Perimenopause
&
Menopause
Perimenopause?
Perimenopause is the hormonal transition that leads up to menopause — the point when you've gone 12 months without a period, marking the end of your reproductive years. During this time, the ovaries gradually slow down, and both the number and quality of eggs decline.
Perimenopause usually begins several years before periods stop completely, often lasting 4–10 years, and most commonly starts in the 40s, although some women notice changes in their late 30s.
As ovulation becomes less consistent, progesterone levels fall and oestrogen levels fluctuate — sometimes dropping, other times peaking higher than usual. These shifts can cause changes in your menstrual cycle: periods may become irregular, heavier or lighter, closer together or further apart, or occasionally skip altogether.
Many women also experience hot flushes, night sweats, sleep disturbance, mood changes, headaches, breast tenderness, reduced libido, vaginal dryness, brain fog, or changes in energy and concentration.
Not everyone will experience all of these symptoms, and some women notice other changes too. Our role is to help make sense of the full picture, look for anything else that may be contributing, and guide treatment in a balanced, evidence-based way.
Perimenopause and menopause can affect almost every system in the body, not just periods. Symptoms often come in clusters and can change over time.
Hormone
Therapy
With years of misinformation, fear, and conflicting messages around hormone therapy, many women come to these appointments feeling uncertain. We believe these conversations should be open, thoughtful, and grounded in evidence — including being honest about what we know, what we do not know, and how benefits and risks apply to the individual woman in front of us.
MHT uses hormones to help manage symptoms related to the menopause transition. For many women, it can be a safe and effective option, particularly for hot flushes, night sweats, sleep disturbance, and genitourinary symptoms.
Not everyone wants or can use hormones, and there are effective non-hormonal options available.
Lifestyle approaches may include regular movement, good nutrition, sleep support, reducing alcohol, avoiding smoking, and identifying hot flush triggers. Some women also consider non-prescription supplements — it is worth discussing these with us so we can help you choose options that are safe and evidence-informed.
Prescription non-hormonal options may include low-dose antidepressant medicines or other medicines such as gabapentin, clonidine, oxybutynin, or fezolinintant for hot flushes and night sweats. Newer options are also emerging, and we can help you decide whether any are appropriate for you.
Midlife is the perfect time to reset habits that support long-term health. Strength training, regular movement, enough protein, plenty of plants, limiting ultra-processed foods and excess alcohol, and looking after sleep and stress can all make a meaningful difference to symptoms and future health.
Menopause is an important time to review bone health, heart health, and routine screening. Depending on your age, risk factors, and symptoms, we may discuss bone density scans, calcium and vitamin D intake, blood pressure, cholesterol, blood sugar, and breast, bowel, and cervical screening.
Perimenopause and menopause are rarely one-visit issues. Symptoms, risks, and treatment needs can change over several years, so ongoing review matters. We use follow-up appointments to check how you are feeling, adjust treatment, revisit risk factors, and make sure your plan still fits both the latest evidence and your life now.
“Perimenopause is a diagnosis made from a patient's story, not their blood test result. If you're noticing changes that don't feel like you, that's reason enough to come in, regardless of your age or what your hormones look like on paper.”
- Dr Jo Mackson
Perimenopause is a gradual transition rather than an overnight hormonal change, so there is often no single moment when you suddenly know you are "in it." Medically, it is the stage when changes related to menopause begin, whether that is through symptoms, changes in your menstrual cycle, or both, and it continues until 12 months after your final period.
Because symptoms can start before periods become obviously irregular, we do not rely on cycle changes alone. If you are noticing symptoms that are affecting your wellbeing or making you feel unlike yourself, it is worth discussing. Our perimenopause consultations give us the time to look at the full picture, including your symptoms, their impact on day-to-day life, and whether anything else could be contributing.
Menopausal Hormone Therapy (MHT) is used to help manage symptoms of the menopause transition. For many women, it can be a safe and effective option, and it can be personalised in terms of dose, formulation, and duration of use depending on your symptoms, age, medical history, timing of menopause, and individual risk factors.
Because MHT has been surrounded by years of fear and misinformation, we take care to explain the evidence clearly, including the benefits, risks, and areas of uncertainty, so you can make an informed choice about what is right for you.
This is a very common concern, and the answer is more nuanced than a simple yes or no. Much of the fear around MHT came from the early WHI study, but we now know that breast cancer risk varies according to the type of MHT, whether oestrogen is used alone or with a progestogen, your baseline risk, and how long treatment is used.
The main concern is not that MHT simply "causes" breast cancer, but that some forms, especially combined therapy, may promote the growth of an existing hormone-sensitive cancer. Where risk does increase, the absolute increase is usually small and needs to be weighed against both symptom burden and other common risk factors, such as alcohol and obesity. This is why MHT decisions should be individualised rather than reduced to a blanket rule.
Hormones are only one option. Depending on your symptoms and goals, non-hormonal medical treatments, lifestyle approaches such as strength training, sleep, and nutrition, and selected evidence-based complementary therapies may all play a role. We can help you understand the options and choose an approach that feels right for you.
The right duration depends on your symptoms, age, medical history, preference, and personal risk factors. For many women, MHT can be used safely for as long as the benefits outweigh the risks, with regular review and dose or formulation adjustment over time rather than a fixed stop date.
The hormonal changes of menopause can affect more than day-to-day symptoms. Over time, lower oestrogen can contribute to bone loss and changes in cardiovascular risk. That is why menopause care should include not only symptom management, but also attention to long-term health, including bone density and cardiovascular screening where appropriate.
It can be frustrating to hear this, but there is no minimum age at which menopausal symptoms can begin. In Australia, the average age of menopause is 51, with a usual range of 45 to 55, and perimenopausal symptoms can start 4 to 10 years before this. Around 12% of women experience early menopause between 40 and 45, and 1% experience premature ovarian insufficiency (POI) before age 40.
When we assess a woman for perimenopause we do not rely on age alone. Instead, we look at the full picture, including your symptoms, cycle changes, medical history, and any other contributing factors, so we can help you understand what may be happening and discuss the most appropriate next steps.
For most women, perimenopause is diagnosed from symptoms and cycle changes rather than a blood test, because hormone levels (particularly oestrogen and FSH) fluctuate too much during this time for a single result to be very helpful. Blood tests may be useful in more complex situations, such as after hysterectomy or endometrial ablation, when using a hormonal IUD, or if there is concern about early menopause or premature ovarian insufficiency.