What is perimenopause?
Perimenopause is the transition leading up to menopause — the years when the ovaries gradually produce less oestrogen, often unevenly, before periods stop altogether. It commonly begins in the mid-40s, sometimes earlier, and can last several years. Because hormone levels fluctuate rather than fall smoothly, symptoms can come and go: irregular or heavier periods, hot flushes and night sweats, disturbed sleep, mood changes, brain fog and fatigue.
How treatment decisions are made
Treatment starts with which symptoms are actually bothering you, your personal and family health history, and your own preferences. For some women that leads to hormone therapy; for others, non-hormonal medicines, psychological strategies, lifestyle changes — or a combination. A good plan is reviewed and adjusted over time, not set once.
Menopausal hormone therapy (MHT)
Menopausal hormone therapy — also called hormone replacement therapy (HRT) — replaces some of the oestrogen the ovaries are no longer producing steadily. For many women with troublesome hot flushes and night sweats, it is the most effective treatment available, and it may also help with sleep and other symptoms. It comes in several regulated, prescription forms, including tablets, skin patches and gels; women who still have a uterus also need a progestogen to protect the uterine lining.
MHT is not right for everyone. Suitability depends on your individual circumstances — including personal and family history — which is why it is prescribed after a proper consultation and reviewed regularly. Australian menopause guidance recommends regulated, approved hormone products rather than compounded “bioidentical” hormone preparations, whose quality and dosing are not standardised.
Non-hormonal options
For women who can’t take hormone therapy, or prefer not to, certain non-hormonal prescription medicines can reduce hot flushes and night sweats for some women. Psychological approaches such as cognitive behavioural therapy can help with the impact of symptoms, sleep and mood. For vaginal dryness and related urinary symptoms, low-dose local treatments are available and can be discussed with your doctor.
Lifestyle and self-care
Lifestyle measures won’t switch symptoms off, but they are the foundation every other treatment builds on: regular physical activity (including resistance exercise for bone health), steady sleep habits, limiting alcohol, not smoking, and looking after heart health. Perimenopause is also a natural checkpoint for preventive care — bones, heart and mental health all deserve attention at this stage.
When to see a doctor
If symptoms are affecting your sleep, work, mood or relationships, that alone is reason enough for a conversation — you don’t need to wait until things are severe, and you don’t need a blood test first (see testing for perimenopause). Very heavy bleeding, bleeding after sex, or bleeding after your periods have stopped should always be checked promptly.
At Lumara, Dr Nirusha Weultjes (FRACGP) sees patients in Wollongong for 45-minute initial consultations, with follow-ups in person or by telehealth. No referral is needed and Medicare rebates apply — see consultation fees, or call (02) 4288 2524. Not sure where you stand? The 2-minute symptom check is a useful starting point.
This page is general health information only. It is not medical advice, and it can’t account for your personal circumstances — please speak with a doctor about what’s right for you.