What's actually happening to your hormones in your 40s

What you might notice in your 40s

Perimenopause is a word you may start to hear in your 40s. It is the name used for the years leading up to your last period, and it looks different for everyone. Some women notice very little. Others notice changes that come and go in a way that can feel unpredictable and confusing.

You may find that one week you feel like yourself, and the next you are sleeping badly, snapping at people you love, and forgetting why you walked into a room. Changes to your periods, sleep, mood, energy, concentration and interest in sex are all things women in this decade mention, along with hot flushes and night sweats.

If any of this sounds familiar, you are not imagining it, and you do not have to put up with it quietly. Keeping a note of what you notice and talking it through with your GP is a good place to start.

Changes you might notice

Tiredness that does not lift

Not ordinary tiredness, but a deep, heavy exhaustion that stays with you however long you spend in bed. Some women describe this as one of the hardest changes to explain to other people. If it sounds familiar, it is worth noting down how long it has been going on and raising it with your GP.

Sleep disruption

You may find it harder to fall asleep, or that you wake in the small hours and cannot get back to sleep. Some women mention vivid dreams, or night sweats that wake them more than once. A simple sleep diary, noting when you went to bed, when you woke and what woke you, can be useful to take to an appointment.

Concentration and memory

Losing a word halfway through a sentence. Walking into a room with no idea why. Finding it harder to focus on things that used to come easily. Some women in their 40s describe this as brain fog. It can be unsettling, and it is worth mentioning to your GP alongside anything else you have noticed, rather than assuming it is just stress.

Mood changes

Irritability that feels out of proportion. Anxiety without an obvious cause. Low mood that comes and goes, tearfulness, or a sense of not being yourself. These are real experiences, not personal failings, and they are worth talking about. If your mood is low and not lifting, please see your GP. If you ever have thoughts of harming yourself, ask for urgent help the same day.

Changes in weight and shape

Some women notice their shape changing in their 40s, often with more weight around the middle, and find that the eating and exercise habits they relied on in their 30s no longer feel the same. If you are concerned about weight change, particularly if it has happened without an obvious reason, it is worth raising with your GP.

Interest in sex

Some women notice less interest in sex in their 40s, or find that sex feels different or uncomfortable. It is not something you simply have to accept, and it is an ordinary thing to bring up with your GP or a practice nurse.

Hot flushes and night sweats

Sudden waves of heat, often with flushing, sweating and a racing heart, which can come at any time of day or night. Not every woman has them, and they vary a great deal from person to person. Noting when they happen and anything that seems to set them off can be useful when you talk to your GP.

Talking to your GP about blood tests

You do not need a blood test before asking for help. If you are wondering whether tests would be useful, your GP can talk through which tests, if any, make sense for you, and what the results mean for you alongside your age, your symptoms and your history.

If you choose a home blood test, it is worth taking the results with you to your GP rather than drawing conclusions from them on your own. Whatever a result says, describe all of your symptoms, not just the ones you think match it.

Before your appointment, it helps to write down when things started, how often they happen, what makes them better or worse, what your periods have been like recently, and everything you take, including medicines, contraception and supplements.

Habits worth trying and options to discuss

Talking to your GP about HRT

Hormone replacement therapy, usually called HRT, is one of the treatment options your GP can talk through with you. Every woman's situation is different, so it is worth asking about the different types and ways of taking it, what the benefits and risks might be for you in particular, how it fits with your own and your family's health history, and how it would sit alongside any contraception you use.

It can help to go in with your symptom diary and a short list of questions. If you would like a longer conversation, you can ask whether there is a GP in the practice with a particular interest in menopause, or ask about a referral to a menopause clinic.

Strength work and movement

Regular movement and strength work are worth making part of your week. A couple of strength sessions a week, using weights, body-weight exercises or a class, alongside walking or other activity you enjoy, is a reasonable aim. If you have a health condition or have not exercised for a while, check with your GP or a qualified instructor first.

Keeping alcohol modest

Keeping alcohol modest, and having some alcohol-free days each week, is worth trying, particularly if you have noticed that sleep or mood feel harder after a drink. The same goes for keeping caffeine to earlier in the day. A regular sleep routine, a cool dark bedroom, and layers you can take off in the night are also worth trying if night sweats are waking you.

If you are thinking about supplements

If you decide to take a supplement, read the label carefully. Look at the amount of each nutrient in one daily serving and the percentage of the reference intake it provides. If you take more than one product, check whether the same nutrient appears in several of them, so you can see the total you are taking. Tell your pharmacist or GP about everything you take, especially if you are on HRT, contraception or any other medicines.

In Great Britain, companies may only describe what a nutrient does using wording taken from the official register of authorised health claims. If a product seems to promise more than that, it is worth being cautious.

When to see a specialist

• If your periods have become much heavier or more frequent, or you have bleeding that is unexpected for you
• If you have bleeding between periods or after sex
• If changes in sleep, mood, concentration or energy are getting in the way of everyday life, or your mood is low and not lifting
• If you would like to talk about treatment options, including HRT
• If a home blood test result has left you with questions
• If you first noticed these kinds of changes before your 40s

Your GP is the place to start, and can refer you to a menopause clinic or specialist if that would be useful. If you would like to see a menopause specialist privately, the British Menopause Society website has a directory of specialists.