Hormone Sense

How does menopause affect your bones?

Wed, 04 Nov 2026 00:00:00 GMT

Menopause affects your bones because oestrogen, the hormone that falls at menopause, helps keep them strong. The NHS says that after menopause, falling oestrogen can lead to a rapid drop in bone density, which is why women are more at risk of osteoporosis (bones that become weak and break more easily) than men. You can’t feel this happening, but there’s a lot you can do: eat enough calcium, keep active on your feet, look after your vitamin D, and talk to your GP if you’re at higher risk.

Why bone loss speeds up at menopause

Bone is living tissue that’s constantly being broken down and rebuilt. Women’s Health Concern (WHC), the patient arm of the British Menopause Society, explains that after menopause more bone is removed than replaced, so bones get thinner and more fragile.

Everyone loses some bone with age. The NHS says bones are strongest until your late 20s and you gradually start losing bone from around 35. But WHC says the major bone loss in women happens with the loss of oestrogen at menopause. The HSE puts it simply: women who have been through menopause have a higher risk of osteoporosis because of the lower level of oestrogen in the body.

Who is most at risk

The NHS says women are at greater risk if they have had:

an early menopause, before 45
a hysterectomy before 45, particularly if the ovaries were also removed
periods that stopped for more than 6 months because of over-exercising or too much dieting

Other risk factors the NHS lists include:

a family history of osteoporosis, or a parent who broke a hip
long-term use of high-dose steroid tablets, such as for asthma or arthritis
a body mass index (BMI) of 19 or less
heavy drinking and smoking
rheumatoid arthritis
conditions that affect how you absorb food, such as coeliac disease or Crohn’s disease
an eating disorder, now or in the past
an overactive thyroid
some breast cancer treatments that affect hormone levels
long periods of inactivity, such as bed rest

Having one of these doesn’t mean you’ll get osteoporosis. It means it’s worth raising bone health with your GP.

How bone health is checked

WHC says osteoporosis can be diagnosed after a break from a minor fall, typically of the wrist, spine or hip, but it can also be found before any break with a DEXA scan. This is a type of X-ray scan that measures bone density. It gives a “T-score” comparing your bones with those of a healthy young adult, which shows whether your bone density is normal, a bit low (sometimes called osteopenia) or in the osteoporosis range.

Not everyone needs a scan. Your GP can tell you whether one makes sense for you, based on your risk factors.

What you can do for your bones

Calcium

The HSE says adults aged 19 to 64 need 700mg of calcium a day, and that you should be able to get all you need from your diet. Good sources include milk, cheese, yogurt and other dairy foods, green leafy vegetables like kale, soya drinks with added calcium, bread made with fortified flour, and fish where you eat the bones, such as sardines. WHC notes that reduced-fat dairy has just as much calcium.

If you think you’re not getting enough, for example if you’re vegan, the HSE suggests talking to your GP about a supplement. The HSE also warns not to take too much, as this could be harmful.

Vitamin D

Vitamin D helps your body use calcium to build strong bones. The HSE says sunlight on your skin triggers your body to make it, and suggests talking to your GP about a vitamin D supplement. In the UK, WHC says people at risk of osteoporosis, or taking an osteoporosis medicine, are advised to take a daily supplement of 20 micrograms (800 IU). Check with your GP or pharmacist about what’s right for you.

Exercise

Both the HSE and WHC recommend:

weight-bearing exercise, where your feet and legs carry your weight, such as brisk walking, dancing or running
resistance or muscle-strengthening exercise, such as using weights

Smoking and alcohol

The HSE advises getting help to stop smoking if you smoke, and cutting down on alcohol, as both are linked to weaker bones.

HRT and other treatments

The HSE says HRT helps prevent osteoporosis by raising your oestrogen level, and that this is particularly important if your periods stop before 45. WHC says HRT has been shown to reduce the risk of fractures and can be used to prevent or treat osteoporosis after menopause. Like any medicine, HRT has risks as well as benefits, which depend on the type and on your health (see our guide to the risks of HRT).

There are also non-hormonal bone medicines. WHC describes several, including bisphosphonates, which slow down bone loss and are taken as a weekly or monthly tablet or given as an injection. Your GP or a specialist will explain which, if any, suit you. Calcium and vitamin D on their own aren’t a treatment for osteoporosis, WHC says, but they support other treatments.

Never start, stop or change a medicine for your bones without talking to your GP or pharmacist first.

Ireland and the UK

The advice on food, exercise and risk factors is the same in both countries. In Ireland, HRT is free at participating pharmacies with a medical card or Drugs Payment Scheme card (our guide explains how). In both countries, start with your GP, who can arrange a bone scan if it’s needed.

What to do next

Check the risk list above and note anything that applies to you, especially an early menopause or a family history of osteoporosis or hip fracture.
Raise bone health at your next GP visit, even if you’re there for something else. Ask: am I at higher risk? Would a DEXA scan help? Should I take vitamin D?
Look at your calcium. Do you have dairy or other calcium-rich foods most days? If not, add one, such as yogurt or kale.
Add weight-bearing exercise you enjoy, like a brisk walk or a dance class, plus some strength work such as using weights.

What are the risks of HRT?

Wed, 04 Nov 2026 00:00:00 GMT

For most women, the risks of HRT (hormone replacement therapy) are small, and both the HSE and the NHS say the benefits usually outweigh them. Recent evidence says the risk of serious side effects is very low. The risks that do exist depend on the type of HRT you take, how long you take it and your own health. Your GP can help you weigh them up for you.

Why HRT got a bad name

If you remember worrying news stories about HRT, you’re not imagining it. The NHS says older studies made many people reluctant to take or prescribe HRT, but that view is now seen as out of date.

The HSE says the benefits are likely to outweigh the risks if you:

are under 60
have menopause symptoms
are not at high risk of breast cancer or blood clots
start HRT within 10 years of becoming menopausal

That doesn’t mean HRT is right for everyone, and it doesn’t mean women outside that group can’t take it. It means the balance needs a closer look with your GP.

Breast cancer

This is the risk most women ask about first, so here are the numbers.

Combined HRT (oestrogen plus a progestogen, the type most women with a womb take) can slightly increase the risk of breast cancer. The HSE and NHS both say there are around 5 extra cases of breast cancer in every 1,000 women who take combined HRT for 5 years.

The risk goes up the longer you take combined HRT, and the older you are. It falls again after you stop. The older HSE risks page says it may return to normal around 5 years after stopping.

Oestrogen-only HRT, which is for women who have had a hysterectomy (an operation to remove the womb), causes little or no increase in breast cancer risk, according to the HSE, NHS and NICE.

If you’ve had breast cancer, the HSE and NHS say you’ll usually be advised not to take HRT. Whatever type you use, keep going to your breast screening appointments.

Blood clots and stroke

Blood clots. HRT tablets can increase the risk of a blood clot in a vein, but the HSE and NHS say the risk is still very low. HRT patches, sprays and gels do not increase the risk of blood clots, because the oestrogen is absorbed through your skin. NICE says that if you’re already at higher risk of clots, you may be offered patches or gel instead of tablets, and with a strong family history of clots you may be referred to a specialist first.

Stroke. HRT tablets (but not patches, gel or spray) slightly increase the risk of stroke. Both the HSE and NHS say the risk is very low, particularly if you’re under 60.

This is one of the most useful things to know: the form of HRT can change the risk, so it’s worth asking your GP whether a patch, gel or spray would suit you.

Womb and ovarian cancer

Womb cancer. Taking oestrogen on its own can increase the risk of womb cancer if you still have a womb. That’s why, the HSE explains, women with a womb are usually prescribed oestrogen together with a progestogen, which protects the womb lining. If that’s you, take both parts as your GP advises.

