menopause that comes and goes

Overview

Menopause that comes and goes usually refers to perimenopause — the time before menopause officially starts. During this stage, your ovaries still produce hormones, but levels rise and fall unevenly. This can cause symptoms like hot flushes, night sweats, and irregular periods that appear, disappear, and then return. It is a natural transition, not a disease.

Yes. Most people who go through menopause experience some symptoms during perimenopause. It is a normal phase of life.

It affects people who have ovaries, usually in their late 40s to early 50s. Some people may start noticing changes in their mid-30s or earlier, especially if they have certain health conditions or treatments.

Symptoms

Common symptoms

• Hot flushes (sudden feelings of warmth)
• Night sweats (hot flushes that happen while sleeping)
• Irregular periods – cycles may become shorter, longer, heavier, or lighter
• Mood changes, such as irritability or low mood
• Brain fog – trouble concentrating or remembering
• Vaginal dryness or discomfort during sex
• Lowered interest in sex
• Sleep problems, even when you are not having night sweats
• Fatigue or low energy

Symptoms in children

• Not applicable – menopause is a stage of female reproductive aging and does not affect children.

Symptoms in older adults

• After menopause, symptoms like hot flushes often ease, but some people continue to have symptoms for years.
• Vaginal dryness and thinning of the bones (osteoporosis) may become more noticeable in later years.

Causes

Main causes

• Natural age-related decline in estrogen and other reproductive hormones
• Hormone levels that fluctuate unpredictably during perimenopause
• Irregular ovulation, which affects periods and symptoms
• Surgical removal of the ovaries or certain cancer treatments can also cause menopausal symptoms

Risk factors

• Family history of early menopause
• Smoking
• Chemotherapy or radiation therapy to the pelvis
• Having your ovaries removed surgically
• Certain medical conditions, such as autoimmune diseases

When to see a doctor

See a doctor urgently if:

• Seek same-day medical care if you have very heavy bleeding, bleeding after sex, severe pelvic pain, or if you are feeling very low and need immediate support.

Book a routine appointment if:

• Make an appointment if your period pattern changes suddenly, your symptoms are bothering you, or you have questions about what is happening.
• It is a good idea to check in with a healthcare professional if symptoms affect your sleep, work, or relationships.

Diagnosis

Healthcare providers usually diagnose perimenopause based on your symptoms, your age, and your period patterns. Blood tests are not always needed, but they may be done to rule out other causes.

Tests that may be done

• A review of your medical history and symptoms
• Blood tests to check hormone levels (like follicle-stimulating hormone, or FSH)
• Thyroid function test, because thyroid problems can mimic menopause symptoms
• A pregnancy test if you are still having periods and are in the age range for menopause

What to expect at your appointment

Your doctor will ask about your symptoms, menstrual cycle, and general health. They may also examine you. This is a normal and helpful conversation – you can bring a written list of your symptoms and questions to make the most of your appointment.

Treatment

Treatment aims to ease bothersome symptoms and support your long-term health. Many options are available, including lifestyle changes and medical treatments. The right plan is personal – what works for someone else may not work for you.

Self-care at home

• Dress in layers so you can peel off a layer when a hot flush starts
• Keep a fan or a cold drink nearby
• Avoid common triggers like spicy food, caffeine, alcohol, and hot rooms
• Practice slow, deep breathing when a flush comes on
• Exercise regularly to help with sleep, mood, and bone health
• Try relaxation techniques like mindfulness or yoga
• If you smoke, consider getting support to quit

Medical treatments

Hormone replacement therapy (HRT) is an option for many people to replace the hormones your body is losing. There are also non-hormone medicines that can help with hot flushes and mood symptoms. Vaginal moisturisers, lubricants, and local oestrogen treatments can help with dryness and discomfort. Your healthcare provider will talk through the benefits and risks of each approach with you.

When is surgery considered?

Surgery to remove the ovaries is rarely the first choice for menopause symptoms. It may be considered if there is another medical reason, such as ovarian cancer or a very high risk of breast cancer, and always after careful discussion with your healthcare team.

Living with this condition

Keep a symptom diary to track when hot flushes happen, what you ate, and how you slept. Patterns become easier to spot, and this information is useful when you speak with your doctor.

Lifestyle tips

• Stay physically active – even a daily walk makes a difference
• Get enough sleep by keeping a regular bed and wake time
• Do pelvic floor exercises to support bladder control
• Limit stress with deep breathing, meditation, or hobbies you enjoy
• Stay connected with people who understand and support you

Diet and exercise

Eat a balanced diet rich in calcium and vitamin D to help keep your bones strong. Good sources include dairy products, leafy green vegetables, and fortified foods. Aim for regular weight-bearing exercise like brisk walking, dancing, or stair climbing – this also helps with mood and sleep.

Mental health and emotional wellbeing

Changing hormone levels can affect your mood and make you feel anxious, irritable, or low. These feelings are common, but they are still worth talking about. If you feel very down or hopeless, please reach out to a healthcare professional. If you are in crisis or thinking about self-harm, contact your local emergency number or crisis support line right away.

Prevention

Menopause is a natural stage of life and cannot be prevented. However, you can reduce the impact of symptoms and protect your long-term health with a healthy lifestyle, especially around diet and exercise.

Vaccines

Stay up to date with your routine vaccinations, such as flu and COVID-19, to protect your overall health.

Screening programmes

Keep up with recommended routine screenings, such as cervical screening (smear test) and breast screening, as suggested by your local health service.

Complications

If left untreated

• Night sweats can disrupt sleep and lead to ongoing fatigue
• Low estrogen over time can increase the risk of bone thinning (osteoporosis)
• Vaginal dryness can make sexual activity uncomfortable and affect relationships
• Mood changes can be distressing if not addressed

Long-term outlook

Menopause is a normal transition, not a threat. Most symptoms ease over time, often within a few years after your last period. With the right support, self-care, and medical help when needed, you can stay healthy, active, and feel like yourself again.

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