WHAT IS PERIMENOPAUSE?

Despite affecting half the world’s population, perimenopause is still a misunderstood area, surrounded by misconceptions and often stigma. Many women think of the menopause as the time of life leading up to, and after, their last period, though this is actually the transition phase called the perimenopause. Menopause officially starts 12 months after the last menstrual period. Once you reach menopause, the perimenopause period is over.

‘Peri’ means near, and perimenopause means the natural transition into menopause, which marks the end of a woman’s reproductive years. During perimenopause, hormone levels fluctuate, which can result in a range of symptoms that are often mistaken for other health conditions. It can be difficult to know if you are experiencing perimenopause, as oestrogen levels fluctuate, and there is no definitive test to diagnose it.  

Most women go through perimenopause between the ages of 40 and 50, but some may experience symptoms earlier. It’s important to note that no two women experience perimenopause in exactly the same way. You can tell you are in perimenopause if you have changes in your menstrual cycle length or flow, and symptoms such as hot flashes and sleep difficulties.

HOW LONG DOES PERIMENOPAUSE LAST?

The duration of perimenopause can vary from woman to woman but the average length is 4 years. Some women might be in perimenopause for just a few months, while others may experience perimenopause symptoms for a decade, or even more.

WHAT ARE THE SYMPTOMS OF PERIMENOPAUSE?

There is a very broad spectrum of perimenopausal symptoms that can vary in both intensity and in frequency. While some women breeze through perimenopause, and others have only a few bothersome symptoms, some may find their symptoms disrupt their daily life.

Decreased oestrogen production during perimenopause can cause both physical and mental symptoms. You may experience none, some, or all of the following symptoms.

Physical symptoms

Changes to your menstrual cycle: The first sign of perimenopause is usually a change in the pattern of your periods. As ovulation slows, your menstrual cycle will become irregular. You may start having unusually light or heavy periods. The frequency of your periods may also be affected. You may have one every two or three weeks, or you may not have one for months at a time. Eventually you’ll stop having periods altogether.

Hot flashes: Hot flashes, also known as hot flushes and scientifically called vasomotor symptoms, are the hallmark signs of perimenopause. A hot flash is a short, sudden feeling of intense heat, usually in the face, neck and chest. Your face, neck, and chest may also turn red, you may have heart palpitations, and perspire heavily. When the hot flash is over, you might feel chilly and shivery. Some women experience a couple of hot flashes over a week while others may have 10 or more intense hot flashes a day. They can also occur at any time, causing discomfort, and sometimes embarrassment in social situations.

Night sweats: Many women wake up several times during the night sweating heavily, and sometimes so drenched with sweat that they have to change their clothes and bedding, which is one reason why many perimenopausal women report fatigue.

Weight gain: Fluctuating oestrogen levels may be partly to blame for weight gain during perimenopause, particularly around the abdomen area. According to the Mayo Clinic, menopausal women gain on average 1.5 pounds per year in their 50’s.

Joint pain: More than 70 per cent of women experience joint and muscle aches and pain during perimenopause, and for 25 per cent of them, it’s debilitating, according to recent research. Low levels of oestrogen can lead to many of your joints feeling stiff and aching.

Bone density loss: As oestrogen levels decrease during perimenopause, women are at an increased risk of osteoporosis, a condition where bones become fragile and more susceptible to fractures. 

Decreased sex drive: Women often lose the desire to have sex due to physical issues like vaginal dryness or pain. Hormonal mood changes can also affect your sex drive.

Vaginal atrophy: Low oestrogen levels cause the vaginal tissue to lose its elasticity and become thinner. Vaginal atrophy causes dryness, pain, irritation, and bleeding after sex.

Hair, skin and nail changes: As your levels of oestrogen drop, you may notice your skin sagging. Hormonal changes can also cause your skin to become dry, your hair to thin, and brittle nails.

Urinary incontinence: Changes during perimenopause cause the muscles in the vagina and urinary tract to weaken. This can lead to stress incontinence or involuntary peeing while sneezing, laughing, coughing, exercising, or carrying heavy objects.

Recurrent UTIs: You’re at an increased risk of urinary tract infections because perimenopause can cause your urethra to become dry, irritated, or inflamed. Vaginal infections can also occur more frequently because your vagina has become dryer and thinner.

Mental symptoms

Mood swings: Perimenopause can cause mood swings, irritability, anger, depression, and anxiety. Hormonal changes and trouble sleeping can contribute to these issues. Also, how you feel about menopause may come into play. For example, distress about low libido or the end of fertility can contribute to depression during this time.

Memory and cognitive changes: Many women notice they have difficulty concentrating during the perimenopause. This is often called ‘brain fog’. Sleep disturbances can also contribute to forgetfulness and a lack of mental clarity.

Sleep disturbances: It’s common to have difficulty falling or staying asleep due to hormonal changes, making you feel tired and irritable during the day. Night sweats or nocturnal hot flashes can also disturb your sleep during perimenopause.