Ovarian cancer. The HSE says experts are not sure whether HRT increases the risk. If it does, they think the risk is very small: one study found 1 extra case for every 1,000 women taking HRT for 5 years. The risk is thought to fall after stopping.

Heart disease, diabetes and dementia

Heart disease. HRT has little or no effect on the risk of coronary heart disease, according to the HSE and NHS. NICE says starting HRT before 60 does not increase your risk of cardiovascular disease.
Type 2 diabetes. HRT does not increase the risk, and the HSE and NHS say some recent studies suggest it may even slightly reduce it.
Dementia. It’s not known whether HRT changes the risk of dementia. The NHS says research is ongoing and any risk or benefit is likely to be small.

Vaginal oestrogen

Vaginal oestrogen (creams, pessaries or a ring used for vaginal dryness) is a much lower dose. The HSE and NHS both say it does not increase the risk of breast cancer, blood clots or other conditions.

Common side effects

Separate from these longer-term risks, some women get side effects, especially in the first few months. The NHS says it’s common to have none, or only minor ones. Those listed by the NHS and HSE include headaches, breast tenderness, nausea, mood changes and unexpected spotting or bleeding. If they don’t settle, talk to your GP, as a different type or dose may suit you better.

When to get help straight away

The HSE and NHS side effects pages list these as emergencies. Call 112 or 999, or go to the emergency department (don’t drive yourself), if you have:

chest pain and breathlessness
difficulty speaking or moving an arm or leg, or one side of your face drops

Contact your GP, or call 112 or 999, urgently if you have pain, redness or swelling in one leg, usually the calf, which can be a sign of a blood clot.

See your GP soon if you notice a breast lump or other breast changes, or changes in vaginal bleeding after you’ve been on HRT for more than a few months.

Ireland and the UK

The guidance on risks is essentially the same in both countries. In Ireland, HRT is free at participating pharmacies with a medical card or Drugs Payment Scheme card (our guide explains how). In the UK, talk to your GP or practice nurse; the NHS also says a pharmacist can talk you through HRT options. For the different forms, see our guide to the types of HRT.

What to do next

Write down your own risk factors before your appointment: any personal or family history of breast cancer, blood clots, stroke or heart disease.
Ask your GP these three questions: What are the benefits for me? What are the risks for me, as a number? Would a patch, gel or spray suit me better than tablets?
Book or keep your breast screening appointments, especially if you take combined HRT.
Keep reviewing it. The risks change with age and how long you take HRT, so check in with your GP regularly. Never stop or change HRT without talking to them first.

Why can't I sleep in perimenopause?

Wed, 04 Nov 2026 00:00:00 GMT

Trouble sleeping is one of the most common parts of perimenopause, the years before your periods stop when hormone levels start to change. The HSE lists difficulty sleeping among the physical symptoms, and Women’s Health Concern, the patient arm of the British Menopause Society, says sleep problems affect around 40 to 56% of women going through the menopause transition. Falling oestrogen can disturb sleep directly, and through night sweats, low mood, aches and needing the toilet at night. The good news is that there are effective treatments, so it’s worth talking to your GP.

Why perimenopause disturbs your sleep

Women’s Health Concern (WHC) explains that falling oestrogen affects sleep in two ways. It acts on sleep directly, and it brings other symptoms that wake you up, including:

hot flushes and night sweats
mood changes, such as anxiety or low mood
joint aches
bladder changes, so you wake needing to pass urine

Other things can add to it at this stage of life: getting older, stress, everyday habits, and sleep disorders such as restless legs syndrome and sleep apnoea, which WHC says are both more common from menopause onwards.

The HSE says perimenopause symptoms can start 7 to 10 years before your periods stop, so poor sleep in your early or mid-40s could be part of it, even if your periods are still fairly regular.

Is it insomnia?

Insomnia means you regularly have problems sleeping. The NHS describes the signs as finding it hard to get to sleep, waking several times in the night, lying awake, waking early and not getting back to sleep, and feeling tired and irritable during the day.

WHC describes chronic insomnia as trouble getting to sleep, staying asleep or waking too early on at least three nights a week for three months or more, with daytime effects such as tiredness, low mood or poor concentration. It calls this one of the most common sleep disorders during menopause.

Most adults need around 7 to 9 hours of sleep a night, and WHC points out that this need doesn’t drop as we get older.

Two sleep problems that are easy to miss

Sleep apnoea. This is when your breathing repeatedly stops and starts while you sleep. WHC says it’s more common in menopause and may cause loud snoring, morning headaches, tiredness or mood changes, but not all women with sleep apnoea snore. If your GP suspects it, they may arrange a sleep study, and treatment is available.

Restless legs syndrome. This causes uncomfortable feelings in the legs, often in the evening or at night, that ease when you move. WHC says it’s more common after menopause, and suggests asking for a blood test for ferritin (a measure of your iron stores), because low iron can be a cause.

If either sounds familiar, mention it to your GP.

What helps

Habits that help you sleep

The NHS says insomnia usually gets better by changing your sleeping habits. Between the NHS and WHC, the advice includes:

going to bed and getting up at the same times each day
keeping your bedroom cool, dark and quiet
relaxing for at least an hour before bed, and avoiding screens and heavy meals late in the evening
exercising regularly, but not close to bedtime
cutting down on caffeine and alcohol, especially later in the day
if you can’t sleep, getting up after about 20 minutes and doing something relaxing until you feel sleepy (WHC)

For night sweats, the HSE suggests wearing light clothing, keeping your bedroom cool at night, using a fan or having a cold drink, and cutting down on triggers such as spicy food, caffeine, hot drinks, smoking and alcohol.

CBT for insomnia

CBT (cognitive behavioural therapy) is a talking therapy that helps you change the thoughts and habits that keep you awake. WHC says CBT for insomnia, known as CBT-I, is the most effective treatment for chronic insomnia, can work during menopause, and usually takes about 6 weeks. It can be done in person, in a group or online. The NHS says a GP may offer it face to face or through an online programme, and the HSE says CBT can help with hot flushes and sleep problems too.

HRT and other treatments

WHC says HRT can improve sleep, both directly and by reducing hot flushes and night sweats. If you’re already on HRT and still sleeping badly, it suggests it may be worth reviewing the type of progestogen with your doctor. If waking to pass urine is the problem, WHC says vaginal oestrogen can improve bladder function and so improve sleep.

For women who can’t or don’t want to take HRT, WHC says certain non-hormonal medicines that reduce hot flushes can then improve sleep. Your GP can explain which might suit you.

A word on sleeping pills

The NHS says GPs now rarely prescribe sleeping pills for insomnia, because they can have serious side effects and you can become dependent on them. Sleep aids from a pharmacy can’t cure insomnia and, the NHS says, shouldn’t be used for more than 1 to 2 weeks. The HSE advises talking to a GP before taking herbal supplements or other medicines. Always check with your GP or pharmacist before starting, stopping or changing anything.

When to see your GP

The NHS says to see a GP if changing your sleep habits hasn’t helped, you’ve had trouble sleeping for months, or it’s making it hard to cope with daily life. WHC’s message is simple: you don’t have to put up with poor sleep.

The HSE also says to talk to your GP if you have menopause symptoms before 45, and to get any bleeding from the vagina after menopause checked, even if it only happened once.

Ireland and the UK

The advice is the same in both countries: start with your GP. In Ireland, HRT is free at participating pharmacies for women with a medical card or Drugs Payment Scheme card (our guide explains how). In the UK, the NHS says your GP may offer CBT for insomnia face to face or online.

