Your questions
Your questions, answered
Her Vitals answers the specific questions UK women ask about perimenopause, menopause and HRT in plain English, with each answer tied to a named source such as the NHS, NICE NG23 or gov.uk. The aim is to explain what is normal, what to watch for and when to see a GP or menopause specialist. This is general information, not medical advice.
Can you have perimenopause without hot flushes?
Yes. Hot flushes are common but not universal, and they are not needed for recognition. The other symptoms the NHS lists, and how NICE NG23 recognises perimenopause.
Is waking with anxiety at 4am a menopause symptom?
Early waking and night-time anxiety can be part of the change. Why sleep and anxiety feed each other, and what the NHS and NICE say can help.
Is irregular bleeding on HRT normal?
Often expected in the first few months, but when unscheduled bleeding needs to be checked, under NICE NG23.
My pharmacy is out of my HRT, what now?
Serious Shortage Protocols, asking other pharmacies, and why you should not simply stop. Cited to the NHSBSA and gov.uk.
Can I get HRT over the counter?
The one product you can buy without a prescription, Gina vaginal oestrogen, who it is for, and why whole-body HRT still needs a prescription.
Can a Mirena coil mask perimenopause?
How a coil can hide the change in your cycle, why it does not stop other symptoms, and how it can also be part of HRT.
Can my GP refuse HRT because of a family history of breast cancer?
Why a family history is a factor in a shared decision, not an automatic bar, under NICE NG23, and what to do if you feel refused without discussion.
Where to go next
For symptom-by-symptom detail see the menopause symptoms hub, read the longer evidence-led guides, or look at how prescribing varies across the UK on our HRT prescribing tracker.
Last reviewed June 2026. This is general information, not medical advice, and is not a substitute for a registered clinician. For your own situation, speak to your GP or a menopause specialist.
Editor, Her Vitals
Oliver leads Her Vitals's editorial coverage of women's life-stage health and supplements. He curates and reviews existing branded products across trying to conceive, pregnancy, postnatal, perimenopause, menopause and the senior years, weighing what the evidence supports against guidance from bodies such as EFSA, the NHS and NICE, and is clear that the content is information rather than medical advice.
Last reviewed: 27 June 2026