Menopause & perimenopause

Menopausa et perimenopausa · Menopauza a perimenopauza

female only

What it is

Oestrogen production ends; every oestrogen-dependent tissue adjusts, often roughly.

call 112 / 911 now Chest pain, sudden breathlessness or a swollen, painful calf on HRT
see a doctor soon Any bleeding a year or more after your last period
see a doctor soon Bleeding after sex or between periods
see a doctor soon A breast lump, or a change in breast skin or nipple

HRT — the most effective treatment for flushes; the 2002 scare was over-read, and for women starting in their fifties the extra breast-cancer risk is about 1 case per 1 000 women per year of combined use; oral HRT also slightly raises clot and stroke risk (less with skin patches) trials support
Vaginal oestrogen for dryness, with almost no systemic absorption trials support
Fezolinetant — a modest fall in flushes; rare serious liver injury, long-term safety unknown mixed evidence
SSRIs when HRT is not an option — smaller effect mixed evidence
Bone protection trials support
Elinzanetant (Lynkuet) — licensed 2025 in the UK and US; a modest fall in flushes; drowsiness and tiredness are the commonest side effects mixed evidence

Approaches used outside the guidelines, with what their supporters report and what testing has found so far.

Soy isoflavones — meta-analyses show modestly fewer flushes mixed evidence
Black cohosh — trials disagree; rare liver injury mixed evidence
Clinical hypnosis — one trial cut flushes by about 70% mixed evidence
Acupuncture — trials show modest benefit mixed evidence
Evening primrose oil and dong quai — trials found no benefit over placebo for flushes not confirmed in trials
Compounded 'bioidentical' hormones — the same molecules as licensed HRT, but doses vary; no evidence they are safer anecdotal / traditional