What to do next

Keep a sleep diary for two weeks. Note when you went to bed, how often you woke and why (sweats, toilet, worry), and how you felt the next day. If you still have periods, note where you were in your cycle.
Pick two habits to try, such as a fixed wake-up time and a cooler bedroom, and give them a few weeks.
Book a GP appointment if it isn’t improving, and ask: could this be perimenopause? Would CBT for insomnia or HRT suit me? Could I have sleep apnoea or low iron?
Ask anyone who shares your room what they notice. Loud snoring, or breathing that stops and starts, is worth mentioning to your GP.

Are heavy periods normal in perimenopause?

Tue, 03 Nov 2026 00:00:00 GMT

Heavier periods are common as you get closer to menopause, and for many women there’s no underlying problem. The NHS lists “approaching menopause” as one of the times periods can become heavy. But common doesn’t mean you have to put up with it. If heavy bleeding is affecting your life, or your periods have changed noticeably, it’s worth seeing your GP: there are effective treatments, and a GP can rule out other causes and check you’re not low in iron.

Why periods change in perimenopause

Perimenopause is the time before your periods stop for good, when your hormone levels rise and fall less predictably. The NHS says irregular periods are common just before the menopause, and “irregular” can mean several things: periods coming early or late, lasting more or fewer days, and being heavier or lighter than you’re used to.

So you might go months with light or skipped periods, then have one that’s much heavier. That pattern on its own is often part of perimenopause, but it can also have other causes, which is why it’s worth mentioning to your GP if your periods have become heavier.

How do I know if my periods are heavy?

Bleeding varies a lot from woman to woman, and the HSE points out that what’s heavy for one woman may be normal for another. These are the signs the HSE and NHS use. Your periods may be heavy if you:

need to change your pad or tampon every hour or two
pass blood clots bigger than about 2.5cm (roughly the size of a 50 cent coin or a 10p coin)
bleed through to your clothes or bedding
need to use two types of period product together, such as a tampon and a pad
have periods lasting more than 7 days
avoid things like exercise, or take time off work, because of your period
feel tired or short of breath a lot

An NHS England decision guide for heavy periods adds a few more: getting up in the night to change period products, sudden “flooding”, or simply periods that interfere with your normal routine.

Feeling tired or breathless matters because heavy bleeding over time can lead to iron deficiency anaemia, where your body doesn’t have enough iron to make healthy red blood cells.

What else can cause heavy periods?

For many women there’s no particular cause. The NHS England decision guide says that in about half of people with heavy periods there’s no medical reason at all. Where there is a cause, the HSE and NHS list:

fibroids (non-cancerous growths in or around the womb) and polyps (small growths on the womb lining)
adenomyosis, where tissue from the womb lining grows into the wall of the womb
endometriosis, polycystic ovary syndrome (PCOS) and pelvic inflammatory disease
an underactive thyroid, or a bleeding disorder such as von Willebrand disease
some medicines, including blood thinners and some chemotherapy
a copper coil (IUD), which the HSE says can make periods heavier for the first 3 to 6 months after it’s fitted

The NHS says that, rarely, heavy periods can be a sign of womb cancer. That isn’t a reason to panic; it’s a reason not to ignore a change and to let your GP check.

What your GP may do

Your GP will ask about your bleeding, how your periods have changed and any other symptoms. According to the HSE, you may then have:

a blood test to check for iron deficiency anaemia
a physical examination
an ultrasound scan
a hysteroscopy, where a doctor looks inside your womb with a thin camera

The NHS England guide makes two reassuring points: you can say no to any test, and you don’t have to wait for results to start treatment. It also says most people don’t need to be referred to hospital for heavy periods.

Treatments for heavy periods

The NHS says heavy periods don’t always need treating, but there are options if they’re affecting your daily life. Which one suits you depends on the cause, your general health and what you prefer, so this is a conversation to have with your GP. The options the HSE and NHS describe include:

An intrauterine system (IUS), a small device placed in the womb that releases a progestogen hormone. The HSE says it’s often the first treatment offered. The NHS England guide notes you may have irregular bleeding for up to 6 months after it’s fitted.
Medicines without hormones, such as tranexamic acid, which helps your blood clot and is taken only during your period, or anti-inflammatory painkillers such as mefenamic acid or naproxen.
Hormonal medicines, such as the combined contraceptive pill or progestogen tablets.
Procedures if medicines don’t help or there’s a specific cause, such as removing fibroids or polyps, removing the lining of the womb (endometrial ablation), or, less often, a hysterectomy.

The NHS England guide suggests giving a treatment about 3 months and, if it hasn’t helped, going back to try something else. Some of these options are also contraceptives, which matters because you can still get pregnant during perimenopause. Ask your GP or pharmacist which options fit your health and plans; don’t start or change any medicine without talking to them first.

When to see your GP

The HSE and NHS suggest seeing your GP if:

heavy periods are affecting your life, or you’ve had them for some time
your periods have become heavier
you have severe period pain
you bleed between periods or after sex
you have heavy periods along with other symptoms, such as pain when peeing, pooing or having sex

The NHS England guide adds: see a healthcare professional if you faint during your period, or have to stay in bed because of pain or heavy bleeding.

Bleeding after menopause always needs checking. If you’ve gone a year or more without a period and then have any bleeding, the HSE says to contact your GP even if it’s only spotting, pink or brown discharge, or has only happened once. It’s not usually serious, but it can rarely be a sign of cancer, which is easier to treat when found early.

What to do next

Track your next two or three periods. Note the dates, how many days you bleed, how often you change pads or tampons, any clots or flooding, and how tired you feel. A period-tracking app or a notebook both work.
Book a GP appointment if your periods tick any of the boxes above, or have simply changed in a way that worries you. Bring your notes and ask whether a blood test for anaemia makes sense.
Ask about the full range of treatments, including ones without hormones and ones that also work as contraception, and what to expect from each.
Don’t ignore bleeding between periods, after sex or after menopause. Ring your GP.

How do I talk to my GP about perimenopause?

Tue, 03 Nov 2026 00:00:00 GMT

Book an appointment, say plainly that you think your symptoms could be perimenopause, and bring a short written list of your symptoms, your period pattern and two or three questions. That’s the heart of it. Your GP can usually tell from your age and symptoms whether you’re in perimenopause or menopause, and they can talk you through HRT and other options. If they can’t help, or your symptoms don’t improve, you can ask about a referral to a specialist.

When is it worth seeing your GP?

The HSE suggests contacting your GP if:

your menopause or perimenopause symptoms are worrying you or affecting your daily life
you’re having symptoms before the age of 45
your periods have stopped for a year or more before 45

You don’t need to wait until symptoms are severe. If they’re getting in the way of sleep, work or relationships, that’s reason enough. Many women put it off, worried about wasting the doctor’s time. You’re not: perimenopause is a normal reason to see a GP.

Before your appointment

Keep a symptom diary for a few weeks. Note what you notice, when it happens, how it affects your day and the dates of your periods. Symptoms like anxiety, joint pain, brain fog or poor sleep are easy to forget in the moment or to mention as separate problems. A booklet hosted by the British Menopause Society includes a symptom checklist you can fill in and bring.

Write down your questions. The NHS advises picking your two or three most important questions and writing them down, along with when your symptoms started and what makes them better or worse.

List your medicines, including any vitamins, supplements or herbal remedies, and any relevant history such as migraines, blood clots or breast cancer in you or your family. These can affect which treatments suit you.

Ask who to see. The BMS-hosted booklet suggests asking the receptionist, when you book, whether a doctor or practice nurse has a special interest in menopause. Some have done extra training.

Bring someone if it helps. Both the NHS and the booklet suggest taking a friend or family member if you’re anxious.

During the appointment

Start with the most important thing. Something like “I think I might be in perimenopause, and it’s affecting my sleep and my work” tells your GP straight away why you’re there.

