Spital Clinic offers specialist care for women experiencing perimenopause, the transitional phase leading up to the final menstrual period. Our BMS Accredited doctors provide personalised assessment and evidence-based treatment .British Menopause Society Accredited Doctors.
Book your appointment online or visit us at our City of London clinic, open 7 days a week with same-day appointments available.Our GPs are women's health specialists and British Menopause Society (BMS) Accredited.
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Our BMS Accredited doctors will discuss your symptoms in detail and arrange blood tests or scans where appropriate. They will create a personalised plan which may include HRT or other evidence-based treatments. Any additional investigations will be billed separately.
After your initial assessment, a follow-up appointment allows our specialists to review your progress, check how treatment is working, and make any adjustments needed for optimal results.
The information provided in this article is for educational purposes only and is based on NHS recommendations. It is not a substitute for professional medical advice. Always consult your doctor or a qualified healthcare provider for advice on medical conditions or treatments.
Perimenopause is the transitional phase that leads up to the menopause — the point at which a woman's periods permanently stop. It typically begins in a woman's mid-to-late 40s, though it can start as early as the mid-30s. During perimenopause, the ovaries gradually produce less oestrogen, leading to hormonal fluctuations that can cause a wide range of physical and emotional symptoms. The perimenopause phase can last anywhere from a few months to over a decade.
Unlike menopause itself — which is confirmed after 12 consecutive months without a period — perimenopause is characterised by irregular cycles and unpredictable hormone levels. Women may still ovulate and conceive during this phase, making contraception important. Understanding perimenopause is key to managing symptoms effectively and making informed decisions about treatment options, including hormone replacement therapy (HRT).
Perimenopause is primarily diagnosed through a combination of symptom assessment and medical history. A doctor will ask about changes in your menstrual cycle, hot flushes, sleep disturbances, mood changes, and other symptoms. Because hormone levels fluctuate considerably during perimenopause, a single blood test is not always conclusive, and the NHS does not routinely recommend them for women over 45 presenting with typical symptoms.
For women under 45, or those with atypical or severe symptoms, a follicle-stimulating hormone (FSH) may be used to help confirm the diagnosis. Thyroid function tests may also be requested to rule out conditions such as hypothyroidism, which can mimic perimenopausal symptoms. At Spital Clinic, our Women's Health GPs take a thorough, whole-person approach to ensure an accurate diagnosis and personalised care plan.
Treatment for perimenopause is tailored to the individual and depends on the nature and severity of symptoms. Many women find that lifestyle adjustments — such as regular exercise, a balanced diet, reduced alcohol intake, and improved sleep hygiene — significantly ease perimenopausal symptoms. Cognitive behavioural therapy (CBT) has also been shown to help with mood changes and sleep difficulties during this transition.
For women with moderate to severe symptoms, hormone replacement therapy (HRT) is often the most effective option. According to the NHS, HRT replaces the oestrogen your body is no longer producing in sufficient quantities, helping to relieve hot flushes, night sweats, vaginal dryness, and mood disturbances. For comprehensive gynaecological care and monitoring during perimenopause, our specialists can arrange appropriate investigations. Non-hormonal options such as antidepressants, clonidine, or vaginal oestrogen may be suitable for women who cannot or prefer not to use systemic HRT.
While perimenopause is a universal experience for all women, certain factors can influence when it begins and how severely symptoms present. Genetics play a significant role — if your mother or sister experienced early perimenopause, you may too. Smoking is strongly associated with an earlier onset and more intense vasomotor symptoms. Women with a lower body weight or those who have had certain cancer treatments, such as chemotherapy, may also enter perimenopause earlier than average. Other contributing factors include a history of irregular periods, autoimmune conditions such as thyroid disease, and surgical removal of the ovaries (surgical menopause). Women who have never been pregnant, those with a history of depression, and those with high levels of chronic stress may also be more susceptible to pronounced perimenopausal symptoms. Being aware of these factors can help you and your doctor plan ahead and access appropriate support in good time.
Perimenopause can significantly impact everyday life, and its effects are often underestimated. Symptoms such as poor sleep, brain fog, and low mood can affect concentration at work, while hot flushes and fatigue may disrupt social activities. Intimate relationships can also be affected by reduced libido or vaginal discomfort. However, perimenopause does not have to be endured in silence. With the right support, the vast majority of women manage their symptoms effectively and maintain a good quality of life. Early recognition and personalised treatment can make a substantial difference, and our experienced Women's Health GPs at Spital Clinic are here to guide you through every step.
We provide a comprehensive range of services, from private GP consultations and specialised men's and women's health care to advanced ultrasound scans and proactive health screenings, all within a reassuring and state-of-the-art environment.
You have a question about perimenopause? We have an answer.
