Menopause and perimenopause: what to expect and what helps

Menopause is a normal transition, not an illness — but the symptoms are real and many of them are very treatable. Most South African women reach menopause between 45 and 55, with perimenopausal changes starting several years earlier.

Signs of perimenopause

Cycles becoming shorter, longer, heavier or skipping. Hot flushes and night sweats. Disturbed sleep and daytime fatigue. Mood swings, anxiety, low mood or brain fog. Vaginal dryness, discomfort during sex, or recurrent urinary infections. Joint aches, weight gain around the middle, and hair or skin changes.

What we check

Blood pressure, weight and waist measurement. Blood tests where useful: full blood count, thyroid function, glucose, cholesterol, iron and sometimes hormone levels. Bone health risk, especially with a family history of osteoporosis or early menopause. A pap smear and breast awareness review if you are due. Any bleeding after 12 months without periods is always investigated — do not wait on that one.

What actually helps

Hormone therapy — the most effective treatment for flushes, sweats and vaginal symptoms in suitable women; we screen carefully for risks first. Local vaginal oestrogen — very effective for dryness and recurrent UTIs, with minimal absorption. Non-hormonal medication for flushes and mood where hormone therapy is not suitable. Strength training and weight-bearing exercise for bone and muscle, plus adequate protein. Calcium, vitamin D and sensible alcohol and caffeine limits. Sleep routine and stress management — often the highest-yield change.

Long-term health after menopause

Cardiovascular risk rises after menopause, so blood pressure, cholesterol and glucose deserve annual attention. Bone density falls fastest in the first five years. This is the ideal moment to establish an annual well-woman visit if you do not already have one.

When to book

If symptoms are affecting your sleep, work, mood or relationship, book a consultation. There is a great deal we can offer and no need to simply endure it.