Do I need a blood test? Often not. The NHS and HSE say a GP can usually diagnose perimenopause or menopause from your age and symptoms. The BMS-hosted booklet explains that NICE guidance says healthy women over 45 should be diagnosed on symptoms alone, partly because hormone levels go up and down during perimenopause, so a single test can be misleading. Blood tests are more likely if you’re under 45.

Useful questions to ask, adapted from the NHS:

Could my symptoms be perimenopause, or could something else be causing them?
What are my treatment options, and what do you recommend for me?
What are the benefits, risks and side effects of each?
How will I know if the treatment is working, and when should I come back?
Who do I contact if things get worse?
Do you have any written information, or know of a support group?

The booklet also suggests it’s fine to make two appointments: one to talk through your symptoms and options, and a second to decide on treatment once you’ve had time to think and read up.

What your GP might offer

The HSE says hormone replacement therapy (HRT) is the main medicine treatment for perimenopause and menopause symptoms. The type depends on things like whether you still have periods and whether you’ve had a hysterectomy.

If HRT isn’t suitable for you, or you’d rather not take it, the NHS says there are other options. These include cognitive behavioural therapy (CBT, a talking therapy that can help with hot flushes, sleep and anxiety), and some non-hormonal medicines for hot flushes or low mood. For vaginal dryness, your GP may suggest vaginal oestrogen, and the HSE notes that moisturisers and lubricants are available from pharmacies without a prescription.

Your GP will talk through what suits your health and history. Don’t start, stop or change any medicine without their advice. A pharmacist is also a good person to ask about how to use what you’ve been prescribed.

Follow-up: if you start HRT, the HSE says you’ll usually have a review after 3 months and then once a year.

What about the cost of treatment?

In Ireland, HRT is free on prescription from participating pharmacies if you have a medical card or a Drugs Payment Scheme card, as the HSE explains. The GP visit itself isn’t covered by that scheme. Our guide to free HRT in Ireland has the details.

In the UK, prescription charges work differently in each nation, and England has an HRT prescription prepayment certificate. The same free HRT guide explains how it compares.

If you’re not getting the help you need

The HSE says your GP may refer you to a specialist menopause service if treatment isn’t helping, you have ongoing side effects, you can’t take HRT, or you have a complex medical history. In Ireland, these specialist complex menopause clinics see the most complex cases. In the UK, the NHS says you can be referred to a specialist menopause centre if treatment and lifestyle changes haven’t helped.

The BMS-hosted booklet says not to be afraid to ask for a second opinion, or for a referral, if your GP isn’t able to help. Seeing a different GP in the same practice is often the simplest first step.

When not to wait

Some symptoms need a prompt GP visit rather than a routine one:

any bleeding after menopause (12 months or more without a period), even if it’s only spotting
bleeding between periods or after sex, or periods that are suddenly much heavier
bleeding that hasn’t settled after the first six months on continuous HRT, according to the BMS-hosted booklet

If your mood is very low or you’re having thoughts of harming yourself, don’t wait for a routine appointment. Talk to your GP today, call Samaritans free on 116 123 (Ireland and UK, any time), in Ireland call Pieta on 1800 247 247 or text 50808, in the UK text SHOUT to 85258, and in an emergency call 999 or 112.

What to do next

Start a symptom diary today and keep it for two to four weeks, with your period dates.
Write down your top two or three questions and your list of medicines and supplements.
When you book, ask whether a GP or nurse at the practice has a special interest in menopause.
At the appointment, say clearly that you think it might be perimenopause, and agree when you’ll go back to review how things are going.
If things don’t improve after a few months, ask about a referral or a second opinion.

What is early menopause, and what if it happens before 40?

Tue, 03 Nov 2026 00:00:00 GMT

Early menopause is when your periods stop before the age of 45. If it happens before 40, it’s called premature menopause or premature ovarian insufficiency (POI). It can happen on its own or as a result of treatment such as surgery or chemotherapy, and often there’s no clear reason. If you’re under 45 and your periods have become less frequent or stopped, the HSE and NHS both say to see your GP. That’s partly for your symptoms, and partly because replacing the missing hormones helps protect your bones and heart.

How early is “early”?

Menopause is when you haven’t had a period for 12 months. The NHS says it usually happens between 45 and 55, and the HSE says the average age in Ireland is 51.

Early menopause: periods stop before 45.
Premature menopause or POI: periods stop before 40. “Ovarian insufficiency” simply means the ovaries aren’t making enough hormones, particularly oestrogen.

The HSE says around 1 in 100 women reach menopause before 40. A booklet hosted by the British Menopause Society puts it at about 1 in 1,000 under 30.

What are the signs?

The main sign is your periods becoming less frequent or stopping when you’re not pregnant. Beyond that, the HSE says the symptoms are the same as for menopause at the usual age, including:

hot flushes and night sweats
difficulty sleeping, tiredness and lack of energy
low mood or anxiety
problems with memory or concentration
vaginal dryness, discomfort during sex and a lower sex drive
headaches, joint aches and heart palpitations (a fast, fluttering or pounding heartbeat)
recurring urinary tract infections

The HSE also points out that some women have no symptoms at all, apart from their periods changing. That’s one reason it’s worth acting on missed periods even if you otherwise feel fine.

What causes it?

The HSE says that in most cases the cause isn’t known. Known causes include:

surgery to remove your ovaries, which may happen during a hysterectomy (removal of the womb)
cancer treatment: radiotherapy and chemotherapy can cause early menopause, which may be permanent or temporary. The risk depends on your age, the type of chemotherapy and the area treated; it’s higher with radiotherapy around the pelvis or brain
chromosome differences, such as Turner syndrome
autoimmune diseases, where the immune system attacks the body’s own tissues
some infections, such as tuberculosis, malaria and mumps, in rare cases

It can also run in families, especially if a relative went through menopause in her 20s or 30s. The NHS adds that it’s more likely if you started your periods early, smoke or are underweight.

None of this is your fault, and many women with POI never find out why it happened.

How is it diagnosed?

Your GP will ask about your symptoms, your periods and your family history. For women over 45, a menopause diagnosis is usually based on symptoms alone. For younger women, blood tests to check hormone levels are more likely: the HSE says you’ll have blood tests, and the NHS says a GP may sometimes do them if you’re under 45.

For women under 40, the BMS-hosted booklet says at least two blood tests are needed, taken about four to six weeks apart, because hormone levels can go up and down.

Your GP may refer you to a GP who specialises in menopause, a gynaecologist or an endocrinologist (a hormone specialist).

Why treatment matters

Oestrogen does more than control your periods: it helps keep your bones and heart healthy. Both the HSE and NHS say early or premature menopause raises your risk of osteoporosis (weak bones that break more easily) and cardiovascular disease (heart and circulation problems).

That’s why the usual treatment is to replace the missing hormones, most often with hormone replacement therapy (HRT), and sometimes with the combined contraceptive pill. The HSE says you may be advised to stay on treatment until around 51, the usual age of natural menopause. This is different from taking HRT later in life for symptoms: here, the aim is partly to replace hormones your body would normally still be making.

Hormone treatment isn’t suitable for everyone. Both the HSE and NHS say it may not be an option if you’ve had certain cancers, such as some types of breast cancer. If that applies to you, your GP may refer you to a specialist menopause clinic. Your GP or specialist is the right person to talk through what suits you; don’t start or stop any hormone treatment without their advice.

The NHS also suggests regular exercise and calcium-rich foods such as yoghurt to help look after your bones.

In Ireland, HRT is free on prescription from participating pharmacies if you have a medical card or a Drugs Payment Scheme card, as the HSE explains.

