What changes in the body
The ovaries gradually release fewer eggs, while hormone levels fluctuate and then fall. This can change cycles and cause symptoms affecting temperature regulation, sleep, mood, vaginal tissues, muscles and bones.
Medical information · clearly explained
The complete guideto perimenopauseand menopause
What changes, which symptoms may occur, how diagnosis works and which options exist. A final menstrual period can only be named 12 months later.
Educational information based on guidance from The UK National Institute for Health and Care Excellence. It publishes clinical guidance based on evidence assessment. and The European Society of Endocrinology, a professional medical society that publishes guidance on hormones and endocrine glands.. Evidence searched to 15 July 2026. No independent clinical review.
0
luni de la ultima menstruație
First, the essentials.
Perimenopause and menopause describe stages of the same biological process. The experience, duration and need for treatment vary greatly between people.
When and why it can happen
Menopause usually happens between ages 45 and 55. It can happen earlier spontaneously, after the ovaries are removed, chemotherapy or radiotherapy; sometimes the cause remains unknown.
What you can do now
Track symptoms and cycles. Regular sleep, physical activity including strength exercise, a balanced diet and identifying hot-flush triggers may help. Discuss supplements with a doctor or pharmacist, and ask for help when symptoms affect your life.
The 90-second map
One process, several landmarks.
The transition varies greatly between people. The calendar helps with definitions; symptoms and their impact guide the conversation about care.
before point zero
Perimenopause
Perimenopause is the beginning of the transition. Cycles may change and symptoms can begin years before the final menstrual period.
point zero, seen in hindsight
Final menstrual period
On the day it happens there is no certain label. Confirmation comes after 12 months, in the absence of another explanation.
after 12 months
Menopause
The term describes this clinical landmark. Hormonal contraception, hysterectomy and some treatments can make the calendar harder to interpret.
the years that follow
Postmenopause
Some symptoms ease and others continue. Bone, cardiovascular, sexual and urinary health remain part of routine care.
You can ask for help before 12 months.Treatment can be discussed for symptoms and their impact without waiting for menopause to be confirmed.
Pregnancy remains possible in perimenopause.Hormone replacement therapy: treatment with oestrogen, sometimes combined with a progestogen. is not contraception. Contraceptive needs are discussed separately.
Menopause can happen earlier.Ages 40–44 are classed as early menopause; under 40, premature ovarian insufficiency is assessed.
What matters for diagnosis
Age changes the role of tests.
A single hormone result may capture one day in a fluctuating process. History, cycles, symptoms and medical context are essential.
45+
Usually a clinical diagnosis
In otherwise healthy people, NICE recommends identifying perimenopause or menopause from symptoms and cycle changes, without routine laboratory tests.
40–45
Follicle-stimulating hormone, measured with a blood test. Its level can fluctuate during perimenopause. may have a role
At this age FSH can be considered alongside symptoms and cycle changes. Assessment also looks for other possible explanations.
<40
Assess for premature ovarian insufficiency
NICE requires symptoms and two raised FSH results 4–6 weeks apart. One test does not establish the diagnosis.
The symptom constellation
There is no single experience.
Choose an area. The guide shows patterns associated with menopause and a useful next topic for an appointment; it does not establish the cause.
12
Ciclul își poate pierde regularitatea.
Menstruațiile pot veni mai devreme sau mai târziu și pot deveni mai ușoare ori mai abundente. Sângerarea neobișnuită are nevoie de evaluare; schimbarea nu trebuie atribuită automat perimenopauzei.
Pentru consultație: notează datele, durata, abundența, cheagurile, durerea și orice sângerare între menstruații sau după contact sexual.
Symptoms can be mild or severe, brief or long-lasting. Some people have few symptoms; others experience major effects on work, relationships and sleep.
The brain in transition
Brain fog has recognisable forms.
Cognitive changes are commonly reported during perimenopause. They are usually mild, but can affect work, confidence and daily life.
The word is on the tip of your tongue
It may take longer to retrieve a familiar word, name or number.
You lose the thread more easily
Distractions can interrupt a conversation, reading or a task that used to flow naturally.
Information does not stay long enough
It can be harder to hold a code, a step or the reason you entered a room briefly in mind.
Appointments and details slip
You may forget a meeting, a date or part of a recent conversation.
In studies, average performance usually remains within normal limits.
The most consistent changes are in verbal learning and memory; effects on attention and working memory are more modest or less consistent. The experience is real, but brain fog does not establish a dementia diagnosis.
fragmented sleephot flushes and sweatsanxiety or depressionstressmedicinesthyroid disease or anaemia
Treatment addresses symptoms and contributing factors. HRT can be discussed for menopause symptoms when appropriate, but it is not prescribed solely to improve cognition or prevent dementia.
