Are You Going Through The Perimenopause?

What exactly is the perimenopause?
“While the menopause officially starts one year after your last period, the perimenopause is the period of time leading up to that. The menopausal symptoms people refer to are often actually perimenopausal symptoms. Levels of the female hormones oestrogen and progesterone are fluctuating as our periods stop and eventually drop to very low levels after the menopause. Levels of testosterone, which is classically thought of as a male hormone, are also dropping, which contributes to the majority of symptoms and physiological changes.” – Dr Anita Mitra, consultant clinical oncologist, aka the Gynae Geek

When does it happen?
“The perimenopause doesn’t just happen to ‘old’ women. The menopause (so 12 months after your last period) occurs on average at the age of 51. However, many women experience perimenopause in their 30s and 40s, some even in their 20s. Some women experience the perimenopause around the same time their mother did, so this can be an indicator. There are also many other factors that can lead to a surgical menopause – these include cancer and a hysterectomy. Some radiotherapy treatments can also induce an early menopause.” – Victoria Howell, registered nurse, coach and women’s health specialist

“The average age of the perimenopause is 47. Your mother’s age can be a bit of a guide but I don’t hold too much to it. Women nowadays have a different lifestyle to their mothers – work, partying, different relationship statuses, drinking and smoking, and these can all affect your age of menopause. For example, if you are a smoker, you are more likely to go through the menopause 2.8 years earlier.” – Dr Shahzadi Harper, The Menopause Doctor and founder of The Harper Clinic 

How long does it last?
“It varies significantly from woman to woman. The average duration of the perimenopause is four years, but it can range from a few months to ten years.” – Anita 

What are the symptoms?
“There is a huge array of symptoms, and not all women will get all of them. These can include hot flushes, night sweats, headaches, lack of energy, painful joints, insomnia, poor concentration, palpitations, irritability, loss of libido, restless legs, thinning hair, digestive issues and increased allergies. Anxiety is one less obvious symptom that is often not recognised as being linked to the perimenopause – perhaps you have never been an anxious person and are suddenly experiencing anxious thoughts before your period, or have previously suffered with anxiety and find it hits you on a whole new level prior to your period. Crying spells are also common, especially about things that seem irrational. Low mood, depression and mood swings are also common – these tend to be similar to premenstrual symptoms but may feel more intense and last longer. Brain fog can also occur – this is due to changing levels of oestrogen.” – Victoria 

“There’s also the less sexy stuff that women are often shy to talk about – vaginal dryness and irritation, urine leakage and hairs in places that were previously fuzz-free.” – Anita

Are you still fertile in perimenopause?
“Yes. During the perimenopause women still ovulate, and the uterus may well have the right environment for conception to take place. If you are not planning on a pregnancy then you still need to use contraception. Women have been known to become pregnant post-menopause, which is why guidelines recommend contraception is used up to two years following your last period.” – Victoria

What treatment options are available?
“The perimenopause is an excellent time to start topping up oestrogen because of the benefits to long-term health. Hormone replacement therapy (HRT) is the first recommendation – this tops up and/or replaces the oestrogen in our bodies, largely eradicating symptoms, helping women to feel better about themselves. HRT can also protect bones from osteoporosis, and emerging evidence suggests HRT can reduce the risk of dementia and cognitive decline. If you are considering HRT, try and see a GP who’s trained in the menopause or a private practitioner. Sadly, many GPs have no training in the menopause and women have been misdiagnosed and given antidepressants or other incorrect advice as a result. The best forms of HRT come in patch form, gel or spray.” – Victoria