Fertility and contraception

Early or premature menopause can make it harder to get pregnant, because you don’t release an egg every month. But the HSE says a small number of women with POI do ovulate and become pregnant, so if you don’t want to get pregnant, keep using contraception until you’ve talked it through with your GP.

If you’d hoped to have children, this can be very hard news. Your GP can refer you to a fertility specialist. The HSE and NHS mention options such as egg donation, IVF with your own frozen eggs, surrogacy and adoption.

Looking after your feelings

An early menopause can bring grief, worry or a sense of losing control, on top of the symptoms. The HSE says counselling may help. Support groups include The Daisy Network (for women with premature menopause) and, in Ireland, the National Infertility Support and Information Group. If it’s affecting your mental health, the NHS notes you can refer yourself to NHS talking therapies in England without seeing a GP first.

What to do next

See your GP if you’re under 45 and your periods have become less frequent or stopped, even if you have no other symptoms.
Before the appointment, note your period dates, any symptoms, any past surgery or cancer treatment, and the age your mother or sisters reached menopause, if you know it.
Ask your GP whether blood tests are needed, whether hormone treatment is right for you, how long you’d take it, and whether you need a referral to a specialist.
Keep using contraception if you don’t want to get pregnant, until your GP says otherwise.
Look after your bones: ask about exercise and calcium, and don’t smoke.

How can I manage menopause symptoms at work?

Mon, 02 Nov 2026 00:00:00 GMT

You can make a real difference with small, practical changes: a fan or a desk near a window, breathable clothing, regular breaks, flexibility around start times on bad-sleep days, and planning your hardest tasks for when you’re at your best. Official guidance in Ireland and the UK encourages employers to support these, and the first step is usually a short, prepared conversation with your manager. Alongside that, talk to your GP if your symptoms are hard to manage, because treating the symptoms themselves often helps most.

How menopause can affect your working day

Women’s Health Concern, the patient arm of the British Menopause Society, says up to a third of women will have severe menopausal symptoms that affect their quality of life. The difficulties women most often report at work, it says, are poor concentration, tiredness, poor memory, feeling low and lowered confidence. Hot flushes, poor sleep and heavy or unpredictable periods can add to that.

Many women feel embarrassed to mention it, or worry they’ll be judged. That’s understandable, but you’re not asking for special treatment: you’re asking for the kind of adjustments employers already make for other health needs.

Practical changes that help

Ireland’s Civil Service Menopause in the Workplace Policy Framework and the UK government’s guidance for employers both list practical adjustments. They’re written for employers, but they’re a useful menu for you to choose from.

For hot flushes and feeling too warm:

a desk fan, or moving your desk nearer a window or door
easy access to fresh drinking water
flexibility in dress code where possible, and breathable, dark-coloured uniforms with comfortable waistbands
short breaks to step out for fresh air, and access to a quiet area

The UK government guidance also suggests employers look at workplace temperature and ventilation, and whether uniforms make people too hot.

For poor sleep and tiredness:

a later start time after sleepless nights, which the Irish framework gives as an example
flexible hours, or working from home where the job allows
a private area to rest

For brain fog and memory problems:

realistic goals and flexible breaks
quiet places to work
notes and reminders for things you need to remember, as the HSE’s leaflet for employees suggests
planning your most demanding tasks for the time of day you’re at your best, if you can

For heavy or unpredictable periods:

easy access to toilets and frequent toilet breaks, especially in long meetings
a “caught-out kit” in your desk or locker with sanitary products, wet wipes, a towel and spare clothes (an HSE tip)
an easy way to ask for a spare uniform

For aches and stiffness, the Irish framework suggests breaks so you can get up and walk about.

How to talk to your manager

Telling your manager is your choice. But the HSE’s leaflet points out that it can be an important step in getting the support you need. A little preparation makes it easier.

List your symptoms, then pick out the ones that affect your work most. This approach comes from the HSE’s leaflet.
Think about what would help. Choose one to three changes from the lists above that would make the biggest difference.
Ask for a private conversation. The Irish framework says managers should offer a private, confidential place to talk, listen without assumptions, and respect your right not to share personal details you’d rather keep private.
Get it in writing. The framework says managers should confirm in writing anything agreed. Adjustments can be temporary and reviewed as things change.

If you’d rather not talk to your own manager, the Irish framework suggests another manager or a trusted colleague instead. Many workplaces also have HR, occupational health or an Employee Assistance Programme that can help. Check whether your employer has a menopause policy: the UK guidance encourages employers to have one.

What the law says

In Ireland

There is no Irish law that specifically covers menopause at work. The Civil Service framework says this plainly. It goes on to say protection comes through the Employment Equality Acts, which ban discrimination on grounds including gender, age and disability, as Citizens Information explains. The framework adds that employers must provide reasonable accommodation for employees with a disability, and that this could, in some circumstances, include medical issues that arise during menopause.

Employers also have a general duty under the Safety, Health and Welfare at Work Act 2005 to protect employees’ safety, health and welfare, so far as is reasonably practicable.

The Civil Service framework itself only applies to civil service employers, who were asked to have a menopause policy in place by mid-2024. Other employers aren’t bound by it, but it’s a good model to point to. If you need advice on your rights, Citizens Information can help, and complaints go to the Workplace Relations Commission.

In the UK

The UK government’s position is that menopause is not a protected characteristic under the Equality Act 2010, but that sex, age and disability are, and these protect employees going through menopause from unfair treatment. Women’s Health Concern also points to employers’ duties under health and safety law, including the Health and Safety at Work Act 1974.

Don’t forget the health side

Changes at work help, but treating your symptoms often helps most. The HSE’s leaflet says it’s okay to reach out for help if symptoms are causing you stress, and suggests going to your GP with a record of your symptoms, how long you’ve had them and the date of your last period. Treatments such as HRT may help (see our guide to the different types of HRT), and your GP can talk you through the benefits and risks for you. The HSE leaflet also suggests regular exercise, relaxation and mindful breathing, watching spicy food and alcohol (both can make hot flushes worse) and a cool bedroom with light layers.

If you have any bleeding from the vagina after menopause, even spotting, the HSE says to contact your GP.

What to do next

Write your list: the symptoms that affect your work most, and one to three changes that would help.
Check for a policy. Look on your staff intranet or ask HR whether there’s a menopause policy.
Book a short, private chat with your manager or another person you trust, and ask for anything agreed to be confirmed in writing.
See your GP if symptoms are affecting your work or wellbeing, and bring your symptom notes.

Can perimenopause cause anxiety?

Mon, 02 Nov 2026 00:00:00 GMT

Yes, it can. Both the HSE and the NHS list anxiety, along with low mood and mood swings, among the common symptoms of perimenopause and menopause. It often comes alongside poor sleep, hot flushes and brain fog, which can make it worse. If anxiety has crept up on you in your 40s or early 50s, it’s worth talking to your GP, because there are treatments and simple changes that can help.

Why perimenopause can bring anxiety

Perimenopause is the time before your periods stop, when your hormone levels change and symptoms begin. The HSE says symptoms can start 7 to 10 years before your periods stop, so many women notice changes long before they’d think of menopause.

The HSE’s list of common mental health symptoms of perimenopause and menopause includes:

changes to your mood, such as low mood, anxiety, mood swings and low self-esteem
irritability
problems with memory or concentration (brain fog)

On its things you can do page, the HSE puts it simply: it’s common to have mood swings, low mood and anxiety around the time of perimenopause and menopause. So if this is happening to you, you’re not imagining it, and you’re far from alone.

How sleep, hot flushes and anxiety feed each other

Anxiety in perimenopause rarely shows up on its own. The NHS describes a few links that are worth knowing about:

Sleep. Not being able to get to sleep or stay asleep can make you feel irritable, stressed and anxious, the NHS says, and sleep problems may be worse if you also have night sweats.
Tiredness. Mood changes and memory problems may feel worse if you’re sleeping badly and feel very tired.
Hot flushes. A hot flush can make you sweat a lot, feel dizzy, and cause palpitations or anxiety.

