Perimenopause is the stretch of years before periods stop, and it is where most of the symptoms live. Its symptoms are also easy to put down to stress or a busy stretch of life. Two changes in 2025 have made this a much better conversation to have with a GP.
What perimenopause actually is
Menopause is a single point in time — twelve months after your final period. Perimenopause is everything leading up to it, and it commonly runs for four to eight years. For most Australian women it begins in their mid-forties, though it can start earlier.
During perimenopause, hormone levels do not decline in a tidy line. They fluctuate, sometimes sharply, which is why symptoms come and go and why one month can feel entirely different from the next. Periods often become irregular, heavier or lighter, closer together or further apart.
If your periods stop before the age of 45, or before 40, that is a different situation and it is worth an appointment sooner rather than later — early menopause and premature ovarian insufficiency have implications for bone and heart health that are worth managing. See our women’s health page.
Symptoms worth raising
Hot flushes are the famous one, and plenty of women never get them. The symptoms that most often go unconnected to perimenopause are the ones that look like something else.
Commonly reported in perimenopause
- Hot flushes and night sweats.
- Sleep that breaks up — waking at 3am, awake for an hour, then exhausted all day.
- Mood changes, irritability, anxiety that feels new or out of proportion.
- Brain fog, losing words, difficulty holding a train of thought.
- Periods that change — heavier, closer together, or unpredictable.
- Joint aches and stiffness.
- Vaginal dryness, discomfort with sex, or urinary symptoms.
- Loss of libido.
- Weight changing shape rather than simply increasing.
- Migraines starting or worsening.
If several of these have arrived together in your forties, perimenopause is worth putting on the table. That is not to say everything is hormonal — thyroid problems, iron deficiency, sleep apnoea and depression can all look similar, which is exactly why it is worth being assessed properly rather than guessing.
Do you need a blood test?
Usually not, for diagnosis. In a woman over 45 with typical symptoms and changing periods, perimenopause is diagnosed clinically — from your age, your history and your symptoms. Hormone levels fluctuate so much during perimenopause that a single blood test can be misleading, and a normal result does not rule anything out.
Blood tests do have a role. They are useful in younger women, where the picture is unclear, and to look for the other things that can cause the same symptoms — thyroid function, iron studies and full blood count in particular. Your GP will explain which tests are useful in your case and why.
What helps most is arriving with information. A few weeks of notes about your periods, your sleep and your symptoms is more diagnostically useful than any single blood test.
What changed in 2025
Two things, both practical.
From 1 March 2025, three menopausal hormone therapies were listed on the PBS — the first new MHT listings in more than twenty years. For women who need them, that turned a significant annual out-of-pocket cost into a PBS co-payment. The general PBS co-payment then fell again on 1 January 2026.
From 1 July 2025, Medicare introduced a dedicated menopause and perimenopause health assessment — a longer appointment, claimable once every 12 months, for women experiencing perimenopause or menopause, early menopause or premature ovarian insufficiency. It exists precisely because this conversation does not fit into a standard consultation.
If you have been putting this off because you did not think there was much on offer, both of those changes are worth knowing about. Ask reception for a longer appointment and mention what it is about.
What the options actually are
Treatment is individual, and the honest answer is that it depends on your symptoms, your medical history and what matters most to you. Broadly, these are the categories your GP will work through:
- Menopausal hormone therapy. Australian guidance describes it as the most effective treatment for troublesome symptoms, and several formulations are now PBS-listed. Whether it suits you depends on your history — including any history of breast cancer, blood clots or cardiovascular disease.
- Vaginal oestrogen. A local treatment for vaginal and urinary symptoms, used separately from systemic MHT and suitable for many women who cannot take it.
- Non-hormonal medicines. Several options can help hot flushes, sleep and mood where hormones are not suitable or not wanted.
- Managing the specific symptom. Heavy bleeding, migraine, insomnia and low mood each have their own approaches, and sometimes treating the loudest symptom is the right first move.
- Bone and heart health. Oestrogen affects both. Perimenopause is a sensible point to check blood pressure, cholesterol and, where indicated, bone density.
If you have felt dismissed about these symptoms before, book a longer appointment and say so. There is a lot that can be assessed, and a lot that can be done.
This article is general information for people in the Gosford and Central Coast area. It is not advice about your situation and it does not replace a consultation with your own doctor. If you are worried about a symptom, book an appointment or call us on (02) 4311 3800. In an emergency, call 000.
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