Options follow the symptom
A conversation with several paths.
Treatment is chosen through shared decision-making, based on what bothers you, medical history, anatomy, risks, preferences and local availability.
HRT is a family of decisions
Route, combination and timing matter.
The label ‘hormone therapy’ covers different treatments. Benefits and risks should be discussed for the actual formulation and the actual person.
In the comparisons below, HRT containing oestrogen and a progestogen. The progestogen protects the lining of the uterus from the effects of oestrogen. means oestrogen plus a progestogen.
Uterus presentSystemic oestrogen is combined with a progestogen to protect the endometrium.
Total hysterectomyA progestogen protects the lining of the uterus, called the endometrium, from the effects of oestrogen. After a total hysterectomy there is no uterus, and NICE recommends oestrogen-only HRT. may be offered when HRT is appropriate.
Oral or transdermalNICE says venous thromboembolism risk rises with oral HRT and does not rise with HRT delivered through the skin, usually as a patch, gel or spray. Oestrogen enters the bloodstream through the skin. The route matters because NICE says venous thromboembolism risk does not rise with transdermal HRT, unlike oral HRT.; dose, age and medical history remain relevant.
Local or systemicVaginal oestrogen treats genitourinary symptoms locally; it is not equivalent to systemic treatment for hot flushes.
ContraceptionHRT does not prevent pregnancy. Contraception is decided separately.
Benefits and risks in absolute numbers
Breast cancer: the difference in 1,000 women.
NICE estimates new cases between ages 50 and 69. Every bar uses the same scale, from 0 to 100 cases per 1,000.
estimated breast cancer cases between ages 50 and 69
no HRToestrogen + progestogenoestrogen only
UK population estimates, not personal predictions. Use starts at age 50 and risk is measured over 20 years. The NICE graph combines continuous and sequential combined regimens.
Composition changes risk
Breast cancer risk rises with combined HRT and with duration. NICE describes little or no increase with oestrogen alone. Sequential combined HRT carries less risk than continuous combined HRT, but more than no HRT.
Route changes other risks
Transdermal treatment matters mainly for blood clots and stroke. It does not remove the effects of composition and duration on breast cancer risk.
Personal risk starts elsewhere
Age, family history, alcohol, weight and medical history change baseline risk. A personal history of breast cancer requires individual discussion, sometimes with the oncology specialist.
NICE says evidence is still insufficient to establish whether micronised progesterone or dydrogesterone carries a different breast cancer risk from other progestogens.
HRT is the most effective option for hot flushes and night sweats in eligible people and reduces fracture risk while it is taken. Overall, NICE says HRT is unlikely to affect life expectancy.
Open the full NICE discussion aidA tool for your appointment
Turn difficult days into a useful clinical story.
Select what you want to discuss. The note is created only in your browser; the page does not send or save your answers.
When not to wait
Some signs have their own medical pathway.
Menopause is not an automatic explanation for every symptom appearing in midlife.
Call emergency services
Chest pain with breathlessness; facial droop, affected speech or movement; severe bleeding with fainting or severe dizziness; immediate risk of self-harm. A mental health emergency is as serious as a medical emergency.
Seek prompt medical assessment
Any bleeding after at least 12 months without a period, bleeding after sex, very heavy bleeding, new symptoms under 45, or persistent adverse effects after starting treatment.
Frequently asked questions
The questions people ask most often.
Short answers about duration, tests, contraception, HRT, weight, memory and sexual health.
Can symptoms begin while I am still having periods?
Yes. Perimenopause happens before the final menstrual period, and symptoms may begin while periods continue. If the pattern is unusual or symptoms do not fit, assessment should also look for other causes.
How long can symptoms last?
The NHS estimates that symptoms usually last 7 to 9 years, sometimes longer, and may change over time. Vaginal dryness, urinary symptoms or joint pain can continue after menopause.
How can I tell where I am if I use a hormonal coil or have had a hysterectomy?
Hormonal contraception can make periods irregular or stop them. A hysterectomy stops periods but does not automatically cause menopause if the ovaries remain. A clinician uses age, symptoms, the type of surgery or treatment and, only in selected situations, an FSH test, which measures follicle-stimulating hormone.
Is an at-home menopause test useful?
Home tests measure FSH, or follicle-stimulating hormone. A positive result does not confirm menopause, and a negative result does not rule out perimenopause. The test does not show fertility or tell you when contraception can stop. After age 45, NICE usually recommends clinical identification without routine hormone tests.
Can I still become pregnant, and when can I stop contraception?
