Are you going through the perimenopause?

What is perimenopause?

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.

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Women's health

Perimenopause

Perimenopause refers to the transitional phase that occurs before menopause. It typically begins several years before menopause, although the exact duration can vary from woman to woman. During perimenopause, a woman's body undergoes hormonal changes as the ovaries start producing less oestrogen. Symptoms include hot flushes, night sweating, mood changes, vaginal dryness, and changes in libido.

by Dr Hayley Willacy, FRCGP

Symptoms of perimenopause

Most women will experience some form of perimenopausal symptoms before the menopause.

Dr Harpreet Brar, a gynaecologist based in Atlanta, USA recommends keeping a record of the symptoms related to menopause. She suggests documenting changes to your periods and any other troubling symptoms you are experiencing. This will help your doctor develop an individualised treatment plan.

Perimenopausal symptoms can include:

Irregular periods

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.

Hot flushes

Hot flushes are one of the most common symptoms of perimenopause. 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 around 2 to 4 minutes. Hot flushes can occur daily or even hourly.

Night sweats

You may wake up several times each night drenched with sweat and need to change your bed clothes and bed linen. This is known as night sweats.

Mood changes

Mood swings, irritability or increased chance of depression may happen during perimenopause.

Sleep changes

Problems with your sleep during perimenopause can be exacerbated by hot flushes, night sweats, and other uncomfortable symptoms.

Vaginal dryness and changes in sexual function

Problems with vaginal dryness and having sex are another common complaint in perimenopausal women. This may cause a drop in your hormone levels leading to a reduced or absent sex drive - your libido. This can also be related to low testosterone levels in your body.

Weight gain

Fluctuating oestrogen levels may be at least partly to blame for the extra weight that tends to appear out of nowhere, particularly around your midsection.

Headaches

Headaches and migraines can get worse as hormones fluctuate.

A fuzzy head

Focus and concentration can become worse during this transition and may give you 'brain fog'.

Joint pain

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 at least 30 minutes each day - five days a week - of aerobic and strength training exercise. This will also help reduce your chance of developing osteoporosis that comes with the menopause.

2. Make healthy food choices

Nutrition from whole foods - quality protein, vegetables, fruits, complex carbohydrates, and good fats - will help keep blood sugars level. 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 medicine to treat symptoms. This includes hormone replacement therapy (HRT), vaginal oestrogen, and antidepressants.

In addition to the general tips listed above, the following tips can help manage specific symptoms:

4. Alleviate hot flushes

You can try to manage hot flushes on a day-to-day basis by dressing in loose-fitting layers, using a personal fan, and avoiding triggers such as spicy foods.

Moderate to severe symptoms may require a course of treatment.

5. Sleep better

Treating hot flushes can help alleviate some of these sleep disturbances. But practice good sleep hygiene and techniques.

6. Use lube

Brar recommends using personal lubricants, but she also notes that these issues often require oestrogen therapy, which is usually limited to vaginal oestrogen replacement.

How long does perimenopause last?

If you are experiencing menopausal symptoms - but still having periods - then you may be perimenopausal. You can expect to go through this premenopausal stage for around 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 a menstrual period.

Brar says: "Most women begin to experience the symptoms of perimenopause in their mid 40s, with the average age being 47."

The average age of the menopause is 51 years. However, perimenopause or menopausal transition occurs in the years before your periods stop.

Perimenopause is a natural life transition that many women go through. Some 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.