Managing Menopause + Perimenopause

Menopause + Perimenopause

Unfortunately, perimenopausal and menopausal symptoms are something all women will inevitably experience in mid/later life, with some women suffering from symptoms far worse than others. But you don’t have to struggle with this alone – there is a whole wealth of help and advice available on perimenopause and menopause to support women through this potentially difficult time. At London Doctors Clinic, our experienced GP’s offer comprehensive and fully confidential advice for women struggling with all women’s health and menopause-associated issues.

What is Perimenopause?

Perimenopause, while not discussed as often, is the initial stage of menopause marked by changing female hormones, typically in mid-30s to mid-50s. This transitionary period is usually when menopause symptoms start and can last for years. Perimenopause can bring on common symptoms such as:

  • Irregular periods
  • Hot flushes
  • Vaginal dryness

While fertility decreases during perimenopause, contraception is advisable if not planning more children. Menopause is confirmed after 12 consecutive months without a period.

What is Menopause?

The menopause is a natural process which occurs as a woman stops menstruating (having periods.) It is caused by declining levels of a hormone called oestrogen. It usually occurs between the ages of 45 to 55.

The ovaries are female reproductive organs which produce and release eggs. The ovaries are responsible for producing the hormones oestrogen and progesterone. These hormones work together to regulate the monthly menstrual cycle. A decline in oestrogen due to the natural ageing process will lead to the cessation of menstruation; the menopause.

Symptoms of Menopause

Symptoms can vary enormously from person to person but they commonly include:

  • Hot flushes
  • Night sweats
  • Vaginal dryness and pain during sexual intercourse
  • Mood changes (eg. anxiety, low mood)
  • Difficulty sleeping
  • Reduced libido (sex drive)
  • Urinary incontinence


What is premature Menopause?

Menopause usually affects women aged 45-55. Premature menopause occurs when a woman experiences cessation of menstruation before the age of 40. This can be caused by primary ovarian insufficiency, where the ovaries fail to produce enough of the hormone oestrogen. This means eggs are not produced by the ovaries, leading to infertility.

Symptoms of premature menopause are similar to those of the menopause. Your pituitary gland (a gland which is attached to the brain) produces more follicle-stimulating hormone (FSH) in response to low oestrogen. Testing your levels of this hormone can be used to determine if you are undergoing premature menopause.

If you are under 40 and think you are experiencing menopausal symptoms, you can arrange a 15-minute appointment with a GP, costing just from £89 at any London clinics. You will be assessed and blood tests can be performed. This can help diagnose or exclude premature menopause if appropriate.


Menopause symptoms seen in women under 40 is known as premature menopause


Risks Associated with Menopause:

Cardiovascular disease

Oestrogen is a hormone which protects against cardiovascular disease, so there is an increased risk of coronary artery disease, stroke and peripheral arterial disease after menopause as oestrogen levels fall. If you are worried about your cardiovascular risk, speak to one of our Private GPs about your concerns. A cholesterol test for triglycerides and cholesterol levels can be arranged to determine if action needs to be taken.


Osteoporosis, which is a reduction in bone density, is caused by the decrease in oestrogen levels following menopause. Osteoporosis leads to an increase in the risk of bone fractures. Lifestyle measures which can help reduce your chances of developing osteoporosis include ensuring an adequate intake of vitamins and minerals. These lifestyle measures include calcium consumption (around 700mg/day), exercising regularly, stopping smoking and reducing alcohol intake. Increasing your vitamin D levels by spending some time in the sun is also important to maintain strong healthy bones.

X-Ray fracture menopause

Bones are easily fractured in patients suffering from Osteoporosis, commonly seen in post-menopausal women

If you are not sure whether you are getting enough calcium and vitamin D, at LDC we can facilitate a vitamin deficiency test, and supplements can be prescribed if necessary. Simply arrange an appointment with one of our Private GPs to discuss whether this is appropriate for you.

Treatments and Therapies

For some women, perimenopause and menopause symptoms can greatly affect their quality of life. There are many treatments which can provide relief from these symptoms. Some treatments are associated with potential risks and side effects and may not be appropriate for certain groups of patients. Our GPs can help determine which treatments are appropriate for you and will be able to explain their potential risks and benefits.

Hormone Replacement Therapy (HRT)

HRT works by replacing oestrogen in the body to help relieve menopausal symptoms. An additional hormone called progesterone is usually given alongside oestrogen if you have an intact uterus.

HRT exists in several forms including tablets, patches, gels and creams. During a consultation with one of our Doctors, they can decide which would be the best form of treatment for you.

Any HRT treatment will need to be reviewed annually by your GP.


Oestrogen or combined oestrogen-progesterone tablets are available. They can help to alleviate menopausal symptoms such as night sweats and hot flashes. There are risks associated with tablet HRT that apply to certain groups of women. These include a slightly increased risk of blood clots, strokes and breast cancer. One of our GPs would be able to discuss whether these risks apply to you when considering this treatment.

Transdermal patches and gels

If you prefer not to take tablets, transdermal patches are a convenient alternative option. They can be applied to your skin and only need to be replaced a couple of times a week. An oestrogen gel applied daily to the skin is an alternative.


Transdermal patches are a convenient way of administering HRT

Vaginal Oestrogen Creams

Vaginal oestrogen creams can be usedlocally to relieve vaginal dryness and urinary incontinence. Simple lubricants and moisturisers can also be prescribed.

Treatments for low mood and anxiety

The psychological symptoms of perimenopause and menopause can be very troubling for some women. Our doctors may recommend psychological interventions, such as cognitive behavioural therapy (CBT), or sometimes they may suggest an antidepressant medication which can be particularly effective in managing these symptoms during menopause.


It's important to remember you are not alone during this period of your life. Reach out to friends and family for support or a healthcare professional. If you would like to speak to one of our GPs about how to manage the symptoms and risks associated with menopause, book online for a 15 or 30-minute consultation at one of our central London clinics.