Menopause is defined as the point at which you've had no natural period for 12 months; the lead-up is perimenopause. Many women won't know exactly when this is — for example if you're on progesterone-only contraception, have had heavy periods treated with ablation, or have no womb but intact ovaries. Symptoms often develop gradually and can start at any age, so don't wait until you've missed 12 months of periods — seek advice as soon as you feel you may be developing symptoms, as early treatment can help.

Symptoms are often due to low or fluctuating oestrogen, progesterone and testosterone, and because hormone receptors are found throughout the body, they can affect you head to toe. Headline symptoms include changes to periods, hot flushes, night sweats, weight gain and vaginal dryness. Early signs are often subtle — new or increasing anxiety, feeling overwhelmed, irritability, mood swings, low mood, low confidence, memory problems and brain fog, alongside tiredness, palpitations, headaches, joint aches, recurrent urinary symptoms, painful sex and changes in libido.

HRT replaces the reproductive sex hormones that fluctuate during perimenopause and stay persistently low afterwards — most commonly 17-beta-estradiol, estriol, progesterone and testosterone. These hormones help maintain normal function in cells throughout the body, which is why a deficiency can cause such a wide range of symptoms across every system.

There's no fixed time frame — you can stay on HRT for as long as you need, provided you have regular reviews to ensure it remains in your best interests. An annual, individualised review of the risks versus benefits is best practice, and a planned break can help judge whether symptoms have settled. The aim is always the lowest effective dose to manage your symptoms.

You shouldn't have to suffer for any set period if symptoms are causing difficulty. Some clinicians were trained to view HRT as unsafe, which can limit access. If you're being asked to wait a defined time, a private perimenopause assessment may help — we can often tailor a plan and ask your NHS GP to take over prescribing once your symptoms are stabilised.

HRT remains the most effective way to manage the root cause of symptoms, but there are alternatives — important especially for women who can't use HRT. Certain anti-anxiety and antidepressant medications can help mood and hot flushes; calcium, vitamin D and bone medications support bone health; and specialist women's-health and pelvic physiotherapists help musculoskeletal and pelvic concerns. Four lifestyle pillars also matter: nutrition (stable blood sugar, fibre- and plant-rich diet, omega-3s, calcium, vitamin D, less alcohol); movement (varied activity including strength and weight-bearing exercise); sleep (prioritised, with good light habits and less caffeine/alcohol); and stress management (breathing, mindfulness, boundaries and self-care). There's no strong evidence for specific herbal supplements.

Weight gain is very common and is a normal response to falling oestrogen — the body increases fat cells that can convert other hormones into oestrogen, while lower oestrogen and testosterone slow metabolism. Eating well (low-GI whole foods, and crucially not starving/dieting, which raises stress hormones), regular weight-bearing and aerobic exercise, cutting down alcohol and avoiding processed, salty foods can all help.

If it's safe for you, starting early in perimenopause can help — particularly when symptoms affect quality of life — and may prevent some deficiency symptoms developing. Everyone is different. A common, safe approach combines transdermal (through-the-skin) oestrogen with body-identical progesterone where needed, plus vaginal oestrogen for local urogenital symptoms and transdermal testosterone for symptoms such as low desire. Taking planned breaks to reassess is good practice, using the lowest effective dose. There's no longer a fixed cut-off age for HRT.

No. A consultation is about understanding your symptoms and options, not pushing a particular treatment. Some women choose HRT; others prefer non-hormonal or lifestyle approaches. Effective non-hormonal options include medications for hot flushes or mood, sleep and anxiety support, and symptom-targeted strategies — used alone or alongside other treatments.

The effect depends on the type of HRT, how long it's used and your individual background risk. Your clinician will explain this in a clear and balanced way using up-to-date evidence, so you can make an informed decision.

Yes. Hormonal changes can contribute to anxiety, low mood, irritability and brain fog. Menopause treatment can help, though psychological support or talking therapies may also be recommended where appropriate.

Initial follow-up is usually at 6–12 weeks, and once you're stable, reviews are typically annual. Follow-up ensures your treatment remains safe, effective and appropriate for you.