Perimenopause can last anywhere from a few months to around 10 years, though the average duration is four to eight years. It ends when a woman has gone 12 consecutive months without a menstrual period, at which point she has reached menopause. The length and intensity of perimenopause varies considerably between individuals and is influenced by genetics, lifestyle, and overall health. Some women experience only mild, short-lived symptoms, while others may find the transition more prolonged and disruptive. Seeking early support can help you manage symptoms more effectively throughout this phase.
Menopause is a universal experience for women. In the United States alone, approximately 1.3 million women reach menopause each year. Globally, the number of postmenopausal women is rising, with women aged 50 and over representing 26% of all women and girls worldwide as of 2021 according to WHO. This demographic shift reflects longer life expectancies, with women living more years after menopause.
Yes — you can still become pregnant during perimenopause, as ovulation continues to occur, albeit irregularly. Fertility declines as you approach menopause, but it does not disappear entirely until 12 consecutive months have passed without a period. For this reason, contraception remains important throughout the perimenopausal transition unless you wish to conceive. If you are unsure which contraceptive method is most appropriate for you during perimenopause, our Women’s Health GPs can advise on safe and suitable options that complement any other treatments you may be receiving.
Adopting healthy lifestyle habits can meaningfully reduce perimenopausal symptoms. Here are some key recommendations:
Quit Smoking: Smoking is associated with earlier onset and more severe perimenopausal symptoms, including worse hot flushes. Quitting can help reduce their frequency and intensity.
Limit Alcohol: Alcohol can worsen hot flushes, disrupt sleep, and contribute to low mood. Reducing your intake may noticeably improve perimenopausal symptoms.
Maintain a Healthy Weight: Hormonal changes during perimenopause can promote weight gain, particularly around the abdomen. A balanced diet and regular physical activity can help maintain a healthy weight and reduce symptom severity.
Exercise Regularly: Regular exercise protects bone density, supports mood, and improves sleep during perimenopause.
Eat a Balanced Diet: A diet rich in calcium, vitamin D, and phytoestrogens supports bone health and helps balance hormones during perimenopause.
Manage Stress: Mindfulness, yoga, and breathing techniques can reduce stress-related symptom flare-ups and support emotional wellbeing during perimenopause.
Consider Supplements: Some women find relief with supplements such as magnesium, black cohosh, or isoflavones. Always consult your doctor before starting any new supplement.
Environmental Adjustments: Dressing in layers, keeping your bedroom cool, and using breathable bedding can help manage hot flushes and night sweats more comfortably.
These lifestyle changes can make a meaningful difference to your wellbeing during perimenopause. Our doctors can help you identify which adjustments are most relevant to your symptoms and circumstances.
Perimenopause and menopause are distinct stages of the same hormonal transition, and it is helpful to understand how they differ:
Perimenopause is the transitional phase before menopause. Oestrogen levels fluctuate and begin to decline, causing symptoms such as irregular periods, hot flushes, and mood changes. Women can still ovulate and conceive during this stage. It typically lasts four to eight years but can be shorter or longer.
Menopause is confirmed after 12 consecutive months without a period. It marks the official end of the reproductive years. The average age in the UK is 51, though it can occur earlier or later.
Postmenopause refers to all the years after menopause is confirmed. Some symptoms may ease, while others such as vaginal dryness or joint discomfort may persist. Long-term health considerations such as bone density and cardiovascular health become increasingly important during this stage.
Understanding where you are in this journey can help you seek the right support at the right time. If you are unsure, our Women's Health GPs can help clarify your stage and guide you through your options.
For most women, HRT is a safe and highly effective treatment for perimenopausal symptoms. Current guidance from the British Menopause Society and NICE confirms that for healthy women under 60 who start HRT within 10 years of their last period, the benefits generally outweigh the risks. HRT can significantly reduce hot flushes, night sweats, mood disturbances, vaginal dryness, and sleep problems, while also protecting bone density.
HRT may not be suitable for women with a personal history of certain hormone-sensitive cancers, blood clots, or stroke. It is essential to have a thorough assessment with a qualified doctor before starting treatment. At Spital Clinic, our BMS Accredited Women's Health GPs will review your full medical history and discuss all available options to find the safest and most effective approach for you.
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"Great experience. Frustratingly we had 3 NIPTs come back with no result so had to do 3 blood redraws but thanks to LPC’s persistence we finally got a result on the 4th draw. After the 3rd no result they also kindly offered us a free anomaly scan."
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"I really recommend this clinic, everything was smooth and perfect. All staff are helpful and our sonographer Miss Shaz is an expert on her job, she is very kind and explained everything that we asked. I am glad to choose LPC."
Our medical centre is at 36 Spital Square, E1 6DY, City of London.
