What is Perimenopause?
Perimenopause is the transitional phase in a woman’s life leading up to her final menstrual period. During this time, the body experiences fluctuations and progressive decline in the sex hormones, oestrogen and progesterone in particular. Oestrogen plays a role in several body functions hence the widespread impact of its decline.
Perimenopause is often divided into two stages: early perimenopause stage and late perimenopause. The symptoms can vary and may change or worsen depending on which stage a woman is in.
When to expect Perimenopause?
Perimenopause typically begins in a woman’s 40s, though it can occasionally start as early as the late 30s. It last for an average of 3 – 7 years but can be as short as one year and as long as 10 years. The average age at which menopause (final menstrual period) occurs is age 51yrs.
Research suggests that several factors can influence the timing of menopause, including:
- Hereditary factors (age of menopause in mother or sisters)
- Environmental factors (pollution or exposure to toxins)
- Lifestyle factors (weight and smoking)
5 common symptoms
Perimenopause is characterised by a wide range of symptoms and this can vary from woman to woman, both in terms of their experience and the severity of the symptoms. While hot flashes and irregular periods are widely recognized as key symptoms, there are other common symptoms which are usually the presenting symptoms for most perimenopausal women and cause significant distress.
- Menstrual Irregularities
Menstrual cycles may become shorter or longer, with periods becoming heavier or more prolonged. Some women may also experience new PMS symptoms, such as mood swings, which they may not have had before.
- Sleep Difficulties
Sleep disturbances are very common, affecting about 60–70% of women in perimenopause and can cause a lot of distress. Symptoms include difficulty falling asleep, frequent waking during the night, or being unable to fall back asleep after waking. Sleep difficulties can be an issue on its own but can also be due to hot flashes and night sweats.
- Mood changes
Around 50% of women experience mood changes during perimenopause. Symptoms include increased anxiety, irritability, mood swings, and, in some cases, panic attacks. Depression may also occur, but it’s less common.
- Cognition /Memory problems
Often referred to as “brain fog” or “foggy head,” cognitive issues such as forgetfulness, struggling with learning, and difficulty multitasking are common. These symptoms can cause anxiety about early dementia, but they are typically related to declining oestrogen levels and are generally temporary.
- Hot flushes & Night sweats
Approximately 75% of women experience hot flashes and night sweats during perimenopause. These can range from mild to severe and occur multiple times a day. The severity of hot flashes is often linked to the drop in oestrogen levels in the late stages of perimenopause. Night sweats can significantly disrupt sleep.
Other symptoms that are not any less important, but are not as common, in the earlier phase of perimenopause include vaginal dryness / painful intercourse, weight gain, low libido, heart palpitations, dry/itchy skin, and recurrent urinary tract infections. Rare, lesser-known symptoms, include tinnitus, gum or jaw pain, and burning mouth and loss of taste.
Why treat Perimenopause?
Perimenopause is a natural phase of life and many women are able to cope with it when symptoms are mild.
So, when is treatment warranted? Or why treat perimenopause?
- To ensure the best quality of life: For women whose symptoms significantly impact daily functioning.
- To improve health outcomes as women age: HRT has been shown to not only protect against the symptoms mentioned above, but can also protect against osteoporosis, cardiovascular disease, and possibly reduce the risk of cognitive decline when started early in the menopause transition.
Therefore, as every woman’s experience of perimenopause varies, the best treatment approach considers your background, medical and family history, psychosocial factors, and personal preference. These are then used to develop a holistic and individualised plan for you.
Treatment Options
Broadly speaking, treatment should not solely focus on perimenopause alone but should also support healthy ageing. Options include:
- Medications:
- HRT: this can include oestrogen, progesterone, and testosterone. These therapies come in various forms, such as tablets, patches, gels, creams, and pessaries, and can be combined with contraceptives.
- Non-HRT Medications: These options are typically used to manage specific symptoms and include antidepressants, gabapentin, clonidine, Fezolinetant, and Selective Estrogen Receptor Modulators (SERMs). These are often less broad in scope compared to HRT, but they can be effective for certain women.
- Natural and Nutritional Supplements:
Supplements such as chasteberry (vitex), red clover, black cohosh, and evening primrose have variable benefits and may help some women. Micronutrients like vitamin D, vitamin B6, and magnesium also play important roles in overall treatment.
- Lifestyle Measures:
Regular exercise and a balanced diet can improve treatment outcomes. Certain foods, such as spicy foods, caffeine, and alcohol, can worsen hot flashes. Exercise supports weight loss, bone health, and pelvic floor strength.
- Stress Minimization and Self-Care:
While mentioned last here, this isn’t any less important. Stress management techniques such as mindfulness, meditation, and activities that bring joy can significantly reduce the impact of symptoms.
Where to Find Help and Who Can Assist with Your Care?
Several healthcare professionals can help guide you through perimenopause, including:
- GP (General Practitioner)
- Menopause care specialists
- Gynaecologists
- Endocrinologists
- Nutritionists
- Exercise physiologists
- Naturopaths
Conclusion
The perimenopausal transition is a natural part of aging, and while it can come with challenges, it can also be a time of growth and empowerment. With the right care, support, and self-awareness, women can navigate this phase with confidence and ease.
Here’s to owning your menopausal transition and embracing it in a way that allows you to thrive and celebrate this new chapter of life!
Written by Dr Kemi Adu
