Perimenopause: why we need to talk about it

Frustrated by night sweats? Tired and teary, but too young to be menopausal? It could be the perimenopause

Feel as though your emotions are on a roller-coaster ride (one minute you’re on top of the world, the next you’re plunging earthwards)? Hot flushes even when it’s chilly? Irregular periods driving you crazy? And as for your concentration levels… erm, what was I saying?

If you’re in your 40s and recognise some or all of the above, you’re not ovaryacting (sorry!). It could be your hormones fluctuating as you make the transition to menopause. This stage, known as the perimenopause, is when you could experience the start of some menopausal symptoms.

‘But I’m only 40. Surely I’m a long way off the Big M?’ we hear you cry. Over to GP Dr Juliet McGrattan†. ‘The perimenopause – or menopause transition – is less discussed than the menopause itself, but it usually starts in a woman’s 40s, although very occasionally, it can begin earlier,’ she explains. ‘During the process lots of natural hormonal changes occur, including the ovaries gradually making less oestrogen in the run-up to the menopause.’

The perimenopause  – and perimenopause symptoms – are different for everyone and, on average, it can last from three to four years. It ends when you reach the menopause, which is when you’ve had 12 consecutive months without a period. This happens, on average, at age 51. (FYI, if you’re under 40 and haven’t had a period for a year, this may indicate an early menopause and you should speak to your GP.)

But as every smart woman knows, knowledge is power. ‘Some of us sail through this time and don’t realise it’s happening. However, for others, those shifting hormones can be a pretty big deal when it comes to our wellbeing,’ says Dr McGrattan. So the more you know, the better your chances of minimising any possible effects – now and in the future. Here are some helpful pointers…

It’s not you – it’s your hormones

So just how do you know if you’re going through the perimenopause? A red flag (pun intended) could be a change in your menstrual cycle, such as lighter, heavier or irregular periods.

But what can be even trickier is dealing with emotions-gone-haywire. ‘Many women struggle with this,’ says Dr McGrattan. ‘Anxiety, mood swings and irritability can all become a problem. One reason for this could be that oestrogen can have an effect on serotonin – the body’s happy hormone.’


"Anxiety, mood swings and irritability can all become a problem"

On top of this, you might start to get menopause-style symptoms such as hot flushes. And there’s the possibility of night sweats, which may affect your sleep. What’s to blame? A decline in oestrogen and progesterone is thought to affect your body’s temperature control. Other menopausal symptoms, including vaginal dryness, insomnia and aching joints – to name a few – can also become a nuisance.

Although this is a natural stage in every woman’s life, it’s crucial to seek expert advice if you have any concerns about something that’s not right. ‘If you have bleeding between periods or after sex, or anything is unusual with your breasts, energy, or general health, see your GP,’ advises Dr McGrattan.

You don’t need a blood test to confirm it’s the perimenopause. ‘That can be unreliable because hormone levels vary from day to day,’ explains Dr McGrattan. In fact, the National Institute for Health and Care Excellence (NICE) no longer recommends blood tests for this for women over 45, but advises that treatment is based on your symptoms alone.

Don’t let the symptoms get you down

There’s no need to suffer in silence, as there’s plenty of help out there. To ease the hormonal roller coaster, your GP might suggest some suitable options, which could include taking up a relaxing activity, such as yoga, or even prescribing antidepressants if you have been diagnosed with depression.

If you’re struggling with heavy bleeding, an intrauterine system inserted in the womb may be suggested as a way to help reduce your flow. As for night sweats and hot flushes, a low dose of HRT (hormone replacement therapy) to ‘top up’ oestrogen levels may help. Talk it through with your GP, who will point out the pros and cons. You can usually begin HRT as soon as you start experiencing menopausal symptoms, so make sure you speak to your doctor if you have any concerns.

For more ways to stop those, ahem, damp nights, Dr Alanna Hare, a consultant in sleep at the Royal Brompton Hospital, in London, has these suggestions: ‘Keep your bedroom cool, wear a cotton nightie or pyjamas, and avoid potential hot-flush triggers such as spicy food, caffeine, cigarettes and alcohol.’


"Getting more sleep might help to ease some of your symptoms and also regulate your mood"

But what if it’s an AWOL libido that’s keeping you awake? Talking to a counsellor or therapist can help you and your partner work through this time. If the problem stems from sex becoming uncomfortable, there are over-the-counter vaginal moisturisers that may be able to help.

Unfortunately, even though you might have heard or read positive things about bioidentical (aka naturally derived) hormones and their ability to help ease symptoms, there’s no evidence to suggest that they do actually work. ‘If you want to try them, however, first check with your GP or a pharmacist to ensure they won’t react with other medications you might be taking,’ says Dr McGrattan.

How you can boost the feel-good factor

The key point to remember about the perimenopause and its big sister, the menopause is that they need to be viewed in the right way. ‘They’re not illnesses, but stages of life,’ says Kathy Abernethy from the British Menopause Society, and author of Menopause: The One-Stop Guide (Profile). ‘In fact, it can be a great opportunity to take control of your health and change it for the better.’

That’s why experts agree that, as well as talking through concerns with your GP, you should also let this be a cue for making lifestyle changes. ‘Anything that helps you feel perkier, which can include getting to and staying at a healthy weight, giving up smoking, reducing your alcohol and caffeine intake, exercising regularly, doing relaxing activities such as yoga, and getting more sleep, might help ease some symptoms and regulate mood,’ says Kathy. ‘Improving your general health can also help protect against the long-term effects of oestrogen deficiency, which may be a factor in heart disease and osteoporosis.’

Another clever move? Keep a record of the natural patterns of your cycle in your diary or on a phone app – many smartphones have a built-in health app. Or download the Hormone Horoscope app to track your cycle and get a predictive horoscope. Notice you always feel low at a certain time of your cycle? Do whatever healthy things soothe you the most. If that means watching every episode of Friends on Netflix, so be it!

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