Perimenopause
The hormonal transition often begins years before the last period — with symptoms rarely attributed to hormones: sleep problems, irritability, PMS with new force, palpitations, cycle chaos. If you know the patterns, you need not wonder for years.
How to recognise it
The pattern is typical, not the single symptom: cycles shorten or become irregular, bleeding heavier or moodier, plus sleep problems (often waking at 3 or 4 a.m.), mood swings, breast tenderness, new migraine, occasional palpitations and first hot flushes. Many women receive diagnoses like burnout or depression in this phase — and nobody looks at the hormones.
- Progesterone falls first — hence sleep and mood issues often precede hot flushes
- Oestrogen fluctuates chaotically rather than simply declining — hence the up and down
- Single hormone values say little in this phase; the history is the test
What actually helps
Treatment follows the leading symptom: cycle stabilisation and sleep often respond to progesterone, pronounced bleeding problems to the hormonal IUD, vasomotor symptoms to low-dose hormone therapy. Plus the inconvenient truth that is true anyway: strength training, reducing alcohol and sleep hygiene work measurably — as a foundation, not as a brush-off.
Our approach
Structured history with cycle and symptom log, targeted labs only where they change the decision (thyroid, ferritin — the great mimics), then a plan with priorities. First consultation 30 minutes, follow-ups shorter. No hormone bashing, no hormone hype — perspective.
Frequent questions about perimenopause
Can this really start in my early 40s?
Yes — the transition begins on average four to eight years before menopause, which occurs at a mean age of 51. Early to mid 40s is the classic, constantly overlooked onset.
Why is a hormone test of so little use?
Because values fluctuate massively from week to week in this phase. A normal FSH does not rule out perimenopause; a high one proves little. The pattern of your symptoms over months is more informative than any single value.
Pill or hormone therapy — which is right in this phase?
Both can fit: the pill additionally settles contraception, body-identical hormone therapy is closer to physiology. The choice depends on risk profile, bleeding situation and preference — exactly what the consultation is for.
Do I just have to get through it?
No. "That is just your age" is not a diagnosis but a brush-off. The symptoms are real, hormonally explainable and in most cases well treatable.
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