Perimenopause Is Not Something You Should Put Up With

Most women in the UK will spend years experiencing perimenopause symptoms before anyone tells them what is happening. They are not imagining it. They are not just stressed. They are not “getting older and need to deal with it.” They are going through a significant hormonal transition that affects the brain, the body, the joints, the mood, the sleep, and the ability to function normally, and there is effective medical treatment available.

An estimated 13 million women in the UK are currently perimenopausal or menopausal. That is roughly one third of the entire female population. Despite this, research consistently shows that women wait years before seeking help, and many never receive a proper assessment at all.

This is not a minor inconvenience. It is a medical condition with medical solutions. And it starts much earlier than most people think.

What Is Perimenopause and When Does It Start?

Perimenopause is the transitional phase leading up to menopause. It is the period during which oestrogen and progesterone levels begin to fluctuate unpredictably, producing a wide range of physical and psychological symptoms. Menopause itself is defined as 12 consecutive months without a period. The average age of menopause in the UK is 51. But perimenopause typically begins much earlier.

Most women start experiencing perimenopausal symptoms in their early to mid-40s. Some notice changes from their mid-30s. Around one in 100 women experience menopause before the age of 40, known as premature ovarian insufficiency, and those women may begin perimenopause even younger.

The perimenopause can last anywhere from a few months to over a decade. On average, symptoms persist for around five to seven years from the point periods become irregular, though around one in ten women experience them for up to 12 years.

This means that a woman who starts experiencing symptoms at 42 may still be managing them at 52 or beyond. That is a significant portion of her working and personal life spent dealing with symptoms that are entirely treatable.

The Symptoms Are Real, They Are Common, and There Are More Than You Think

When most people think of perimenopause, they think of hot flushes. That is one symptom out of more than 30 recognised symptoms associated with this transition. The reality is that perimenopause affects virtually every system in the body, and many women do not recognise their symptoms as hormonal because they do not match the narrow public image of menopause.

Vasomotor symptoms

Hot flushes and night sweats are the most well-known symptoms, caused by fluctuating oestrogen levels affecting the body’s temperature regulation. They can range from mildly uncomfortable to completely disruptive, waking women multiple times a night and making it impossible to function normally during the day.

Sleep disturbance

This is one of the most commonly reported and most debilitating symptoms. Data from the Fawcett Society’s 2022 survey found that problems sleeping and exhaustion was the single most difficult perimenopause symptom, with nearly 85% of women reporting it as very or somewhat difficult.

Cognitive changes

Brain fog, difficulty concentrating, poor memory, and word-finding problems affect more than 75% of women over 40 experiencing perimenopausal symptoms. These are not imagined. Oestrogen plays a direct role in cognitive function, and its decline produces measurable changes in brain performance.

Mood changes and mental health

Anxiety, low mood, irritability, mood swings, and feelings of being overwhelmed are among the most common and most under-recognised perimenopause symptoms. Mood changes affect over 80% of women in their 40s and 50s experiencing this transition. Many women are misdiagnosed with depression or anxiety disorders and prescribed antidepressants when their symptoms are actually driven by hormonal changes that respond to hormonal treatment.

Musculoskeletal symptoms

Joint pain, muscle stiffness, and aching are increasingly recognised as perimenopause symptoms. They show a clear increase with age, affecting over 74% of women in their 40s and nearly 80% in their 50s. Women are frequently told this is “just ageing” when it is directly linked to declining oestrogen, which plays a protective role in joint and bone health.

Genitourinary symptoms

Vaginal dryness, discomfort during sex, recurrent urinary tract infections, and urinary urgency are caused by thinning of the vaginal and urethral tissues as oestrogen declines. These symptoms tend to worsen over time without treatment and do not resolve on their own after menopause.

Other symptoms

Weight gain (particularly around the abdomen), heart palpitations, headaches, changes in skin and hair, reduced libido, tinnitus, and digestive changes can all be driven by the hormonal shifts of perimenopause. On average, women experience around eight different symptoms. Every woman’s experience is different, and no two presentations are the same.

Why You Should Not Just Live With It

There is a persistent and damaging idea that perimenopause is simply something women must endure. That it is a natural process and therefore does not require medical intervention. This is wrong, and it causes real harm.

Perimenopause is natural in the same way that high blood pressure or type 2 diabetes can develop naturally with age. The fact that something is a normal biological process does not mean it should go untreated when it causes significant symptoms and affects quality of life.

The consequences of leaving perimenopause symptoms unmanaged are not trivial. Three quarters of women aged 50 to 64 report that the menopause has affected their lives. Over two thirds of working women between 40 and 60 with symptoms say it negatively affects them at work. Almost a quarter of women consider reducing their working hours or leaving their jobs entirely because of unmanaged symptoms. Research from BUPA estimates that nearly 900,000 women in the UK have left their jobs because of menopausal symptoms.

