Perimenopause and menopause usually affect women aged 45 to 55, but they can happen earlier. If they are affecting your day-to-day life, the NHS says to speak to a doctor, nurse or pharmacist about HRT and other options. The symptom list is broader than hot flushes alone.
What the NHS says to treat first
Menopause and perimenopause are a natural part of life. Common symptoms include hot flushes, night sweats, sleep problems, mood swings, anxiety, low mood and vaginal dryness. NICE says people have the right to be involved in discussions and to make informed decisions about their care.
The updated NICE menopause guideline NG23 was published in November 2024 and has a planned review in November 2027. Care is meant to be individualised.
How HRT is matched to your body and history
HRT is still the main treatment for symptom control. The type you are offered depends partly on whether you still have periods and whether you have had a hysterectomy. That changes which hormones are needed and whether the womb lining needs protection.
Oestrogen is the main type of HRT used to manage symptoms, and it can be taken as tablets or used as patches, spray or gel. Oestrogen-only preparations are given to people without a uterus, while combined oestrogen and progestogen preparations are given to people with an intact uterus. If you are still bleeding, have irregular periods, or have had your womb removed, that is the first thing to make explicit in the appointment.
Vaginal symptoms need their own treatment
Vaginal dryness is one of the common symptoms of menopause, and local oestrogen can be used as a cream or pessary for vaginal dryness. That is the right route when symptoms are concentrated in the vagina rather than across the whole body.
Vaginal oestrogen is used specifically to treat vaginal dryness and irritation during menopause. The brand names listed by the NHS are Vagifem, Gina, Ovesse, Estriol and Vagirux. If dryness, irritation or painful sex is the main problem, ask about local vaginal treatment rather than assuming you need full-system HRT.
Vaginal dryness can sit alongside urinary symptoms, including needing to pee more often and recurrent urinary tract infections. If the symptom is local, local treatment is usually the conversation to have.
When HRT is not suitable
HRT is common, but it is not for everyone. If you have had breast cancer, you will usually be advised not to take it. If you cannot take HRT or do not want to, other medicines may still help your menopause symptoms, and the NHS tells you to ask a GP for advice.
One of those options is for hot flushes and night sweats. NICE has recommended fezolinetant, also known as Veoza, for moderate to severe vasomotor symptoms when HRT is unsuitable. That gives women in England a non-hormonal prescription route for symptoms that can dominate sleep, work and concentration when oestrogen is off the table.
Antidepressants are another option, but only for certain symptoms. They can help with mood symptoms if you have been diagnosed with depression or anxiety. They are not a universal menopause treatment, and they are not the first answer for vaginal dryness or urinary symptoms.
What to do while you wait for treatment
Practical support can start before medication is sorted. Lifestyle advice includes regular rest, healthy sleep routines, a balanced diet, calcium-rich foods such as milk, yoghurt and kale, and weight-bearing exercise. Looking after mental wellbeing can also help with symptoms during perimenopause and menopause.
If symptoms are severe, that support is not a substitute for treatment. If you are sleeping badly, struggling at work, or avoiding sex because of pain or dryness, the next step is still a clinical review. Care should be adjusted over time as symptoms change, which means a treatment plan should not stay frozen if it is not working.
How to push for a proper review
If symptoms are being dismissed, go in with the facts that matter: what the symptom is, how often it happens, whether periods are still happening, and whether you have had a hysterectomy. Say clearly if the problem is hot flushes, sleep disruption, mood changes, anxiety, low mood, vaginal dryness or urinary symptoms. The treatment pathway changes depending on which of those are driving the problem.
If access is the issue, there are three entry points: doctor, nurse or pharmacist. Use the appointment you can get, and ask for a menopause-specific review if the first contact is not enough. If you are dealing with vaginal symptoms, ask specifically about local vaginal oestrogen and whether your current prescription matches your stage of the menopause transition. If you are unable to take HRT, ask what non-hormonal option fits your symptoms instead of being sent away with general reassurance.