Hot flushes get the attention, but many women reach their forties and fifties with a different list: aching hands and knees, waking at three in the morning, a short fuse, a foggy head, a drop in interest in sex, and a sense that they no longer feel like themselves. These are often treated as separate problems, or put down to stress and getting older.
Oestrogen has roles well beyond the menstrual cycle. It influences joint and tendon comfort, sleep quality, mood regulation, skin and the lining of the bladder and vagina. As levels become erratic in perimenopause and then fall, any of these can change, often before periods stop. That is why symptoms can begin years earlier than women expect, and why they do not always arrive in the textbook order.
None of this means every symptom is hormonal. Thyroid problems, low iron, low vitamin D, sleep apnoea, depression and medication effects can look very similar, and joint aches may have their own cause. A good assessment keeps these on the table rather than assuming menopause is the answer to everything.
We start with a conversation about your pattern, periods and health history, then examine and test only what is useful. Blood hormone levels fluctuate and are not always needed to recognise the transition, whereas checks for thyroid, iron and blood pressure often are. Management is tailored: sleep and activity measures, treatment of local symptoms, and a clear discussion of the benefits and risks of hormone therapy for you specifically, if it is something you wish to consider.
If your symptoms are affecting work, relationships or sleep, that is reason enough to be seen. You do not need to wait for periods to stop first.
THE FIT CLINIC is on the 8th Floor of EM Tower, EMSPHERE, 628 Sukhumvit Road, a short walk from BTS Phrom Phong, open daily 10:00 to 19:00. No referral is needed; book on LINE @thefitbkk, +66 92 294 6555, or bkkgyne@gmail.com. Consultations are in English or Thai, and an interpreter in another language can be arranged with advance notice if you ask on LINE when booking.