Palpitations (a heartbeat that feels faster, slower, fluttering or more noticeable) are on both the HSE and NHS symptom lists. They can feel frightening, especially if you’re already anxious. The NHS says to see your GP if you have symptoms like palpitations, so do get them checked rather than assuming.

Symptoms can also change over time. The NHS notes that you might have hot flushes and night sweats for a while, then find they ease and are replaced by low mood and anxiety. Everyone’s experience is different.

What can help

Treatments your GP may talk about

HRT. The HSE’s things you can do page lists HRT (hormone replacement therapy) among the treatments that can help with mood changes in menopause. The HSE’s treatment page calls HRT the main medicine treatment for perimenopause and menopause symptoms. Whether it suits you depends on your health and history, which is a conversation for your GP. (See our guide to the different types of HRT.)

CBT. Cognitive behavioural therapy is a talking therapy that helps you notice and change unhelpful patterns of thinking. The HSE says CBT can help with low mood and feelings of anxiety, and that it can also help with hot flushes and sleep problems.

Antidepressants. The NHS treatment page says that if you have low mood, depression or anxiety caused by perimenopause or menopause, you may be offered antidepressants. It lists them among the non-hormonal treatments, which it describes as options if HRT doesn’t work for your symptoms, you can’t take it, or you don’t want to.

Every treatment has its own benefits and risks, and what’s right for one woman isn’t right for another. Talk to your GP before starting, stopping or changing any medicine.

Things you can try yourself

The HSE suggests that to ease mood changes, you try to:

get plenty of rest, including keeping to a regular sleep routine
do relaxing activities, such as yoga, tai chi or meditation
make time for things you enjoy
exercise regularly, which the HSE says releases endorphins that help your mood
talk to other people going through the same thing, such as family, friends or colleagues

Because hot flushes can bring on anxiety, the HSE’s advice on hot flush triggers may help too: it suggests cutting down on spicy food, caffeine, hot drinks, smoking and alcohol, and trying to reduce stress.

A word on supplements: the NHS says there is very little evidence on how well herbal remedies such as red clover and black cohosh work, or how safe they are, and some can cause serious side effects alongside other medicines. The HSE advises talking to a GP before taking herbal supplements.

When to see your GP

The HSE says to talk to your GP if you experience low mood or depression, or if your symptoms are difficult. The NHS says early advice can help reduce the effects of perimenopause and menopause on your health, relationships and work.

Also see your GP if:

you have palpitations
you’re under 45 and have menopause symptoms, or your periods have stopped for a year or more before 45 (both are on the HSE’s list of reasons to talk to your GP)
you have any bleeding from the vagina after menopause, even spotting, which the HSE and NHS both say needs checking

If your GP can’t help, the HSE says you may be referred to a specialist, for example if treatment isn’t working or you can’t have HRT. In Ireland there are complex menopause clinics at several hospitals, listed on the HSE’s treatment page.

Ireland and the UK

The advice above is much the same in both countries. In Ireland, start with your GP; HRT is free at participating pharmacies with a medical card or Drugs Payment Scheme card (our guide explains how). In the UK, start with your GP or practice nurse; the NHS also says you can talk to a pharmacist about HRT and other options.

What to do next

Track it for a few weeks. Note when the anxiety comes, how you slept, any hot flushes or palpitations and, if you still have periods, where you are in your cycle. Patterns help your GP.
Book a GP appointment and say plainly that you think it may be linked to perimenopause. Ask: could this be hormonal? Would HRT, CBT or another treatment suit me? What are the benefits and risks for me?
Pick one or two small changes from the HSE’s list, such as a regular bedtime or a daily walk, and see how you feel.
Tell someone. A friend, partner or colleague who knows what’s going on can make a hard day easier.

If you’re struggling

If anxiety or low mood is getting too much, please reach out. Talk to your GP. You can call Samaritans free on 116 123, any time, in Ireland and the UK. In Ireland, you can call Pieta on 1800 247 247 or text 50808. In the UK, you can text SHOUT to 85258. In an emergency, call 999 or 112.

What are the different types of HRT?

Mon, 02 Nov 2026 00:00:00 GMT

HRT (hormone replacement therapy) comes in two main kinds: combined HRT, which has oestrogen and a progestogen, and oestrogen-only HRT, which is usually for women who have had their womb removed. Combined HRT is taken either in a monthly cycle (if you still have periods) or every day without a break (if your periods have stopped). And you can take it in several ways: tablets, skin patches, gel, spray, or with a hormone coil, plus vaginal oestrogen for local symptoms. Your GP will help you choose, and it’s normal to try more than one before you find what suits you.

The hormones in HRT

As you approach menopause, your levels of the hormones oestrogen and progesterone fall. The HSE explains that HRT replaces them, which can help with hot flushes, night sweats, sleep problems, anxiety and low mood, and vaginal dryness.

There are two main ingredients:

Oestrogen is the main hormone that eases symptoms. The NHS says the type most commonly used in HRT is called estradiol.
Progestogen is the name for progesterone and medicines that act like it. Its main job in HRT is to protect your womb.

A doctor may also sometimes prescribe testosterone, which we cover below.

Combined HRT or oestrogen-only?

This depends mostly on whether you still have your womb.

If you still have your womb, you need both oestrogen and a progestogen. The NHS explains that oestrogen on its own can thicken the womb lining, which slightly increases the risk of womb cancer, and the progestogen protects against that. The HSE says most women are prescribed combined HRT. You can get it as one product with both hormones, or as two separate products, for example an oestrogen patch or gel with progestogen tablets.

If you’ve had a hysterectomy (an operation to remove the womb), both the HSE and NHS say oestrogen-only HRT is recommended.

Cyclical or continuous: the two routines

Combined HRT comes in two routines, and which one you’re offered depends on where you are in the menopause.

Sequential (cyclical) combined HRT is usually recommended if you have menopause symptoms but still have periods. The NHS describes it as oestrogen every day with a progestogen added for the last 10 to 14 days of each cycle. You should get a bleed at the end of each progestogen phase. Both the HSE and NHS say to talk to your doctor if that bleed doesn’t come.

Continuous combined HRT means taking oestrogen and progestogen every day without a break. It’s usually recommended once you’re post-menopausal, which means you haven’t had a period for 1 year. If you start on sequential HRT, your GP may suggest switching to continuous combined later on.

If you’re on oestrogen-only HRT, you take it every day.

The different ways to take HRT

This is where most of the choice is. Here’s what the HSE and NHS say about each form.

Tablets. Usually taken once a day, and available as oestrogen-only or combined. They may be the easiest option. However, both the HSE and NHS say some risks of HRT, such as blood clots, are higher with tablets than with patches, gel or spray, although the overall risk is still small.

Patches. You stick a patch on your skin below the waist and change it every few days, depending on the brand. They come as oestrogen-only or combined. Unlike tablets, patches don’t increase your risk of blood clots. They can be handy if you find tablets hard to swallow or easy to forget. The downsides: they may not stick well, especially on moisturised skin, and can leave redness or irritation.

Oestrogen gel. You smooth it onto your skin once a day. It doesn’t increase your risk of blood clots, though it can take 5 minutes or more to dry. If you still have your womb, you’ll need a progestogen alongside it.

Oestrogen spray. One to 3 sprays on the inner arm or inner thigh, once a day. Like gel, it doesn’t increase your risk of blood clots, and you need a progestogen with it if you have a womb. You can get dressed 2 minutes after spraying but should wait an hour before a bath or shower.