TREATMENT OPTIONS FOR PERIMENOPAUSAL SYMPTOMS

Some women choose to go through perimenopause without getting any treatment, while others prefer some form of treatment to help manage their symptoms. There are a range of treatment options for perimenopausal symptom relief, including prescribed hormonal and non-hormonal treatments, over-the-counter products, complementary and alternative therapies, and lifestyle recommendations that can help make life easier. 

Interesting fact

According to The British Medical Journal (BMJ), studies show that 60-80% of women experience symptoms so bothersome that they seek medical care.

Hormonal therapy

• Hormone Replacement Therapy (HRT): HRT, also known as hormone therapy, is a medication that replaces the oestrogen and progesterone you lose during perimenopause. It helps stabilize your hormone levels, thereby reducing symptoms including hot flashes and night sweats, problems sleeping, mood swings, loss of libido, and vaginal dryness. It may also protect your heart and bones. It comes in a range of doses and is available as tablets, skin patches, sprays, vaginal creams, or gels. If you are thinking about starting HRT, you should discuss the potential risks and benefits with your doctor first, as it is not suitable for everyone.
• Birth control: For some women, remaining on the birth control pill offsets perimenopausal symptoms. The birth control pill reduces hot flashes, and alleviates heavy or painful periods in perimenopause. 

Non-hormonal therapy

• SSRIs: Anti-depressant medications can reduce hot flashes and mood swings.
• Gabapentin: Originally used to treat seizures, gabapentin can also help manage hot flashes.
• Veoza: A newly approved medication called fezolinetant (Veoza) blocks temperature regulation pathways in the brain and relieves hot flashes.

Over-the-counter products

• Magnesium: Magnesium supplements can help some women with lack of sleep or insomnia, according to research.
• Creams and lubricants: These are used to treat symptoms like vaginal dryness and discomfort.
• Calcium and vitamin D: Be sure you are getting enough calcium and vitamin D as the risk of osteoporosis rises during perimenopause. Eat foods rich in calcium such as dairy products, leafy green vegetables, almonds, and dried beans. Ask your doctor if taking a supplement with calcium and vitamin D could benefit you.

Complementary and alternative treatments

• Herbal supplements: Some women get some relief from their symptoms by taking herbal supplements such as black cohosh, evening primrose oil, or red clover. As with any supplements, you should always check with your doctor first to make sure they’re safe for you.
• Cognitive behavioral therapy (CBT): CBT is a type of counselling that focuses on changing certain thoughts and behavior patterns. It can help you to feel less bothered by hot flashes.
• Acupuncture: Some studies suggest that acupuncture can reduce the severity of hot flashes and improve overall wellbeing during perimenopause.
• Yoga: According to several studies, yoga can be very effective for reducing menopausal symptoms. Women have also reported that yoga stretching and relaxation techniques lift their mood and improves their quality of life during perimenopause.
• Hypnotherapy: Hypnotherapy can help you manage and reduce the symptoms of perimenopause. It has been shown to reduce the frequency and intensity of hot flushes in addition to helping with mild depression and anxiety. According to research, focusing on cooling imagery during hypnosis gives you greater control over hot flashes and can even help prevent them altogether. 

Lifestyle recommendations

• Eat a healthy diet: Eat a balanced diet rich in fruits, vegetables, whole grains, and lean proteins to promote overall health and make the transition to perimenopause easier.
• Get regular exercise: Engage in regular exercise to help manage weight, strengthen bones, and improve sleep and mood. Try to fit in 30 to 60 minutes every day, five days a week, of both aerobic exercise such as running and swimming, and strength training exercise. Low-intensity exercise, such as yoga and Pilates, can strengthen the pelvic floor and decrease urinary incontinence. 
• Develop a good sleep routine: Practice good sleep hygiene to minimize sleep disruptions due to hot flashes at night. Try cutting out alcohol and caffeine to promote better sleep. Create a relaxing bedtime. Whether it’s a warm bath, reading a book, or meditating, relaxation techniques about an hour before bed can put you in the right mindset. Good sleep is also more likely if your bedroom feels restful and cool.
• Manage hot flashes: Avoid foods and activities that trigger hot flashes such as alcohol, caffeine, smoking, spicy food, hot weather, and tight clothes. Use cooling sheets, lighter blankets, wear pyjamas made out of cotton, and keep a glass of water or fan nearby.
• Engage in stress management techniques: Engage in stress-reducing techniques such as meditation, mindfulness, deep breathing, and yoga.
• Engage in new activities that bring joy: Join a club, volunteer, learn a new skill, or take up a new hobby.

Every woman has her own journey as she transitions through from perimenopause to menopause, which can be an incredibly challenging time. If your perimenopause symptoms are so severe that they are impacting your quality of life, or if you’re just not sure what’s going on, it’s important to talk to your doctor about how you’re feeling. By recognizing the signs of perimenopause early and seeking appropriate medical advice, and treatment options tailored to your needs, this life milestone can be navigated with greater comfort and confidence.