How is perimenopause treated?

Perimenopause is the transition before periods stop, and hormone levels can change unevenly. Symptoms may include hot flushes, night sweats, sleep disruption, mood changes, vaginal dryness and periods that become irregular or heavy. Treatment focuses on the symptoms that disturb you and considers your medical history, contraception needs and bleeding pattern.

Hormone replacement therapy can help some temperature-related and vaginal symptoms when it is suitable. Non-hormonal menopause treatment may be preferred when hormones are unsuitable or not wanted. Local measures can ease vaginal dryness. A hormonal coil may provide contraception and help manage heavy bleeding for some people, but it is not suitable for everyone.

Track periods, hot flushes, night sweats, sleep, mood and vaginal symptoms for a few weeks. Wear easily removable layers, keep the bedroom comfortable and use a vaginal moisturiser or lubricant if dryness affects comfort. Arrange a review if symptoms interfere with work, sleep, relationships or exercise. Continue to consider contraception while pregnancy remains possible, because perimenopause does not end fertility immediately.

Contact a clinician promptly for very heavy bleeding, bleeding between periods, bleeding after sex, bleeding that causes dizziness, or a new symptom that feels severe. Seek urgent help for fainting, severe weakness, chest pain or difficulty breathing. Heavy periods may need assessment rather than being attributed to perimenopause alone.

Ask which symptoms treatment is expected to improve, whether hormone treatment is appropriate with your health history, what contraception you need, and how unexpected bleeding will be assessed. Ask when to review the plan if sleep, mood or vaginal symptoms remain difficult.