last longer or become shorter, they can occur more frequently or miss some months. Periods can become more painful and some women can start experiencing symptoms of Premenstrual syndrome (PMS) or worsening of their PMS.

Helpful Tip: the Mirena IUS is very effective in controlling heavy menstrual bleeding and period pain as well as providing contraception. It can also be used as the progestogenic part of HRT.


A Hot flush is period of intense heat in the upper body, face and arms with flushing of the skin and profuse sweating, followed by chills. It is often accompanied by palpitations (unpleasant sensation of irregular or forceful beating of the heart) and a sense of anxiety. It can be triggered by small increases in core body temperature – caused by changes in the room temperature or triggers such as stress, rushing, alcohol intake, spicy foods or caffeine.

Helpful Tip: wear layers which you can remove easily to help you cool down

Night sweats are hot flushes which occur whilst sleeping, causing disturbed sleep by frequent waking, often drenched in sweat.

Helpful Tip: keep a window open at night or have a fan in your room to keep cool

Sleep problems: Night Sweats can cause disturbed sleep by frequent wakening. Sometimes, even without night sweats, some women have trouble getting to sleep, staying asleep, wake up earlier or generally have a poorer quality of sleep.

Helpful advice: Menopause and insomnia

Mood and Psychological symptoms can occur at times of hormonal fluctuation such as during the perimenopause, premenstrually or in the postnatal period. Depressed or low mood, feeling hopeless, tearfulness, mood swings, irritability, loss of patience, anxiety and panic attacks can be really distressing and often occurs out of the blue and completely out of character. These can lead to difficulty in coping, loss of confidence and loss of motivation.

Helpful Tip: Cognitive Behaviour Therapy (CBT) for Menopausal Symptoms helps people to develop practical ways of managing problems and provides new coping skills and useful strategies

Tiredness or exhaustion can result from poor sleep, low mood as well as reduced hormone levels.

Cognitive symptoms are common in menopause and can be caused by stress, tiredness, lack of sleep and depression. Oestrogen has key functions in brain health and is important for delivering glucose to the brain. As oestrogen levels drop, it can lead to a range of symptoms such as difficulty in concentration, difficulty in finding the right words, poor memory, being forgetful and brain fog (lack of clarity in thinking or “head feels full of cotton wool”). Some women are frightened that they may have dementia, especially if there is a family history but often, replacing the hormones early can improve brain fog.

Genital and urinary symptoms are often under reported by women, under diagnosed and under treated. The lack of oestrogen causes thinning of the genital and lower urinary tract tissues (urogenital atrophy or vulvovaginal atrophy). This thinning of the vaginal walls, reduction in the natural lubricants and loss of the stretchiness of the vagina can cause vaginal dryness, irritation, burning or itching. Sex can become uncomfortable or painful and the vulval skin and vagina can split and bleed more easily.

Oestrogen receptors are present in the bladder and the neck of the bladder, the urethra. The lack of oestrogen can cause the feeling of needing to pass urine more frequently, urgently, and/or irritation on passing urine. There may be more frequent urine infections or symptoms of urine infections without infection.

Helpful Tip: The best treatment for these genital and urinary symptoms is vaginal oestrogen (oestrogen which is inserted into the vagina via a tablet, cream, pessary or ring).  Non hormonal vaginal moisturisers (E.g. YES VM) used regularly, every 3 days, and lubricants used during sexual intercourse can also help relieve vaginal dryness.

Urinary incontinence and prolapse (bulging down of vaginal tissues) can get worse with menopause. Leaking urine is common but should not be accepted as normal. It is not something you just have to put up with as you get older.

Helpful Tip: NHS Squeezy App can help you with pelvic floor exercises. Consider a referral to a specialist pelvic floor physiotherapist.

Sexual Problems and reduced libido -  There may be lots of reasons for lack of sexual desire such being tired, poor sleep, low mood or irritability. It can also be due to low hormone levels, vaginal dryness and discomfort or pain during sex. Difficult relationships or a past history of trauma may also affect sexual desire and counselling may be helpful to explore psychological reasons for low sexual desire.

Helpful Tip: It is important to speak to your partner and explain how you are feeling. Look at ways which will help you remain close to your partner even if you don’t want to have sex. Male partners might find The Man Shed useful.


Joint pain and stiffness affects more than half of menopausal women, in particular, neck, wrists & shoulders. It can be worse after sudden loss of hormones for example after surgical removal of ovaries or with some breast cancer treatments. Backache, muscle aches and muscle heaviness can also be problematic.


Headaches, new or worsening of migraines may occur due to the changes in hormone levels in the perimenopause and can generally improve once hormone levels stabilise. Other symptoms such dizziness and palpitations (feeling of heart racing) can also occur even at rest.

Skin, hair and nails can become dry and more brittle with some women experiencing thinning of their hair. Some women can develop acne or an increase in facial hair. Skin can become thinner and lose their elasticity. Some women can feel a crawling sensation on their skin (formication).

 Helpful Tip: you may have to moisturise more frequently or use different, richer skin and hair products. Sun screen is important to prevent further damage to thinning skin.

Loss of fertility: For some, this may bring relief in no longer requiring contraception or risk of an unintended pregnancy. For others, the loss of their reproductive ability may cause sorrow, loss of purpose or regret, in particular if they have not had or wanted a pregnancy in the past or if they have experienced pregnancy loss or child bereavement.

Helpful Tip: women going through the perimenopause or have premature ovarian insufficiency will still need contraception. Contraception is no longer required after the age of 55

Weight Gain: Oestrogen is important for controlling metabolism and usually promotes fat storage around hips and thighs (Pear shape) which is important to support women’s bodies through pregnancy and breastfeeding. During perimenopause, lack of sleep, tiredness, joint stiffness and muscle aches can reduce the motivation to exercise or feel more fatigued after exercise. From the age of 40, there is about an 8% loss of muscle every 10 years (sarcopenia). Muscle burns more energy. Low mood can lead to comfort eating and excessive alcohol intact. The combination of the metabolic effects of lack of oestrogen as well as moving less and burning fewer calories can lead to excess fat, which is often stored around the abdomen and can lead to an increased risk of heart disease, insulin resistance and type 2 diabetes.

Helpful tip: Although lifting weights and resistance training is best for bones and muscle, do any form of activity which you enjoy like walking or dancing. It will benefit your heart, can lift your mood and can help you sleep better