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Perimenopause and menopause: what is happening, what helps and who to talk to

By Kerri Hopkins · 6 min read · 20 October 2026

Hello, hormones

Nobody hands you a leaflet at 42 that says "your hormones are about to rearrange the furniture." So many of us do not realise what is happening, and put the tiredness, the mood and the 3am wake-ups down to being busy or "just getting older". It is none of those things. It is a natural stage of life, and you deserve to understand it.

When it happens

Perimenopause is the run-up to menopause, when your hormone levels start to change and your periods become unpredictable. It usually affects women between 45 and 55, but it can start sooner, and it is different for everyone. Menopause is when your periods have stopped. If your periods stop before 45, see your GP. It may be early menopause, and it is important for your bone health.

Symptoms usually last 7 to 9 years, sometimes longer, and they can change over time.

What happens: the physical side

One of the first signs is usually a change to your periods: more or less frequent, heavier or lighter, before they stop altogether. Other common symptoms include:

• hot flushes and night sweats
• sleep problems
• palpitations
• weight gain, often around the middle
• vaginal dryness, which can make sex painful
• more urinary infections, and leaks
• headaches and migraines
• muscle aches and joint pain
• hair thinning, and dry or itchy skin
• reduced sex drive
• loss of bone density

What happens: your mind and mood

This is the part people talk about least. Symptoms can include:

• mood swings, low mood or depression
• anxiety, stress and irritability, often made worse by poor sleep
• brain fog and trouble concentrating, such as walking into a room and forgetting why

If you feel like you have lost your spark or you are not yourself, it is not a character flaw. Hormones, sleep and stress are all involved. Speak to your GP. Treatments for low mood and anxiety are available, and so is talking therapy.

A gentle warning about heavy periods

Periods can get heavier in perimenopause. If you are bleeding more than before, see your GP, because heavy periods can cause iron deficiency, as I know all too well. Read more in my guide to iron, ferritin and fatigue. Any bleeding after you have gone 12 months without a period needs checking too.

Nutrients that matter

• Calcium. Adults need 700mg a day, which most of us can get from food: milk, yogurt, cheese, calcium-fortified soya drinks, tinned fish with soft bones such as sardines, and kale. Spinach is not a good source, because the body cannot absorb all of its calcium.
• Vitamin D. It supports your bones. The advice is 10 micrograms a day, and the government recommends everyone consider a supplement in autumn and winter.
• Iron. Worth checking if your periods are heavy.
• Fibre, and regular meals. They help gut health, and help keep energy steady. See my guide to your gut and brain.

Bone loss speeds up in the first few years after menopause, which is why strength and weight-bearing exercise matter so much. See my strength guide.

What can help

• Keep cool. Lightweight clothes, a cool bedroom, a fan, or a cold drink can help with hot flushes. Spicy food, caffeine, alcohol, smoking and hot drinks can be triggers for some people.
• Sleep. Keep a regular routine. CBT can help with sleep problems.
• Move. Weight-bearing and strength exercise help protect your bones.
• Relax. Yoga, tai chi or meditation may help.
• Herbal remedies. Red clover and black cohosh are sold for menopause, but there is very little evidence on how well they work or how safe they are, and some can interact with other medicines. Talk to your pharmacist or GP first.

HRT

Hormone replacement therapy (HRT) replaces some of the hormones your body is making less of. It is effective at relieving most perimenopause and menopause symptoms, and it helps protect your bones. It comes as tablets, patches, gels or sprays, and as a cream or pessary for vaginal dryness. If you still have your womb you need a progestogen too.

Like any medicine it has risks as well as benefits, which depend on your age, your health and the type you take. For example, the risks differ between tablets and patches, gels or sprays, and it may not suit you if you have had certain cancers or blood clots. So it is a conversation to have with your GP, who can help you choose what is right for you. For most women with symptoms who are under 60, the NHS says the benefits usually outweigh the risks. There are also other treatments if HRT is not for you, such as CBT, or medicines for low mood and hot flushes.

If you decide to take HRT, a prescription prepayment certificate can save money.

Why it is worth talking about

Many of us keep quiet at work and at home, and then struggle on alone. Talking helps.

• At home. Tell your partner, family or close friends what is going on. Even "I'm exhausted, I'm not myself and I'm not sure why" gives them something to work with. They cannot help with what they cannot see.
• At work. Consider telling your manager or HR what you need. It might be a fan, a cooler desk, a flexible start, a break in a long meeting, or a bit of understanding on a foggy day. Acas, the workplace advice service, says employers should treat menopause as a health and wellbeing matter and handle it sensitively. Menopause is a conversation for everyone, so men should be part of it too.
• With your friends. You are not the only one. Talking to others going through the same thing is one of the most helpful things you can do.

The government's renewed Women's Health Strategy (April 2026) says a menopause question is being added to the routine NHS Health Check. It also says employers with 250 or more staff will have to publish a menopause support action plan from 2027, subject to legislation. So this is becoming a conversation that workplaces are expected to have.

When to see your GP

• you think you have symptoms and want to know your options
• you have palpitations
• you are still having periods but bleeding more than before
• you have not had a period for 12 months and then have any bleeding
• you have had any bleeding after menopause
• you are on HRT and bleeding or spotting continues after 6 months
• low mood, anxiety or sleep problems are affecting your life

Contraception. You can still get pregnant during perimenopause. The advice is to keep using contraception for 2 years after your last period if you are 40 to 49, and for 1 year if you are 50 or over.

Sources

NHS: Menopause symptoms · NHS: Menopause treatment · NHS: Things you can do · NHS: About HRT · NHS: HRT benefits and risks · NHS: Calcium · NHS: Vitamin D · Acas: Menopause at work · GOV.UK: Renewed Women's Health Strategy for England (April 2026)

BioHer provides educational information only. It is not medical advice, diagnosis or treatment, and it does not replace your GP or other healthcare professional. If symptoms feel urgent or severe, call 111 for urgent advice, or 999 in an emergency.