Ovulation can still occur during perimenopause, and HRT is not contraception. Do not stop contraception because of symptoms or a home test. Timing depends on age, the method used and the date of the last natural period, so agree it with a doctor or pharmacist.
Can I start hormone therapy (HRT) during perimenopause?
Yes, if symptoms are troubling and treatment is suitable for you. You do not need to wait for 12 months without a period. The regimen depends on whether you have a uterus, your cycle pattern, medical history and preferences.
Does HRT cause weight gain?
There is little evidence that most types of HRT cause weight gain. Weight and fat distribution can change in midlife for several reasons, including age, sleep, activity and hormonal changes. Some people notice temporary fluid retention.
How quickly does HRT help, and how long can I use it?
Some symptoms may improve within a few weeks; the full effect can take up to 3 months. NICE recommends a review at 3 months and then annually. There is no single duration for everyone: benefits, risks and the need to continue are reviewed, and symptoms may return after stopping.
What bleeding is usual after starting HRT?
For people with a uterus, vaginal bleeding can be common during the first 6 months of systemic HRT or during the first 3 months after changing the dose or preparation. Seek prompt medical help if it occurs beyond these timeframes. Very heavy bleeding or any bleeding after 12 months without a period needs assessment.
Can I use HRT if I have migraine, clot risk or a history of cancer?
These medical histories change the discussion, but they do not all have the same answer. Transdermal treatment through a patch, gel or spray may matter for clot risk, and a personal history or high risk of breast cancer requires individualised options and menopause expertise. Tell your clinician about migraine, blood pressure, liver disease, clots, cancer, heart disease or stroke before choosing treatment.
Can vaginal dryness, painful sex, urinary symptoms or low desire be treated?
Yes. Vaginal moisturisers, lubricants and low-dose vaginal oestrogen have different roles, and symptoms may return if local treatment stops. Sexual desire can be affected by pain, sleep, mood, relationships and medicines. NICE says testosterone can be considered for low sexual desire associated with menopause when HRT alone has not helped.
Does brain fog mean dementia is starting?
Concentration problems and forgetfulness are commonly reported during the transition and do not establish a dementia diagnosis. Poor sleep, depression, anxiety, thyroid disease, anaemia and medicines can contribute. Progressive or severe change, or change affecting safety, deserves assessment. HRT is not prescribed to prevent dementia.
Are ‘bioidentical’ hormones or natural supplements safer?
Unregulated compounded hormones sold as ‘bioidentical’ have not been shown to be safer or more effective than authorised medicines; dose, purity and safety may be uncertain. Authorised medicines containing hormones identical to human hormones are a different category. Herbal products can interact with other medicines, so discuss them with a doctor or pharmacist.
What should I monitor for long-term health?
Keep up with screening recommended for your age and history. Routine appointments can cover blood pressure, cardiovascular and diabetes risk, bone health, fractures, muscle strength, smoking, alcohol and physical activity. Tests are chosen according to personal risk factors and national recommendations.
Does HRT cause breast cancer?
HRT is not a single treatment. Combined HRT raises breast cancer risk, and the increase is greater with longer use. NICE describes little or no increase with oestrogen alone. Personal risk also depends on age, family history, alcohol, weight and medical history; the comparison per 1,000 women above shows the estimated magnitude and does not predict an individual outcome.
Evidence and limits
You can check the route.
This guide synthesises clinical guidance and official patient information. It does not replace medical assessment or confirm availability of every treatment in Romania.
Searchup to 15 July 2026
Main guidelinesNICE 2026 · ESE 2025
JurisdictionsUnited Kingdom · European Union
Clinical reviewNo independent clinical review has yet taken place
01
NICE · Menopause: identification and management (NG23)
Definitions, diagnosis, management, HRT benefits and risks. Updated 15 April 2026.
02
European Society of Endocrinology · Clinical Practice Guideline
Evaluation and management of menopause and perimenopause in Europe. Published 13 October 2025.
03
NHS · Menopause and perimenopause
Public information on symptoms, treatment, contraception and bleeding. Reviewed May 2026.
04
EMA · Veoza (fezolinetant)
European authorisation, product information and warning on liver injury and liver-function monitoring.
05
FDA · Menopause home-use tests
What at-home FSH tests measure and why they do not confirm menopause, fertility or when contraception can stop on their own.
06
NICE · HRT discussion aid
Absolute risks per 1,000 people for breast, ovarian and endometrial cancer, cardiovascular outcomes, fractures and dementia.
07
International Menopause Society · Brain fog in menopause
Clinical white paper on memory, attention, contributing symptoms, dementia concerns and brain health in midlife.