Knowing what to do is not the same as knowing what to do first, or when. This is the same advice as everywhere else on this site, arranged as a sequence — one or two things a month, in the order that makes each step easier than it would have been alone.

Where we stand: Menova is an independent publication. We sell no plans or programmes, we are not your doctor, and this is general education, not medical advice. Adapt the timing to your life; the order is the useful part.

Before month one

If any of these apply, do them now rather than working through the sequence:

  • Bleeding after twelve months without periods — any amount
  • A new breast lump, or a skin or nipple change
  • Persistent bloating, most days for three weeks or more
  • Rectal bleeding, or a lasting change in bowel habit
  • An irregular pulse
  • Any thoughts of harming yourself — seek help immediately

The full list is in symptoms most often misread as menopause.

Month 1 — measure, and get the bloods

Start recording. Five things a day: bleeding, hot flashes (day and night), wakings, mood out of five, and one note. Four weeks of this changes every appointment that follows — our free 30-day symptom tracker is exactly that.

Book one appointment and ask for: full blood count, ferritin, thyroid, B12, HbA1c, vitamin D, plus blood pressure. These rule out the conditions that imitate the transition, and every one is treatable — see where to start.

Not hormone panels. For women over 45 they are advised against for diagnosis — see was that my last period.

Nothing else this month. Do not buy supplements before you know what is low.

Month 2 — sleep, and the treatment conversation

You now have a record and results. This is the month to use them.

Treat the sleep. If night sweats are waking you, that is a treatable medical problem and it sits upstream of mood, cravings, concentration and patience. Nothing else in this plan works well on four broken hours — see night sweats in perimenopause and menopause insomnia.

Have the treatment conversation properly, armed with counts. Hormonal, non-hormonal, or both — see HRT risks and benefits, non-hormonal prescription options, and what actually happens at a menopause appointment.

Correct any deficiency found, with a plan for when it will be rechecked.

Month 3 — the genitourinary bit

The one that gets deferred and should not, because unlike hot flashes it progresses without treatment.

If you have any dryness, urinary urgency, discomfort during sex, or recurrent urinary infections, ask about local vaginal estrogen. It is low-dose, acts locally, suits many women who cannot take systemic hormones, and takes three months to judge — see how to use vaginal estrogen and GSM and urinary changes.

Also this month: if you leak, ask for pelvic health physiotherapy. Self-referral is possible in many places — see leaking when you exercise.

Month 4 — start lifting

By now you are sleeping better and any deficiency is being corrected, which is why this comes fourth rather than first — it is much easier from here.

Twice a week, five movements, progressively heavier. Squat, hinge, push, pull, carry. Two or three sets of six to twelve. If you have never lifted, two or three sessions with a trainer solves the "I don't know what to do" problem — see starting from zero or using a gym in midlife.

This is the intervention that protects bone, and bone loss is fastest in exactly these years — see bone health in menopause.

Add protein, particularly at breakfast, where nearly everyone falls short — see how much protein you need.

Month 5 — the long game numbers

Lipids and HbA1c, if not already done, alongside blood pressure. Three numbers, one visit, and they cover most of what changes silently in this decade — see cholesterol after menopause and blood pressure and menopause.

Mention pre-eclampsia or gestational diabetes in any pregnancy, and early menopause if it applies. Both are recognised markers of later cardiovascular risk and nobody asks.

Check your screening is current — cervical, breast, bowel. Cervical screening does not stop at menopause — see health screening in your 50s.

Bone density, if you have risk factors — early menopause, a previous fragility fracture, long-term steroids, low body weight, or a parent who fractured a hip.

Month 6 — review, and the two cheap levers

Review the treatment. Twelve weeks at a settled dose is the point to judge it. Partial response is common and adjustable — see is my dose too high or too low and what to change when HRT isn't working.

Compare your record against month one. This is the only reliable way to know what worked.

Alcohol. Worsens sleep, hot flashes, mood, blood pressure and long-term risk, and its effect in midlife is larger than most women expect — see alcohol in midlife.

Contraception, if you might still conceive — twelve months after your last period if over 50, two years if under — see contraception in perimenopause.

What is deliberately not in the plan

  • Supplements, before the blood tests. Most have weak evidence and the money is better spent — see what the supplement research says
  • Private hormone panels
  • Buying anything in month one
  • Changing several things at once, which makes it impossible to tell what helped
  • Permanent decisions about work during the worst months — see menopause and career decisions

Why this order

Each step makes the next easier.

The record makes the appointment productive. The bloods stop you treating the wrong thing. Sleep makes everything else tolerable. The genitourinary treatment goes early because it is the one that worsens with delay. Lifting comes once you have the energy for it. The long-game numbers get a baseline while you are already in the system. And the review is only meaningful because month one exists.

Doing them in a different order still works. Doing month four first, on no sleep and low ferritin, usually does not.

Our free printable visit prep sheet is what each appointment runs on, and the free 2-minute Menova self-check gives you the month-one baseline — no account, not a diagnosis, and your answers never leave your device.

This article is general education, not medical advice. Report the symptoms listed at the top to a licensed clinician promptly. Treatment decisions belong with a clinician who knows your history.

Sources: NICE NG23 — Menopause, The Menopause Society, ACOG — The Menopause Years, and NHS — Menopause.