Perimenopause, Menopause & HRT
Menopause care starts with understanding the stage, the symptom pattern, and whether HRT is truly appropriate
WHI: Providing doctor-led online assessment for adult women with hot flushes, night sweats, cycle change, sleep disruption, brain fog, vaginal symptoms, low libido, and other midlife hormone-related concerns.
WHI provides assessment-first menopause care for adult women across Portugal and the EU.
The aim is to clarify whether symptoms fit perimenopause, menopause, GSM, another condition, or a mixed picture.
Then decide whether systemic HRT, local treatment, non-hormonal care, further investigation, or onward referral is the safest next step.
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A more careful approach to menopause and hormone therapy
Not every woman with midlife symptoms needs HRT.
Menopause care should begin with a structured assessment, not assumptions.
WHI reviews symptoms, stage, uterus status, bleeding history, medical background, and risk profile before recommending treatment.
Some women benefit from systemic HRT.
Some need local vaginal treatment.
Non-hormonal options, broader investigation, or onward referral better serve some.
Good care depends on getting the diagnosis and treatment logic right first.
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What perimenopause and menopause are
Early perimenopause
Periods are still coming, but cycle pattern, sleep, mood, or early vasomotor symptoms may begin to change.
Late perimenopause
Cycles often become more erratic, symptoms may intensify, and bleeding patterns may become less predictable.
Early postmenopause
Symptoms such as hot flushes, sleep disruption, brain fog, and vaginal symptoms may still be prominent after periods stop.
Later postmenopause
Some symptoms settle, while GSM, vaginal dryness, urinary symptoms, sexual discomfort, and long-term bone and metabolic considerations may become more relevant.
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​Common symptoms and why they vary
Hot flushes and night sweats
Often, the most recognised symptoms are not the only ones that matter.
Sleep disruption
Sleep may worsen directly, or through night sweats, anxiety, and broader hormonal change.
Brain fog and mood change
Poor concentration, irritability, anxiety, and reduced resilience may all appear in the right context.
Cycle change and bleeding change
Periods may become heavier, lighter, more frequent, less frequent, or more unpredictable.
Vaginal and urinary symptoms
Dryness, irritation, burning, pain with sex, and urinary discomfort may become more prominent over time.
Libido and sexual change
Low desire, arousal difficulties, pain, poor sleep, relationship strain, and hormonal change may all overlap.
Why symptoms are not always “just hormones”
Not every midlife symptom is caused by menopause alone.
Thyroid disease, iron deficiency, sleep disturbance, mood disorders, medication effects, metabolic dysfunction, relationship strain, and GSM can overlap with hormonal change.
Good care involves sorting out what is menopausal, what is not, and what is mixed.
When HRT may help
HRT is primarily used to treat menopausal symptoms such as hot flushes, night sweats, sleep disruption, and quality-of-life symptoms related to hormonal change.
In some women, it also plays a role in GSM support, bone protection, and management of symptoms in early menopause or primary ovarian insufficiency.
HRT suitability depends on symptoms, menstrual stage, uterus status, medical history, bleeding pattern, risk profile, and patient preference. WHI reviews these factors before recommending systemic HRT, local treatment, non-hormonal options, or onward referral.
Suitability is individualised.
Not every woman with fatigue, weight change, anxiety, or low libido needs HRT.
Some women need non-hormonal treatment first. Some need local therapy rather than systemic therapy. Some need onward investigation before any hormone decision is made.
When HRT is not appropriate or needs caution
HRT may not be appropriate, or may need extra caution, in women with:
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unexplained vaginal bleeding
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active or recent VTE or stroke
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active liver disease
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certain breast or estrogen-dependent cancer histories
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known thrombophilia without specialist input
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significant cardiovascular complexity
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migraine or vascular risk where route selection matters
Follow-up and monitoring
Good HRT care does not stop at prescribing. WHI reviews symptom response, bleeding pattern, side effects, treatment tolerability, and whether the route or dose should be adjusted. Early review is usually done after the start of treatment, with ongoing follow-up thereafter.
When testosterone is considered in women, and when it is not
Testosterone is not a routine part of HRT for all women.
It may be considered in selected postmenopausal women with persistent low sexual desire after broader contributors such as GSM pain, relationship strain, depression, medications, and sleep issues have been reviewed.
Where used, it requires careful dosing, informed consent, and monitoring.
POI / early menopause distinction
Women with primary ovarian insufficiency or early/surgical menopause often need a different conversation from women entering natural menopause at the usual age.
In these cases, hormone therapy may be more replacement-oriented and has broader implications for symptom control and bone protection.