The Mirena coil (an IUS). An intrauterine system is a small device placed in your womb that slowly releases a progestogen called levonorgestrel. It can provide the progestogen part of combined HRT if you’re using oestrogen tablets, patches, gel or spray. It can stay in for up to 5 years and also works as contraception. It can cause tummy pain and bleeding.

Vaginal oestrogen. This comes as a cream, gel, vaginal tablet or pessary (the NHS also lists a ring), used inside the vagina for dryness, burning or pain during sex. Both the HSE and NHS say it doesn’t carry the usual risks of HRT and doesn’t increase your risk of breast cancer, and you can use it without a progestogen even if you still have your womb. It won’t help with hot flushes, mood swings or sleep, though, so some women use it alongside other HRT.

If you’ve had blood clots in the past, the HSE notes you may need patches or gels rather than tablets. This is exactly the kind of thing to go through with your GP.

Testosterone and tibolone

Testosterone also falls around menopause, more gradually. Both services say it isn’t currently licensed to treat menopause symptoms, but a doctor can prescribe it (the HSE calls this “off label”, which it says does not mean the medicine is unsafe). It’s usually only considered if you’re post-menopausal, have a low sex drive and HRT alone hasn’t helped. It comes as a gel. The NHS says more evidence is needed on whether it helps other symptoms.

Tibolone (brand name Livial) is a daily tablet that works like combined HRT with a testosterone-like effect. It’s only suitable if your last period was more than a year ago, and the HSE and NHS note it may not be as effective as combined HRT.

Finding the type that suits you

The NHS says it’s normal to try different brands and methods before finding one that suits you. According to the HSE, you’ll usually start on a low dose, and any side effects are usually mild and pass within 3 months. The NHS adds that HRT can take up to 3 months to work fully, and that common side effects such as headaches, breast tenderness and vaginal bleeding usually improve in the first few months.

The HSE says a GP will usually review your treatment 3 months after you start, or after you change type, and then about once a year. If your symptoms don’t improve, the options include changing the dose or type, or a referral to a menopause specialist.

HRT isn’t suitable for everyone. The HSE lists situations where it may not be, including a history of breast, ovarian or womb cancer, a history of blood clots, untreated high blood pressure and liver disease. Your GP will weigh up the benefits and risks for you personally. Please don’t start, stop or switch HRT without talking to your GP or pharmacist first: the HSE notes that if you stop, your symptoms may come back.

Ireland and the UK

In Ireland, HRT is free on prescription at participating pharmacies if you have a medical card or a Drugs Payment Scheme card, as the HSE explains (see our guide Can I get HRT for free in Ireland?). In England, an HRT prescription prepayment certificate can cut the cost; that guide covers it too. The types of HRT described here are the same on both sides of the Irish Sea.

What to do next

Note what matters most to you. Write down your main symptoms, whether you still have periods (and when your last one was), and anything about your health history such as blood clots, cancer, high blood pressure or liver disease.
Ask your GP these questions, some of which the HSE suggests: which type would suit me and why? Would a patch or gel be better for me than tablets? How soon should I feel better? What are the benefits and risks for me? How long might I take it?
Give it time, then go back. Keep a simple diary of symptoms and side effects for the first 3 months, and bring it to your review.
Contact your GP about unexpected bleeding. The HSE says to see your GP about any bleeding from the vagina after menopause, even spotting. And if you’re on sequential HRT and the expected bleed doesn’t come, both services say to talk to your doctor.

What are the signs of perimenopause?

Sun, 01 Nov 2026 00:00:00 GMT

Perimenopause is the time before your periods stop, when your hormone levels are changing and symptoms begin. The most common signs are changes to your periods, hot flushes and night sweats, trouble sleeping, mood changes such as anxiety or low mood, and problems with memory or concentration, often called brain fog. According to the HSE, symptoms can start 7 to 10 years before your periods stop, so they can begin well before your periods actually stop.

Perimenopause and menopause: what’s the difference?

The terms get mixed up a lot, so here’s how the HSE and NHS use them:

Perimenopause is when you have symptoms but your periods haven’t stopped completely.
Menopause is reached when you haven’t had a period for 12 months. The HSE says this usually happens between 45 and 55, and the average age in Ireland is 51.
Postmenopause is the time after that.

It happens because your ovaries make less oestrogen and stop releasing an egg each month. Symptoms don’t always stop when your periods do: the HSE says most last around 4 years from your last period, while around 1 in 10 people have them for up to 12 years. The NHS says symptoms usually last 7 to 9 years, sometimes longer. Both agree it’s different for everyone.

Changes to your periods

Often the first thing women notice is that their periods change. The HSE and NHS describe:

cycles getting shorter or longer
periods that are lighter or heavier than usual
periods lasting more or fewer days
skipped periods, which the HSE says are common

Physical signs

Between them, the HSE and NHS list a wide range of physical symptoms, including:

hot flushes and night sweats: sudden heat in the face, neck and chest, sometimes with a racing heart, anxiety or dizziness
trouble sleeping
headaches, and migraines that are worse than usual
heart palpitations, where your heartbeat feels faster, slower or more noticeable
joint aches, muscle pains and loss of muscle
weight gain, which the NHS says often happens around the stomach and upper body
vaginal dryness, itching or discomfort, and pain during sex
lower sex drive
urine infections (UTIs) that keep coming back, and needing to pee more often
thinning hair, dry or itchy skin
sensitive teeth or sore gums

Lower oestrogen also affects your bones: both services note a higher risk of osteoporosis (weak bones) after menopause.

Mood and mind

These signs are easy to put down to stress or a busy life. The HSE lists low mood, anxiety, mood swings, low self-esteem and irritability, as well as problems with memory and concentration. The NHS also mentions depression and brain fog.

If your mood has dropped a lot or you’re finding it hard to cope, please don’t wait it out. Talk to your GP.

How is perimenopause diagnosed?

There isn’t one single test. The HSE says your GP can usually confirm it based on your symptoms, and may suggest a blood test to check your hormone levels.

The NHS adds two useful points. Hormonal contraception can make it hard to tell whether you’ve reached perimenopause or menopause. And you can still get pregnant during perimenopause, so the NHS advises using contraception until 1 year after your last period if you’re 50 or over, or 2 years after if you’re aged 40 to 49.

When to see your GP

The HSE suggests contacting your GP if:

your symptoms are worrying you or affecting your daily life
you’re having symptoms before the age of 45
your periods have stopped for a year or more before 45

Around 1 in 100 women reach menopause before 40, which is called premature ovarian insufficiency. Early menopause can also follow surgery to remove the ovaries or some cancer treatments, and symptoms can be stronger when it happens suddenly.

The NHS also suggests seeing your GP if you have palpitations, or if your bleeding pattern has changed and you’re bleeding more rather than less.

Bleeding after menopause always needs checking. If you haven’t had a period for 12 months or more and then have any vaginal bleeding, contact your GP, even if it’s only once, only spotting, or pink or brown discharge. The NHS says it’s not usually serious, but it can be a sign of cancer, which is easier to treat if found early.

What to do next

Keep a note of your symptoms for a few weeks: what you notice, when, and how it affects your day, along with your period dates. It makes a GP appointment far more useful.
Book a GP appointment if your symptoms are getting in the way of work, sleep or relationships, or if you’re under 45. Bring your notes and ask directly whether this could be perimenopause and what your options are.
Don’t ignore bleeding after menopause, or periods that are getting much heavier. Ring your GP.
Read up on the treatment options before your appointment so you can ask good questions, and remember that your GP or pharmacist is the right person to advise on what suits you.

Can I get HRT for free in Ireland?

