‘It’s not a blood test. It’s a conversation’: A GP on navigating perimenopause

Hot flushes, hormone changes and health anxiety – is it perimenopause? From cycle chaos to emotional swings, many women find their 30s and 40s come with new, confusing symptoms. Below, a GP and women’s health expert breaks down the signs of perimenopause, and why tuning into your body now could be the smartest thing you do for your future health.

Dr Caoimhe Hartley is a GP and women’s health expert who has spent over 15 years specialising in hormonal care. She now leads women’s medicine at Blackrock Health and the Complex Menopause Clinic at the Rotunda.

In this episode of IMAGE The Check-in podcast, she sits down with host Leonie Corcoran to explore what perimenopause really means, what symptoms to look out for, and how women can take control of their health across the decades.

Understanding the perimenopausal transition

“Menopause is just your final menstrual period,” explains Dr Hartley. “If you go a year without a period, you’re postmenopausal. But perimenopause is the transition.”

During perimenopause, the ovaries begin to function less consistently. Hormone production fluctuates, ovulation becomes less regular, and the reproductive cycle grows increasingly erratic. For some women, that shift comes with physical symptoms, including irregular bleeding, heavier or lighter periods, and increased PMS. For others, it’s emotional or psychological.

“The simplest way to look at it is your ovaries – they produce three different hormones, and they’re responsible for ovulation in your reproductive cycle, and they work in harmony with your brain, which is also producing hormones. And they speak to each other, and it’s a cycle that goes round and round, and that happens throughout most of your reproductive life,” she explains.

Menopause is your last ever period. And if you’ve gone a year with no bleeding, you are post-menopausal, and you will stay that way for the rest of your life… So you have your final period a year later, you’re postmenopausal, and that’s it. In the run-up to that final period, though, we see this change occur.”

The hormonal rollercoaster

“We have to get from having regular ovarian function to having no ovarian function,” Dr Hartley explains. “You don’t just wake up overnight having lost your ovary-brain function… there’s a turbulent crossing.”

She describes hormone production as becoming “more erratic” during this time.

“These big nosedives in hormone production that happen in perimenopause can create a lot of changes in mood and different things,” she says. “It’s a very long list of symptoms, and it’s very, very individual.”

While some women may notice changes in periods – heavier, lighter, closer together, or more spaced out – others are more affected by “worsening of PMS-type symptoms.” And yet, there’s no one-size-fits-all marker.

Getting a diagnosis

Unfortunately, she stresses, no one test or blood test can “confirm” perimenopause.

“We also can’t rely on blood work,” says Dr Hartley. “You’re measuring hormones that are going up and down… Anything where the diagnosis isn’t robust is challenging for clinicians.”

Instead, diagnosis comes from patterns and conversation. “Really, it’s based on really good history-taking, so a good conversation with the patient in front of you.”

And if a patient says something feels hormonal? Dr Hartley says that should be taken seriously: “If somebody says to me, ‘this feels hormonal,’ it probably is, because you’ve been living in your hormones for the last however long. If you feel it’s hormonal, it probably is.”

If symptoms are dismissed

Too often, symptoms are either written off as hormones or completely dismissed despite being hormonal. “We’re awful at sort of dismissing how women report their symptoms – ‘just hormones’ or even not trusting their interpretation of it.”

But at the same time, Dr Hartley stresses that not every issue is hormonal either.

“We can be too quick to label everything as under this umbrella of something hormonal,” she says. “Bloods have a role for younger women to look at alternatives – your thyroid, your full blood count, your iron level – [so we ask ourselves] have we missed something that’s mimicking what we might think is a hormonal symptom?”