Perimenopause and Menopause: Symptoms and Options
Perimenopause and menopause explained: how symptoms change, how long they last, hormone therapy and non-hormone options, lifestyle steps, and when bleeding needs checking.
Content last updated . This page has not been medically reviewed.
What perimenopause and menopause are
Perimenopause is the transition before periods stop. Menopause is reached when you have not had a period for 12 months, and after that you are postmenopausal. [1] It usually affects people between 45 and 55 but can happen earlier. [2] One of the first signs is usually a change in periods: they may come more or less often, and bleeding may get heavier or lighter. [1]Common symptoms
Experiences vary widely, and some people have few symptoms. The NHS lists hot flashes and night sweats, sleep problems, mood changes, memory and concentration changes ("brain fog"), weight gain, vaginal dryness and irritation, more urinary tract infections, joint aches, palpitations, headaches, and weakening bone density. [1] Symptoms usually last 7 to 9 years, sometimes longer, and they can change over time. [1] Ethnic background can affect how severe and long-lasting symptoms are. [1]Details: hot flashes and night sweats, vaginal dryness, and sleep in life stages.
Contraception and bleeding
It is possible to get pregnant during perimenopause. [1] HRT is not contraception. [3] If you have not had a period for more than 12 months and have any vaginal bleeding, it needs to be checked. [1][4]Treatment options
Evidence labels: established recommendation, promising but limited, mixed, insufficient evidence.| Option | What the source found | Strength of evidence |
|---|---|---|
| Hormone therapy (HRT/MHT) | The North American Menopause Society says hormone therapy remains the most effective treatment for hot flashes and night sweats and for genitourinary symptoms. For people under 60 or within 10 years of menopause with no contraindications, the benefit-risk balance is favorable. [5] | Established recommendation |
| Cognitive behavioral therapy, clinical hypnosis, certain antidepressants, gabapentin, fezolinetant | Recommended non-hormone options for hot flashes (Level I evidence). [6] | Established recommendation |
| Supplements and herbal remedies | Listed as not recommended for hot flashes by the same statement. [6] A 2026 review found moderate-certainty evidence for black cohosh but said overall evidence is limited and mostly low-certainty. [7] | Mixed |
| Soy foods and extracts, paced breathing, exercise, yoga, acupuncture | Listed as "not recommended" for hot flashes in that statement (Level II evidence). [6] | Insufficient evidence |
Hormone therapy has risks that depend on type, dose, timing and route. [5] The NHS says combined HRT slightly increases breast cancer risk, tablets can raise blood clot risk, and patches, sprays and gels do not. [8] Estrogen is combined with progestogen if you still have a uterus. [9] Vaginal estrogen can treat vaginal dryness and urinary symptoms. [9] Treatment should be individualized and reviewed. [5]
Lifestyle steps
The NHS suggests regular sleep routines, a balanced diet, calcium-rich foods, weight-bearing exercise, relaxation such as yoga or tai chi, not smoking, and limiting alcohol. [3] Talk to a doctor before taking herbal supplements. [3] For herbs and "hormone balance" claims see black cohosh, soy, red clover and hormone claims.Bones and heart
Menopause can weaken bones. [1] See osteoporosis and bone health. Heart disease risk rises after menopause. [10]When to get help
Contact a clinician if symptoms affect daily life, if your heartbeat feels fast or irregular, if bleeding becomes heavier instead of lighter, or after any bleeding following 12 months without a period. [1] For low mood, see stress and mood pages. If you are in crisis, call or text 988 in the US.Frequently asked questions
How long does perimenopause last?
Symptoms usually last 7 to 9 years, sometimes longer. [1]
Is hormone therapy safe?
Risks and benefits depend on age, timing, type and your health. NAMS says the benefit-risk ratio is favorable for most people under 60 or within 10 years of menopause without contraindications. [5]
Do I still need contraception?
Yes, pregnancy is possible during perimenopause. The NHS gives timelines after your final period depending on age. [1]
Do herbs work for menopause symptoms?
Evidence is mixed and limited, and some herbs interact with medicines. [9][7]
References
- NHS. Symptoms of menopause and perimenopause. Read 2026-10-22.
- NHS. Menopause and perimenopause. Read 2026-10-22.
- NHS. Things you can do to help menopause and perimenopause symptoms. Read 2026-10-22.
- NHS. Postmenopausal bleeding. Read 2026-10-22.
- The 2022 hormone therapy position statement of The North American Menopause Society. Menopause. 2022. PubMed. Read 2026-10-22.
- The 2023 nonhormone therapy position statement of The North American Menopause Society. Menopause. 2023. PubMed. Read 2026-10-22.
- Complementary therapies for management of menopausal symptoms: a systematic review to inform the update of the International Menopause Society guidelines. Climacteric. 2026. PubMed. Read 2026-10-22.
- NHS. Benefits and risks of hormone replacement therapy (HRT). Read 2026-10-22.
- NHS. Treatment for menopause and perimenopause. Read 2026-10-22.
- MedlinePlus. Heart disease in women. Read 2026-10-22.