Beginning stages of menopause: what changes to expect

Periods can become closer together, further apart, lighter or heavier as ovarian hormone levels fluctuate. Symptoms vary between people and can change over time. Pregnancy remains possible while periods continue, so contraception may still matter if pregnancy is not wanted.

This phase before menopause is often called perimenopause. Ovulation becomes less predictable and changing oestrogen and progesterone signals can affect temperature control, sleep, menstrual bleeding, genital tissues and emotional wellbeing. Menopause refers to the point reached after a sustained absence of menstrual periods, but a clinician should assess unexpected bleeding rather than assuming hormones are responsible.

Record bleeding dates, flow changes, hot flushes, sleep and mood so patterns are easier to explain at an appointment. Light clothing, a cool sleeping space and reducing personal hot-flush triggers may improve comfort. Vaginal moisturisers can help ongoing dryness, while a water- or silicone-based lubricant may reduce friction during sex.

Discuss treatment if symptoms disrupt work, rest, relationships or sexual comfort. Options may include hormone therapy or non-hormonal medicines, depending on symptoms, medical history and preferences. Mention migraines, blood clots, breast or womb conditions, liver disease and current medicines before choosing treatment.

Arrange medical review for bleeding between periods, after sex, or after periods had already stopped for a sustained time. Heavy bleeding accompanied by dizziness, faintness, breathlessness or marked weakness needs urgent assessment. Seek immediate help for chest pain, sudden breathlessness, one-sided weakness or thoughts of harming yourself; these symptoms should not be attributed to menopause without evaluation.

Ask whether your bleeding pattern needs investigation, which treatment targets your most troublesome symptom, and how each option fits your health history. Clarify contraception needs, protection from sexually transmitted infections, and whether vaginal symptoms could also reflect infection or a skin condition.