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.

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 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 having a period.

Dr Harpreet Brar, gynaecologist at Detroit Medical Center, 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.

Patient picks for Menopause and HRT

Women's health

How to alleviate your menopause sleep problems

Many women experience sleep disturbances during and after menopause, as well as in the preceding years (perimenopause). We ask the experts about how to treat these issues to improve sleep and boost health and well-being.

by Sally Turner

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 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:

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. This irregular bleeding is normal. However, if your bleeding is very heavy, occurs more often than every three weeks, or lasts much longer than usual, you should contact your doctor.

Hot flushes

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 around two to four minutes. Hot flushes can occur daily or even hourly.

Night sweats

Newson says that many women find they wake up several times each night drenched with sweat and need to change their bed clothes and bed linen. This is known as night sweats.

Mood changes

Mood swings, irritability or increased risk 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 intercourse are another common complaint in perimenopausal women. Newson points to a drop in hormone levels for a reduced or absent sex drive - also called 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 pounds that tend 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 take a hit during this transition.

Joint pain

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 30-60 minutes each day - five days a week - 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. 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 (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

Hot flushes are generally managed conservatively with dressing in loose-fitting 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, which is 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.