Perimenopause is a natural process that occurs in women, where hormonal levels reduce in the run-up to menopause, which is when menstruation (periods) stops.
It usually begins in your 40s, however, some women experience perimenopause earlier in their 30s. Risk factors for early perimenopause include having a family history of early perimenopause, having a hysterectomy, cancer treatment and smoking.
Perimenopause usually lasts for several years, ending when you finally have your last period, which usually occurs in your early 50s. Although this is a natural process, it can nonetheless cause significant discomfort and distress, which is why it can help to seek support from your GP.
Here we’ll explore perimenopause symptoms, how they affect your body and what treatments are available to make perimenopause more comfortable.
Six signs of perimenopause
1. Changes to your periods
During perimenopause, your body starts producing lower levels of the hormones oestrogen and progesterone, which regulate your periods. Consequently, your periods may become more irregular; they may become lighter, heavier, longer or shorter. Nearer the end of perimenopause you may start to skip periods too.
2. Reduced enjoyment of sex and reduced sex drive
You may experience a reduced sex drive and vaginal dryness, which can lead to discomfort during sex.
3. Poor sleep, hot flushes and night sweats
You may experience difficulty sleeping due to hormonal changes, as well as due to hot flushes and night sweats, which usually occur in 5–10 minute episodes. Hot flushes and sudden sweating can also occur during the day.
4. Psychological symptoms
You may develop anxiety or depression, become more forgetful, and experience a loss of concentration and mood swings. These changes can occur as a direct result of hormonal changes and as a consequence of poor sleep.
5. Reduced bone density
Perimenopause can decrease your bone density, which increases your risk of osteoporosis. Reduced bone density can be detected via a bone scan.
6. Raised cholesterol
Perimenopause can increase levels of so-called ‘bad cholesterol’ or HDL and reduce levels of ‘good cholesterol’ or LDL. This can increase your risk of cardiovascular disease.
Other common symptoms of perimenopause include tender breasts, tiredness, urinary incontinence and weight gain. If you have uterine fibroids, these may also worsen during perimenopause.
Your periods and perimenopause
You will continue to have periods during perimenopause, although they may change from what you’re used to, becoming shorter, longer, heavier or lighter.
As perimenopause progresses and you get closer to menopause, you may start to skip periods. If you have not had a period for 60 days, you are likely nearing the end of the perimenopause transition.
As you will still have periods during perimenopause and your ovaries will, therefore, continue to release eggs, you can still get pregnant but your chances of pregnancy are reduced. If you do not want to become pregnant, you should continue to use birth control.
When to see a doctor
Although perimenopause is a natural process, it can affect your quality of life. If you are concerned about your symptoms or perimenopause is significantly disrupting your life, see your GP to discuss home remedies and treatments to ease your symptoms.
It is important to note that changes in your period do not necessarily mean you have started perimenopause. Other conditions may be responsible, such as endometriosis, uterine fibroids, and in rare cases, cancer. If you are concerned about your periods or have noticed spotting after sex or in between your periods, see your GP.
In the vast majority of cases, a GP can give you a diagnosis of perimenopause after discussing your medical history and symptoms. In rare cases, your GP may recommend blood tests to check your hormone levels — as hormone levels are more erratic during perimenopause, you may need several blood tests taken at different times.
Treating perimenopause symptoms
As perimenopause is a natural process, treatment is not aimed at stopping perimenopause but at reducing its symptoms to improve your quality of life. Treatment will depend on your specific symptoms.
If you have hot flushes and night sweats, your doctor may recommend hormone therapy, which is available in several different forms, including creams, gels, pills, sprays or skin patches.
Hormone therapy can also help prevent further reduction in your bone density. Regular exercise, such as walking, hiking and strength-training exercises, will also help maintain your bone density and prevent excess weight gain.
If you can’t tolerate hormone therapy, your doctor may prescribe the anti-epileptic drug gabapentin to reduce your hot flushes.
If you have vaginal dryness and discomfort during sex, vaginal oestrogen applied as a cream, ring or vaginal tablet can help ease your symptoms.
If you are struggling with low mood or mood swings, your doctor may recommend an anti-depressant. You can also practise mindfulness, meditation or other activities that help you relax.
Following a healthy, balanced diet, quitting smoking, reducing how much alcohol you drink and sticking to a regular sleep schedule can also help improve symptoms of perimenopause, such as mood swings, weight gain and poor sleep.
