"You're perimenopausal," my doctor told me during a routine physical check a few years ago. At the time, I remember thinking to myself, "That’s impossible, I’m only 41 years old, it must be something else."
But as soon as I started listing off all of the emotional and physical changes that had been taking place since the last time I saw her, things started making sense.
The good news: I finally had an answer to why I was experiencing headaches, night sweats, weight gain (specifically in the midsection), and increased anxiety and depression. The bad news: my doctor told me this could go on for another 10 years before I reach menopause.
What is perimenopause?
Simply put, perimenopause means 'around the time of menopause' and refers to the time during which your body makes the natural transition to menopause.
Many of the changes you experience during perimenopause are a result of decreasing oestrogen.
GP and menopause expert, Dr. Louise Newson, says that if you are experiencing menopausal symptoms but still having periods, then you are perimenopausal. You can expect to go through this "pre" menopausal stage for about four years; however, some women can experience anything from a few months to 10 years of symptoms. Perimenopause ends when a woman has gone 12 consecutive months without having a period.
"Most women begin to experience the symptoms of perimenopause in their mid 40s, with the average being 47," says gynaecologist Dr Harpreet Brar of Detroit Medical Center (DMC).
The average age of the menopause is 51 years; however, perimenopause or menopausal transition occurs in the years before your periods stop.
Symptoms of the perimenopause
Most women will experience some form of perimenopausal symptoms prior to the menopause.
Brar recommends keeping a record of the symptoms related to menopause. She suggests documenting changes to your periods and any other bothersome symptoms you are experiencing. This will help your doctor develop an individualised treatment plan.
Perimenopausal symptoms can include:
When you have a normal period, the levels of oestrogen and progesterone increase and decrease in a regular pattern. But during perimenopause, your hormone levels are all over the place. As a result, you may have irregular bleeding or spotting. Some months, your period may be longer and heavier. Other months, it may be shorter and lighter. The number of days between periods may increase or decrease, and you may begin to skip periods. This irregular bleeding is not abnormal. But if your bleeding is very heavy, occurs more often than every three weeks, or lasts much longer than normal, you should contact your doctor.
Hot flushes are the most common perimenopausal symptom. According to Brar, they are characterised as a sudden onset of heat and warmth beginning in the chest and face. They are often accompanied by sweating and last on average two to four minutes. Hot flushes can occur daily or even hourly.
Newson says that many women find they wake up several times each night and are "drenched" with sweat and need to change their bed clothes and bed linen.
Mood swings, irritability or increased risk of depression may happen during perimenopause.
Problems with your sleep can be exacerbated by hot flushes.
Vaginal dryness and changes in sexual function
Problems with vaginal dryness and intercourse are another common complaint in perimenopausal women. Newson points to a drop in hormone levels for a reduced or absent libido (sex drive). This can also be related to low testosterone levels in your body.
Fluctuating oestrogen levels may be at least partly to blame for the pounds that tend to appear out of nowhere.
Headaches and migraines can get worse as hormones fluctuate.
A fuzzy head
Focus and concentration take a hit during this transition.
Newson explains that low levels of oestrogen can lead to many of your joints feeling stiff and aching.
How to manage perimenopausal symptoms
At some point, you will experience symptoms related to perimenopause. While you cannot control whether or not your body goes through these changes, you can find ways to manage the symptoms.
1. Move your body
Staying active and eating healthy foods are beneficial for every phase of perimenopause. Aim for five days a week of 30-60 minutes each day of aerobic and strength training exercise. This will also help reduce the raised risk of osteoporosis that comes with the menopause
2. Make healthy food choices
Nutrition in the form of whole foods (quality protein, vegetables, fruits, complex carbohydrates, and good fats) will help keep blood sugars level. And eliminating or reducing alcohol, caffeine, and sugar may also help reduce symptoms. This can help stabilise moods, and fight fatigue, belly bloat, and weight gain. Ideally, tailor your diet to relieve your symptoms.
3. Medications to try
Some doctors use drug therapy to treat symptoms. This includes hormone replacement therapy, vaginal oestrogen, and antidepressants.
In addition to the general tips listed above, the following tips can help manage specific symptoms:
4. Alleviate hot flushes
Hot flushes are generally managed conservatively with dressing in layers, personal fans and avoiding irritants such as spicy foods. However, moderate to severe symptoms may require medication.
5. Sleep better
Treating hot flushes can help alleviate some of these sleep disturbances.
6. Use lube
Brar recommends using personal lubricants but she also notes that these issues often require oestrogen therapy, usually limited to vaginal oestrogen replacement.
Many women who experience milder symptoms may be able to manage any discomfort on their own. But if you find that you are unable to get relief, it may be time to visit your doctor to talk about other options.