Menopause and perimenopause: when to see a gynaecologist

What is menopause?

Menopause is the point when your periods stop permanently, defined as 12 consecutive months without a period. The average age in the UK is 51, but it can happen anywhere between 45 and 55. Perimenopause is the transition leading up to menopause, which can last several years and is when most symptoms begin.

Most women experience menopause as a GP-level concern: hot flushes, mood changes, sleep disruption, and a conversation about HRT. But some symptoms cross into gynaecological territory and need specialist investigation.

When menopause becomes a gynaecology issue

A GP can manage most menopause symptoms. You need a gynaecologist when:

• You are bleeding after your periods have stopped. Postmenopausal bleeding (any bleeding after 12 months without a period) should always be investigated. The most common cause is vaginal atrophy (thinning of the vaginal lining), but it can occasionally indicate endometrial changes that need treatment. A pelvic ultrasound and, if needed, an endometrial biopsy or hysteroscopy give a clear answer.
• Your perimenopause bleeding is heavy or erratic. During perimenopause, irregular periods are normal. But very heavy bleeding, flooding, periods lasting more than 7 days, or bleeding between periods can indicate fibroids, polyps, or hormonal imbalance that needs investigation beyond a standard GP appointment.
• You have pelvic pain or pressure. New or worsening pelvic symptoms during the menopause transition can be related to fibroids (which may grow or change as hormones fluctuate), ovarian cysts, or pelvic organ prolapse. A gynaecological ultrasound is the first investigation.
• You need the Mirena coil as part of HRT. The Mirena coil is often prescribed as the progestogen component of HRT. Fitting and removal should ideally be carried out by a gynaecologist, particularly if you have had difficult fittings or anatomical variations.
• You have vaginal dryness, pain during sex, or urinary symptoms. These are caused by declining oestrogen levels and are collectively called genitourinary syndrome of menopause (GSM). A gynaecologist can assess the tissue changes directly and prescribe topical oestrogen or other treatments following consultation.

What we offer

NHS cervical screening still applies through age 64 for most women. If you are due a test or want screening without the wait, you can book a same-day private cervical smear at the clinic.

Perimenopause symptoms

Perimenopause typically begins in your mid-40s, though it can start earlier. The symptoms are caused by fluctuating and declining oestrogen and progesterone levels. Not every woman experiences all of them, and severity varies widely.

• Cycle changes: Periods become irregular, shorter or longer, heavier or lighter. This is usually the first sign.
• Vasomotor symptoms: Hot flushes and night sweats. These affect around 75% of women and can range from mildly annoying to severely disruptive.
• Sleep disruption: Caused partly by night sweats, partly by hormonal effects on sleep architecture. Chronic poor sleep worsens almost every other symptom.
• Mood changes: Anxiety, irritability, low mood, or emotional flatness. These overlap with depression and are frequently misdiagnosed as such, leading to antidepressant prescriptions when hormone support may be more appropriate.
• Cognitive changes: Difficulty concentrating, word-finding problems, poor short-term memory. Often described as "brain fog."
• Musculoskeletal symptoms: Joint stiffness, muscle aches, and reduced grip strength. Oestrogen decline affects connective tissue and bone density.
• Genitourinary symptoms: Vaginal dryness, discomfort during sex, recurrent UTIs, urinary urgency. These tend to worsen over time without treatment because the tissue changes are progressive.

If your GP has attributed these symptoms to stress or ageing without testing your hormones, a private consultation with hormone profiling will give you a clearer picture.

Hormone testing for menopause

The full hormone panel we use includes LH, FSH, oestradiol, prolactin, testosterone, SHBG, and Free Androgen Index. This is more comprehensive than the FSH-only test most GPs offer.

FSH alone can be misleading during perimenopause because levels fluctuate significantly from day to day. Oestradiol alongside FSH gives a much more reliable picture. Testosterone and SHBG matter because testosterone decline contributes to low libido, fatigue, and muscle loss, and SHBG affects how much free testosterone is available.

The hormone panel is included in our Advanced well woman check (£999) and the comprehensive menopause health screen (£1,499). It can also be ordered as a standalone blood test at a GP consultation.

For women still having periods, timing matters: the panel is most informative when taken on days 2-5 of your cycle. Let us know when you book and we will schedule accordingly.

HRT: what we prescribe

We offer body-identical HRT (hormones that are chemically identical to those your body produces) as well as conventional HRT. Options include patches, gels, tablets, and the Mirena coil for progestogen delivery.

HRT is the most effective treatment for vasomotor symptoms (hot flushes, night sweats) and genitourinary symptoms (vaginal dryness, urinary issues). NICE guidelines recommend offering HRT to women with menopausal symptoms and state that for most women, the benefits outweigh the risks when started before age 60.

The choice of HRT type, dose, and delivery method is individualised. Your doctor will consider your symptoms, medical history, personal risk factors, and preferences before recommending a regimen. If HRT is not suitable (for example, after certain breast cancers), alternative approaches are discussed.

NHS vs private menopause care

Frequently asked questions