The Symptoms Of & Treatment Options For Perimenopause
The Symptoms Of & Treatment Options For Perimenopause

The Symptoms Of & Treatment Options For Perimenopause

While the average age of the menopause in the UK is 51, perimenopause – the period when your hormones start declining – can start up to ten years prior. This means some women will start to experience symptoms as early as their late 30s. Experts agree perimenopause is the most symptomatic phase of the menopause transition but it’s often ignored or misdiagnosed. Fortunately, the conversation is shifting, and treatment options are better and more accessible than ever. Here’s what they want you to know…
By Tor West

What are some of the first symptoms you may notice?

“There are more than 34 symptoms of perimenopause, meaning every woman’s experience will differ. Of these, only a handful are openly talked about, which is one of the reasons why perimenopause often goes unnoticed. But because your hormones are constantly fluctuating and not moving in a linear fashion, these symptoms can come and go. Most women think menopause equals hot flushes, however the main symptoms of perimenopause you’re more likely to notice are changes in mood and PMS symptoms. You may feel more tired or bloated than usual, struggle to focus and notice changes to your skin. You may even experience joint pain, rashes and less robust immunity.” – Dr Sohere Roked, GP & functional medicine doctor

“There are oestrogen receptors throughout the body, meaning symptoms throughout these years can vary – affecting your skin, hair, eyes, ears, heart health (palpitations are common), vagina, vulva, libido and mental health, most notably anxiety.” – Dr Naomi Potter, founder of Menopause Care

How does your cycle change during perimenopause?

“The first sign is usually changes to your menstrual cycle. Your periods may get heavier, lighter, longer or shorter. You may find you skip a period altogether, and if your periods become heavier – which is common – this is usually because oestrogen levels are high compared to progesterone, leading to a thicker womb lining. On the other hand, if oestrogen levels are low, then the lining of your uterus stays thinner, so bleeding is lighter and shorter. Longer cycles often happen later in perimenopause and this is due to a lack of ovulation. Eventually, your periods will stop, and menopause is the day when you’ve not had a period for 12 months.” – Dr Sophie Shotter, aesthetic doctor & hormone expert

What exactly is causing these symptoms?

“The problem with perimenopause is that it’s a master of disguise. It also happens at a stage in life when there are lots of other things going on. This has been particularly notable during the pandemic, when many of our life stressors were amplified enormously – the care of children and elderly parents, as well as career pressures – which can make it hard to know whether symptoms are related to hormones or not. Other physical issues can mimic perimenopause and vice versa – thyroid disorders, vitamin D deficiency, mental health issues and other viral infections can all mimic perimenopausal symptoms.” – Naomi

“Stress plays a part and shouldn’t be ignored. Often, unaddressed stress issues can leave you feeling unwell, or you could be eating too much sugar, which also directly affects cortisol production, making you feel even worse.” – Sohere

Does your medical history affect your perimenopause experience?

“Previous period problems or fertility issues can affect how you go through perimenopause, and it’s also important to think about other medication you take for any chronic conditions. At the same time, if your mum went through an early menopause, then the same may happen for you. Smoking also makes early menopause more likely, and women who are overweight tend to experience worse symptoms. Being on the combined pill, meanwhile, can mask symptoms, but doesn’t alter the age at which you go through menopause.” – Dr Samantha Brown, GP & menopause specialist at The Bronte Clinic

Body identical hormones are structurally identical to our hormones and are better tolerated with FEWER SIDE EFFECTS.

How can your GP help?

“While there is no singular test that can diagnose perimenopause, your GP can help. If you are experiencing symptoms, keep a list of them and note how much they are impacting your life – this could be anything from suddenly being anxious about motorway driving to social anxiety coming out of nowhere to bowel changes. Also, write down whether these symptoms are cyclical or not. If you have spoken to friends about HRT or have an idea what you think you may want to try, do research ahead of time, especially with a GP appointment when time is often short. If you are experiencing mental health-related symptoms, go with an advocate and ask for a double appointment.” – Naomi

How have treatment options changed over the years?

“Treatment for perimenopausal available through the NHS has come on leaps and bounds in the last couple of years, with many GP surgeries appointing specialist menopause practitioners. There are also other options outside of the NHS, including more bespoke treatment with body identical hormone replacement, which can be an excellent choice for many women under specialist guidance, although some GPs can also prescribe them. Body identical hormones are structurally identical to our own hormones and are better tolerated with fewer side effects. One thing that lags behind, however, is the prescribing of testosterone for women, which is still rarely offered on the NHS and can have an enormous impact on a woman’s libido, ability to orgasm and ability to maintain a healthy weight. Nonetheless, there are now so many formulations available across many medications – patches, creams, gels and tablets.” – Sophie

What is the most common first stage of treatment?

“If you are in your early 40s and suspect you may be perimenopausal, seek medical advice. Treatment is symptom-based, although the most common treatment in the initial stages is conventional oestrogen and progesterone, although quality supplements may be enough at this stage. Vitamin D is crucial to take through perimenopause, and I would strongly advocate taking NAD+, which helps boost cellular energy levels.” – Sophie

“Depending on your symptoms and what your body would benefit from, I tend to recommend progesterone for mood and sleep, either by itself or with oestrogen for focus and concentration. Testosterone can be good for energy, mood, focus, concentration, muscle strength and sex drive. Progesterone and testosterone have been previously overlooked in HRT prescribing, but now things are moving forward with bio-identical hormones, so women can experience better mood, hair, sleep, skin, energy and sex drive, as well as less fluid retention, with their hormone treatment.” – Sohere

Do you still need to use birth control?

“Yes, it’s a myth that you can’t get pregnant when taking HRT. You’ll need to use some form of contraception for one year after your last period after the age of 50, and for two years if your last period is before the age of 50. The Mirena coil is a great option – it helps heavy periods, prevents against pregnancy and also provides the progesterone part of HRT. The progesterone-only pill, implant and injection are also an option.” – Samantha

The Mirena coil is a great option – it HELPS HEAVY PERIODS, prevents pregnancy and provides the progesterone part of HRT.

How quickly will you see the results of HRT?

“Many women notice changes very quickly and can feel better within one month. I like to see women at three months initially, by when they should have stabilised on their starting dosage. Once your symptoms are under control, you will then need to see your doctor or specialist every six to 12 months.” – Sophie

What are the signs HRT isn’t working for you?

“Side effects usually settle with time or a change in dose or preparation – for example, switching from an oestrogen patch to a spray. If you still have all or most of your symptoms then this would imply the dose isn’t working, and you should review this with your doctor. It can help to track your symptoms on the Balance App – you can track periods if you have them, make a note of your moods, and log the medication you’re taking.” – Samantha

Alongside medication, what lifestyle changes can ease symptoms?

“Don’t underestimate the power of lifestyle habits – even small changes can make a difference. Find a practice that supports your health every day – even if it’s a morning smoothie. Consider changing the way you exercise around your cycle can also have a huge benefit. Light exercise like walking, yoga and Pilates when you are premenstrual will help balance cortisol levels to not perpetuate perimenopausal symptoms.” – Sohere

“Studies show a Mediterranean diet is the best way to eat to support hormones, especially at this stage in life. Increase your intake of fruit, vegetables and wholegrains, and avoid processed food. Swap intense cardio for strength training and make stress management a priority – rest is essential to keep hormones balanced.” – Samantha

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