Aches, Pain and Stiffness‍

Joint discomfort is a common but under-recognised symptom of perimenopause. Estrogen plays a role in regulating inflammation and supporting joint lubrication. As levels fluctuate and decline, some women notice stiffness, aching joints, or reduced mobility, even without injury or overuse. This can affect the shoulders, knees, hips, or hands.

Common treatment options include:

• Menopause hormone therapy (MHT / HRT), when appropriate
• Targeted strength and mobility training
• Lifestyle and dietary adjustments to reduce inflammation
• Anti-inflammatory supplements, where suitable

Metabolic Changes and Body Composition

Weight gain during perimenopause often feels different from earlier in life. Hormonal changes can affect insulin sensitivity, fat storage, and resting metabolic rate. This commonly leads to increased abdominal fat and weight gain that does not respond to diet or exercise in the usual way. This is a biological shift, not a failure of discipline.

Common treatment options include:

• Menopause hormone therapy (MHT / HRT) when other symptoms are present
• Weight management medications such as GLP-1s, if appropriate
• Metabolic support supplements
• Personalised nutrition and lifestyle guidance

Insomnia and Disrupted Rest

Sleep problems are one of the most common concerns in perimenopause. Estrogen plays a role in temperature regulation, and its decline can contribute to night sweats that interrupt sleep. Progesterone has a calming effect on the brain, and lower levels may result in lighter, more fragmented sleep or early waking.

Common treatment options include:

• Menopause Hormone Therapy (MHT / HRT)
  
• Prescription sleep medications or cognitive behavioural therapy for insomnia
  
• Sleep support supplements
  
• Lifestyle and sleep habit optimisation

Hot Flashes and Night Sweats

Hot flashes occur when declining estrogen disrupts the brain’s temperature regulation system. This can trigger sudden sensations of heat, flushing, sweating, and night sweats that affect comfort, sleep, and daily functioning.

Common treatment options include:

• Menopause hormone therapy (MHT / HRT)
  
• Non-hormonal prescription medications
  
• Cooling or thermoregulation support supplements
  
• Lifestyle trigger identification and management

Irregular Cycles and Flow

As ovulation becomes less consistent, menstrual cycles often change. Periods may become shorter or longer, lighter or heavier, more frequent, or occasionally absent for months before returning. While this can be part of the perimenopause transition, ongoing heavy or unusual bleeding should always be assessed.

Common treatment options include:

• Hormonal regulation such as oral contraceptives or hormonal IUCD / IUDs
  
• Non-hormonal treatments for heavy bleeding or fibroids
  
• Cycle tracking and monitoring
• In-clinic procedures when medically indicated

Brain Fog, Anxiety and Mood Changes

The brain contains many estrogen receptors. When hormone levels fluctuate, neurotransmitter balance can be affected. This may present as anxiety, irritability, low mood, reduced motivation, forgetfulness, or difficulty concentrating, often described as brain fog.

Common treatment options include:

• Menopause hormone therapy (MHT / HRT), when appropriate
  
• Mood-supporting medications if needed
  
• Cognitive and nervous system support supplements
  
• Lifestyle, stress, and sleep interventions

Texture, Elasticity and Overall Health

Estrogen supports collagen production, skin hydration, and hair growth cycles. As levels decline, some women notice drier skin, reduced elasticity, increased fine lines, or hair that feels thinner or more brittle.

Common treatment options include:

• Menopause hormone therapy (MHT / HRT), when appropriate
  
• Prescription dermatology treatments such as retinoids or minoxidil
  
• Targeted supplements
• Hydration and skin-supportive lifestyle changes

Comfort, Desire and Vaginal Health

Declining estrogen can thin vaginal tissue and reduce natural lubrication. This may lead to vaginal dryness, discomfort during sex, recurrent urinary tract infections, or changes in libido. These symptoms are common and highly treatable.

Common treatment options include:

• Vaginal estrogen
  
• Non-hormonal vaginal moisturisers
  
• Menopause hormone therapy (MHT / HRT), when appropriate. Testosterone therapy may be considered for women with persistent low libido that does not improve with estrogen therapy
  
• Pelvic floor physiotherapy