Menopause and perimenopause: symptoms, diagnosis and options
Clear guide to perimenopause, menopause, symptoms, assessment and treatment options.
The essentials in less than a minute
- Perimenopause can begin before menstruation stops, and symptoms vary widely from person to person.
- In healthy people aged 45 years or older with typical symptoms, the diagnosis is usually clinical and does not require a routine hormonal battery.
- Treatment should be tailored to the chief symptom, medical history, individual preferences and risks.
- Unexpected bleeding, very early symptoms or diagnostic doubts require a specific review.
What changes and how it may feel
Menopause is a vital transition, not a single date. Perimenopause describes the years in which ovarian function and menstrual patterns change. Menopause is identified retrospectively when 12 months have passed without menstruation and there is no other cause.
Hot flashes, night sweats, sleep disturbances, vaginal dryness, urinary discomfort, mood changes, muscle or joint pain, and sexual difficulties may appear. The combination, intensity and duration are not the same in all people.
Diagnosis: when tests are needed
NICE guidance indicates that in otherwise healthy people aged 45 years and over with associated symptoms, perimenopause and menopause are often identified without testing. The situation changes if the symptoms appear between 40 and 45 years old, before 40, if certain hormonal treatments are used or if there is another possible explanation.
| Situation | Focus |
|---|---|
| 45 years or older with typical symptoms | The medical history is usually the main element. |
| 40–45 years | FSH may be considered depending on the context. |
| Less than 40 years | Premature ovarian failure and its implications must be assessed. |
| unexpected bleeding | It requires reviewing pattern, treatment and warning signs. |
Treatment options
The plan may include information, changes in habits, cognitive behavioral therapy for certain symptoms, local treatments for genitourinary discomfort, and menopausal hormone therapy when indicated. There is no identical solution for all.
The decision about hormone therapy requires discussing benefits and risks, type of preparation, presence or absence of uterus, history and preferences. Absolute statements that “it is always safe” or “it is always dangerous” do not reflect an individual assessment.
When to consult more urgently
An evaluation should be sought if there is bleeding after menopause, very heavy bleeding, persistent pelvic pain, mass, unexplained weight loss, neurological symptoms, chest pain or shortness of breath. Bleeding while using hormonal treatment should also be interpreted according to when it started, the regimen, and the course.
An online consultation can sort out the history and options, but some situations require in-person examination, blood tests or referral.
Medically reviewed by Dr Paulo
Medical reviewer for Costa Medical Services. Clinical coherence, safety and source quality reviewed.
✓ Ordem dos Médicos Portugal 69376 · Review August 30, 2026Official and clinical sources
Regulatory information may change. Before publishing in WordPress, you should double-check the current version of the SmPC and leaflet.
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