Beyond the impact on work and daily life, untreated perimenopause has long-term health consequences. Declining oestrogen increases the risk of osteoporosis, cardiovascular disease, and genitourinary deterioration. These are not just quality-of-life issues. They are medical risks that can be mitigated with appropriate treatment started at the right time.

There is also a mental health dimension that cannot be ignored. Women aged 50 to 54 have the highest suicide rate of any female age group in the UK. While the causes are complex, the overlap with peak menopause symptoms is not coincidental. Women who are struggling with severe perimenopausal symptoms deserve medical attention, not dismissal.

How a GP Can Help

This is where many women hit a wall. Research shows that 45% of women never speak to their GP about their perimenopause symptoms. Of those who do, nearly a third say it took multiple appointments before their GP recognised what was happening. Over 40% of women with five or more severe symptoms reported the same experience.

This is not acceptable. Perimenopause should be identified clinically, based on symptoms and menstrual history, without unnecessary delays. The updated NICE guideline (NG23, 2024) is clear on this point. For women aged 45 and over with typical symptoms, perimenopause should be diagnosed without blood tests. The diagnosis is clinical. A GP who understands perimenopause should be able to identify it, discuss treatment options, and initiate management in a single consultation.

Here is what a knowledgeable GP can do for you.

Accurate diagnosis

A thorough clinical assessment covering your symptoms, menstrual cycle changes, medical history, and family history. For women under 45, blood tests including FSH levels may be used to support the diagnosis. For women 45 and over, NICE guidance states that laboratory tests are not needed.

Hormone replacement therapy (HRT)

HRT remains the most effective treatment for vasomotor symptoms and is recommended by NICE as a first-line option. It replaces the oestrogen (and, where needed, progesterone) that your body is no longer producing consistently. Modern HRT is available in multiple forms including patches, gels, sprays, and tablets, and can be tailored to your individual needs, medical history, and preferences. The risks of HRT have been significantly overstated for decades, and NICE now recommends that the benefits and risks should be discussed openly so that women can make informed decisions.

Treatment for specific symptoms

Vaginal oestrogen for genitourinary symptoms, testosterone for reduced libido where appropriate, and cognitive behavioural therapy (CBT) for sleep problems and mood symptoms associated with vasomotor changes. A good GP will not offer a one-size-fits-all approach but will tailor treatment to your specific symptoms.

Ruling out other conditions

Many perimenopause symptoms overlap with thyroid disorders, iron deficiency, vitamin D deficiency, anxiety, depression, and other conditions. A proper assessment includes considering and testing for these where appropriate, so that nothing is missed and treatment is targeted correctly.

Ongoing review

Perimenopause is not a single-appointment condition. Symptoms change over time, and treatment may need adjusting. Regular review ensures that your management plan continues to work as your hormone levels and symptoms evolve.

Referral when needed

If symptoms are complex, if there are contraindications to standard treatments, or if initial management is not working, a GP can refer you to a specialist menopause clinic or gynaecologist for further assessment.

When to See a Doctor

You do not need to wait for a specific trigger or a certain number of symptoms before seeking help. If you are experiencing symptoms that are affecting your quality of life, your sleep, your mood, your ability to work, or your relationships, that is reason enough.

Specifically, consider booking an appointment if you are experiencing any of the following.

Periods that have become irregular, heavier, lighter, or more frequent than usual. Hot flushes or night sweats that disrupt your sleep or daily life. Persistent low mood, anxiety, or irritability that is new or worsening. Difficulty sleeping that does not improve with standard sleep hygiene. Brain fog, memory problems, or difficulty concentrating at work. Joint pain or muscle stiffness that has no other obvious cause. Vaginal dryness, discomfort during sex, or recurrent urinary tract infections. Heart palpitations that have been investigated and found to have no cardiac cause. Any combination of these symptoms, particularly if you are in your 40s or have a family history of early menopause.

If you are under 40 and experiencing these symptoms, it is especially important to seek medical advice promptly, as premature ovarian insufficiency requires early diagnosis and management to protect long-term bone and cardiovascular health.

What to Expect at The Online GP by The Wellness

At The Online GP by The Wellness, we take perimenopause seriously. Our doctors are experienced in identifying and managing perimenopausal symptoms and will give you the time and attention your consultation deserves.

You will not be told to “come back in six months and see how things are.” You will not be dismissed. You will receive a thorough clinical assessment, a clear explanation of what is happening, and a personalised management plan that may include HRT, lifestyle guidance, targeted blood tests, or specialist referral if needed.

Our consultations are available in person at our Marylebone clinic or via video call. We can also combine your perimenopause assessment with blood tests, health screenings, or other investigations in a single visit, saving you time and giving you a complete picture of your health.

If you are experiencing perimenopause symptoms and want expert medical advice without the wait, book a consultation today.