Sun, 01 Nov 2026 00:00:00 GMT

Yes. If you live in Ireland and have a prescription for HRT (hormone replacement therapy) to treat menopause symptoms, the State pays for the medicine and the pharmacy’s dispensing fee. The one thing you need first, unless you have a medical card, is to be registered for the HSE’s Drugs Payment Scheme. The GP visit to get the prescription is still something you pay for yourself.

What the free HRT scheme covers

According to the Department of Health’s page on the free HRT measure, the State meets the cost of HRT medicines and products and the dispensing fees. It covers any HRT medicine or product that the HSE already reimburses, so there isn’t a separate short list to check: if it’s an HSE-reimbursable HRT product, it’s in.

“Menopause” is used broadly here. The Department says it includes:

perimenopause (the years of symptoms before your periods stop)
post menopause
early and premature menopause
induced menopause, for example after surgery or some cancer treatments

The HSE announced in June 2025 that people can now get free HRT if they have been prescribed it, alongside a new pharmacy finder.

What it doesn’t cover

The scheme covers the medicine, not the appointment. The Department of Health is clear that GP or other medical consultations related to menopause are not included. So the visit where HRT is discussed and prescribed is paid for in the usual way.

Who qualifies

The Department’s page lists two conditions. You need to:

Have a valid prescription for HRT, from your GP or another healthcare provider, for menopause symptoms.
Be signed up to the HSE Drugs Payment Scheme (DPS), unless you have a medical card.

The Drugs Payment Scheme is an HSE card you register for once. It’s easy to miss this step, and the HSE says you need the card to get free HRT.

The pages we read don’t set an age limit. If your situation is unusual, your pharmacist or GP can tell you whether your prescription qualifies.

How to get your HRT for free, step by step

Register for the Drugs Payment Scheme if you don’t have a medical card. The HSE says you can apply online and you’ll need your full name, date of birth, PPS number and contact details.
Talk to your GP about your symptoms and whether HRT suits you. HRT isn’t right for everyone, and your GP will go through the options, benefits and risks for you personally.
Find a participating pharmacy. Not every pharmacy has signed up. Use the HSE’s HRT pharmacy finder, linked from the Department of Health’s page, to find one near you.
Hand in your prescription and your DPS details, and the HRT and dispensing fee should be covered.

If a pharmacy tells you that your product isn’t covered, ask them to check whether it’s on the HSE’s reimbursement list. If it isn’t, your GP may be able to suggest an equivalent that is.

If you live in the UK instead

The rules are different across the water. In England, the NHS offers an HRT prescription prepayment certificate (HRT PPC). The NHS Business Services Authority says it costs a one-off £19.80 (the price of two single prescription items) and covers an unlimited number of certain HRT medicines for 12 months.

A few things worth knowing about it:

It only covers HRT medicines that are licensed to treat menopause in the UK, so check your medicine is on NHSBSA’s list.
Other prescriptions aren’t included. If you also get several non-HRT items, NHSBSA says a standard 3 or 12-month PPC may save you more.
It isn’t refundable once bought, and you can start it up to a month before or after the day you buy it.
You can buy it online or at some pharmacies.

The HRT PPC is part of NHS England’s help with health costs. If you live in Scotland, Wales or Northern Ireland, check your own nation’s NHS website for how prescription charges work there.

What to do next

Check you’re on the Drugs Payment Scheme. If you’re paying for HRT in Ireland and don’t have a medical card, registering could be the only thing standing between you and free HRT.
Look up a participating pharmacy before your next repeat prescription, so you’re not caught out at the counter.
Book a GP appointment if you think you’re in perimenopause and haven’t talked about treatment yet. Write down your symptoms and questions beforehand so you get the most from the visit.
In England, compare what you spend on HRT over a year with the £19.80 certificate. If you’re on more than one HRT item, it usually adds up quickly.

As always, talk to your GP or pharmacist before starting, stopping or changing any HRT.

What is PMDD, and how is it different from PMS?

Sun, 01 Nov 2026 00:00:00 GMT

PMDD (premenstrual dysphoric disorder) is a much more severe form of PMS. The symptoms are similar, but the NHS says they are much more intense and can have a much greater effect on everyday life, including feeling very anxious, angry, depressed or even suicidal in the weeks before a period. It is a recognised condition, and there are treatments that can help.

What is PMS?

PMS (premenstrual syndrome) is the name for symptoms that can come in the weeks before a period. The NHS says most women have PMS at some point. Common symptoms include:

mood swings, or feeling irritable, low, upset, anxious or emotional
tiredness or trouble sleeping
bloating or cramping
breast tenderness
headaches
spotty skin or greasy hair
changes in appetite or food cravings

For most people these are annoying but manageable.

How PMDD is different

The NHS says a small number of women get the more severe form, PMDD. The mental health charity Mind describes it as causing a range of emotional and physical symptoms every month in the week or two before a period. It’s sometimes called “severe PMS”, but that can undersell it.

What sets it apart is how much it affects your life. Symptoms the NHS links with PMDD include:

feeling very anxious, angry or depressed
suicidal thoughts
headaches, and joint and muscle pain
overeating
sleep problems

Mind notes that PMDD is listed as a mental health condition in the DSM-5, one of the main manuals doctors use to diagnose mental health problems.

Why the timing matters

PMDD follows your cycle. Mind explains that it happens between ovulation and the start of your period, known as the luteal phase, which lasts around 2 weeks for most people. You might have symptoms every day of that time, or just for a few days of it.

That pattern is the key clue. If your mood drops sharply at the same point every month, it’s worth tracking.

It isn’t fully clear what causes PMDD. The NHS says it has been linked to being very sensitive to changes in hormones, or to differences in the genes you inherit.

Getting a diagnosis

The NHS suggests keeping a diary of your symptoms for at least 2 menstrual cycles and taking it to a GP appointment. Note:

the date your period starts each month
each symptom and how strong it is
how it affects your day, your work and your relationships

A clear diary showing symptoms that rise before your period helps your GP see the pattern. The International Association for Premenstrual Disorders (IAPMD), which focuses on PMS and PMDD, also has a symptom tracker and information on the steps to diagnosis.

Treatments the NHS lists

What helps varies from person to person. The NHS suggests starting with:

regular exercise
a healthy, balanced diet; some people find smaller meals every 2 to 3 hours better
plenty of sleep
ways to reduce stress, such as yoga or meditation
painkillers such as ibuprofen or paracetamol for pain
not smoking, and not drinking too much alcohol

If that isn’t enough, the NHS says a GP may suggest:

hormonal medicine, such as the combined contraceptive pill
cognitive behavioural therapy (CBT), a talking therapy
antidepressants

If symptoms continue after trying these, you may be referred to a specialist such as a gynaecologist, psychiatrist or counsellor.

The NHS says there isn’t much evidence that complementary therapies or supplements work for PMS, and advises checking with a GP or pharmacist before taking regular supplements alongside other medicines.

Every treatment has pros and cons, so talk to your GP about what suits you before starting, stopping or changing anything.

What to do next

Start a symptom diary today and keep it for at least two cycles. A free tracker app or a notebook both work.
Book a GP appointment and bring the diary. Say plainly how much it affects your life. If you think it’s PMDD, use the word.
Tell someone you trust about the pattern, so they understand what’s happening and can support you on the hard days.

If you’re struggling

If PMDD is making you feel hopeless or you’re having thoughts of suicide, you don’t have to wait for your next period to pass. The NHS says to call 999 or go to A&E if you have PMDD symptoms and are feeling suicidal. You can also talk to your GP, or call Samaritans free on 116 123, any time, in Ireland and the UK. In Ireland, you can call Pieta on 1800 247 247, or text 50808 to talk to someone by text. In the UK, text SHOUT to 85258. In an emergency, call 999 or 112.