Your last period doesn't announce itself. You only know a year later.

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.

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.

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.

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.

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.

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.

IMS says HRT has no direct effect on midlife weight. It may have small favourable effects on body composition, but it is not prescribed for weight loss or body reshaping. Weight and fat distribution can change because of age, sleep, activity, medicines and hormonal changes; some people notice temporary fluid retention.

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.

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. Outside those patterns, and with any very heavy bleeding, bleeding after 12 months without a period needs prompt assessment.

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.

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; NICE notes that when the recommendation was made, this was an off-label use.

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.

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.

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.

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.

Usually between 45 and 55. Between 40 and 44 it is called early menopause. Under 40, symptoms and absent or infrequent periods may point to premature ovarian insufficiency; NICE recommends confirming it with raised FSH on two blood tests taken 4 to 6 weeks apart. Menopause can also come earlier after removal of the ovaries, chemotherapy or radiotherapy.

No. Any vaginal bleeding after at least 12 months without a period needs a doctor to assess it, even if it is light or happens once. The exception is systemic HRT in women with a uterus: some sequential regimens include planned bleeds, and bleeding can be common in the first 6 months or in the first 3 months after a change of dose or preparation. After those windows, unscheduled bleeding needs prompt checking.