Perimenopause – what it is, what to expect and what can help

Confused about perimenopause? Here’s the Live Better With guide, answering some of the most common questions…

What is perimenopause?

Our bodies are changing all the time and although we tend to think of menopause as a major change in a woman’s life, it doesn’t happen overnight. In fact, a woman’s body can be in a period of transition for five, 10 or even 15 years as she moves towards full menopause, which is defined as not having had a period for a year. Perimenopause is this transition phase.

During perimenopause, there’s a gradual change in hormone levels, starting with those we typically associate with menopause, first progesterone, then oestrogen and testosterone, then others. We’ll tell you what symptoms you might expect to see in perimenopause and give you some guidance on what can help you if you they are causing you problems.

When does perimenopause start?

There is no precise age for the start of perimenopause: most women will start to experience symptoms in their 40s but some will notice changes in their late 30s. If you have a history of gynaecological or reproductive conditions, such as endometriosis or polycystic ovary syndrome, or if you smoke, your perimenopause could start earlier than normal. Similarly, if you have had a hysterectomy – even if your ovaries have been retained – or you have had cancer treatment, such as chemotherapy or radiotherapy, you may develop perimenopausal symtoms earlier rather than later.

What happens during perimenopause?

As your hormone levels begin to change, you might notice some or all of the following:

  • anxiety
  • depression
  • fatigue
  • hot flushes
  • lower libido
  • mood swings
  • periods can become fewer or more frequent; they may last longer or become more heavy, oryou may see spotting between periods
  • pre-menstrual syndrome (PMS) symptoms become worse
  • sex can be uncomfortable or even painful
  • sleep problems
  • tender breasts
  • urinary incontinence or urgency
  • vaginal dryness

These are just the most common symptoms but there may be other less obvious ones – dry and itchy skin, dry eyes, random aches and pains, or changes in the foods you usually enjoy, for example, and some existing medical conditions can become worse during perimenopause. (We recommend keeping a note of any new or changed symptoms that you are aware of and discuss them with your GP or qualified healthcare practitioner.)

There are other hormonal changes too; insulin affects oestrogen, progesterone and testosterone levels and, as you might expect, blood sugar levels. So, our bodies find it harder to cope with foods that are high in carbohydrates, causing weight gain.

Cortisol – the stress hormone – starts to spike and levels can remain higher as we get older, at the same time pushing down our sex hormones and pushing up blood sugar levels.

But our bodies also produce a hormone that can help to restore some balance – oxytocin – the so-called feelgood or happy hormone, which can be triggered by intense feelings of love or joy, for example, during orgasm – anything, in fact, that we enjoy or that helps us to relax, to feel warm and calm, to laugh and smile.

NB Despite these hormonal changes, you can still become pregnant, as many perimenopausal women discover. So, if you are using contraception, don’t stop yet!

How do I know if I am perimenopausal?

If you are starting to experience perimenopausal symptoms, ask your GP to check your hormone levels, to find out exactly how they are changing. We recommend you do this annually as levels can continue to change throughout perimenopause. This is particularly important if you are prescribed any type of hormone replacement therapy (HRT), as your prescription may need changing or adjusting to take account of any subsequent shifts in hormone levels.

The gradual reduction of oestrogen affects bone health too. Make sure you tell your GP if you have a family history of osteopoenia or osteoporosis, as they make want to check your bone density levels.

What can help during perimenopause?

It makes sense to take good care of yourself throughout perimenopause, not simply to help with any symptoms you may experience now, but to prepare yourself for full menopause and to ease yourself through this next major stage of your life and beyond.

Make a point of seeing your GP, preferably one with experience of treating perimenopause and menopause, and go through your symptoms. You might want to consider consulting a menopause specialist privately, if that’s a possibility for you.  If it is suitable, you may be prescribed a form of hormone replacement therapy for general support with perimenopausal symptoms or something specific, such as oestrogen cream, for vaginal dryness. If HRT isn’t appropriate for you or you prefer not to take it, there are other avenues to explore, including herbal supplements, homeopathy, Chinese medicine, Ayurvedic medicine, and acupuncture. In all cases, make sure that you consult a fully qualified, professional practitioner, preferably one who is familiar with treating women going through this extended period of transition.

  • Alcohol – you may find that your tolerance levels start to drop but even if they don’t, it’s important to drink safely. Keep a close watch on what you drink and how much. Alcohol affects hormone levels and, in excess, can lead to chronic and potentially serious health conditions. You can find the latest NHS guidelines on safe drinking here.
  • Calcium – make sure your diet includes plenty of calcium-rich foods such as yogurt and cheese, seeds, beans and lentils, almonds, sardines and other oily fish, leafy greens. Your GP or healthcare practitioner may recommend a supplement if your calcium levels are low.
  • Exercise – keep moving, especially if you are in a job where you are sitting for all or most of the day. You don’t need to join a gym but try to walk whenever possible  and include some simple weight-bearing exercises in your daily routine, for good bone health.
  • Sleep – sleeping well is vital for good health throughout our lives but especially during major periods of change, such as perimenopause. Try to stick to a regular sleep routine, and avoid looking at laptop, tablet or phone screens from two hours before bedtime . Herbal teas such as camomile at bedtime can help; avoid caffeinated tea and coffee after mid-day – switch to decaff. The Live Better With Menopause online shop has a range of recommended products, including sleep balms and aromatherapy oils, to help combat poor sleep and fatigue.
  • Don’t smoke – we probably don’t need to say it, but we will! Apart from making any perimenopausal symptoms worse, smoking puts you at much greater risk of developing heart disease, certain types of cancer, and other serious illnesses.
  • Supplements – you may find that taking a supplement can relieve symptoms that are troubling you. For example, a study in Poland (2014) found that maca powder was effective in balancing hormones and easing symptoms such as night sweats and anxiety in perimenopausal women. The  Live Better With Menopause online shop offers a wide range of supplements, including maca powder and products containing maca. (Always check with your GP or qualified healthcare professional before taking supplements, especially if you are taking other medication, to ensure that they are suitable for you.)
  • Watch your weight – weigh yourself regularly and if the scales are starting to go – or have already gone – in the wrong direction, this is the time to get back to and maintain a healthy weight. Weight loss and management is a very popular topic for discussion in our Live Better With Menopause Community Facebook Group, where you’ll find useful tips and plenty of support from members.

Supporting you through perimenopause

‘Since joining this fab group (I) don’t feel so alone in it all now. Some fantastic suggestions have been made on other posts that are well worth the read.’ Live Better With Menopause community member

If you are struggling with any perimenopausal symptoms, especially a less well-known symptom, the chances are that members of our Community or Facebook group are too.  You’ll find a wealth of shared information that could help you. As one member said, ‘I’ve found that a lot of the . . . standard menopause sites only tend to list . . . the basic symptoms and not the less well known ones. I’ve been reading a few posts and thinking ”not only me then who gets this or that!”’

Visit the Live Better With Menopause Community Forum on Facebook for information, advice, and tips, and to share your own questions and suggestions.

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