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Perimenopause symptoms and treatment - what you need to know

perimenopause symptoms

The first signs of perimenopause can feel incredibly intrusive and disruptive, so it may be helpful to know what to expect and how to deal with it. Maybe you've already started experiencing symptoms and just want to make sure that they are normal? Or perhaps you've had symptoms for some time, but still feel like you are struggling to cope with them? Here's our guide to perimenopause: its symptoms, diagnosis and treatment, as well as gransnetters' collected wisdom on how to cope with this change. 

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What is perimenopause?

Perimenopause refers to the period when women start to experience the changes that will eventually lead to the menopause. Referred to as the 'menopause transition', women start to produce less oestrogen during this time, leading to symptoms like hot flushes, night sweats, sleep disturbances, tiredness, mood swings and changes to their menstrual cycle.

The extent to which women experience signs of perimenopause also varies greatly. While some women have few or none symptoms, others will experience all or most of the common symptoms in the course of their transition to menopause. 

For some women, the symptoms may start as early as their mid-30s, while others will begin to experience perimenopausal-related changes in their 40s. Some gransnetters have even reported experiencing perimenopause in their 50s. In other words, the 'normal' age of perimenopause is quite difficult to pinpoint. 

Perimenopause typically lasts for around four years, and ends when you reach menopause and your menstrual periods stop. 
 

Perimenopause symptoms and signs


Common:

  • Hot flushes and night sweats
  • Trouble sleeping and general tiredness
  • Changes in mood, including irritability or depression
  • Loss of libido
  • Vaginal dryness 
  • Sore breasts
  • Urinary urgency and other 'mild' bladder problems
  • Hair loss/thinning
  • Changes in menstrual cycle, including irregular, heavier or more painful periods
  • Disorientation
  • Weight gain
     

Less common:

  • Headaches and migraines
  • Change in balance or dizziness 
  • Development of (or worsening of) allergies
  • Gum problems
  • Itchy skin
  • Urinary incontinence
  • Thinning nails
  • Memory lapses

 

Are my symptoms normal? 

As most women will experience a combination of symptoms, it is normal to question whether you should be seeking help. While it is not mandatory to speak to your GP, if you feel unsure about anything you should consult a health professional. 

perimenopause age

Gransnetters say:

"I had a couple of years in my mid-50s when I had very heavy bleeding and really bad migraines."

"I had no hot flushes, sweats, headaches or anything else." 

"So, thinning body hair might be a sign of perimenopause? I've been waxing my fuzzy legs for 25 years, except in the last year where the hairs have gotten finer and more sparse... This coincides with raging mood swings, palpitations, a couple of hot flushes, bad sleep, breast pain, spots, aches and pains."

Diagnosis: talking to your GP

Should you start to experience extreme or disruptive symptoms, or if you feel that your symptoms are unusual or worsening, you will need to speak to your GP. For example, whilst it is normal to experience irregular periods during perimenopause, if they suddenly become very heavy, include unusual blood clots, last several days longer than usual or occur closely together, it could be a sign that something else is happening to your body. This is also the case if you find that you are spotting after sex.

Sometimes it can be beneficial to visit the doctor to determine whether your symptoms could be linked to something else, such as hypothyroidism. Symptoms of hypothyroidism can sometimes be similar to those of perimenopause, as they include tiredness, weight gain and depression. Hypothyroidism can be diagnosed with blood tests, so your GP will be able to determine if your symptoms are related to a thyroid problem rather than perimenopause.

perimenopause periods 

There are some factors that affect perimenopause. If they apply to you, it is more important that you consult your GP. These are:

  • Smoking - it has an adverse effect on perimenopausal symptoms (they may occur earlier and be more severe).
  • Surgeries - women who have had a hysterectomy (removal of the uterus), single or bilateral oophorectomy (removal of one or both ovaries), or cervical cancer/pelvis surgery have reduced amounts of oestrogen and progesterone in their bodies which can lead to early menopause.
  • Chemotherapy and radiation - both will significantly increase the risk of early onset menopause.
  • Family history - women with a history of premature menopause in their family have an increased risk of experiencing premature menopause themselves.
     

Gransnetters say:

"I wish I'd had a more thorough test for perimenopause as that time of life also coincides with the start of hypothyroidism... I should have gone to GP to confirm, but I didn't and it took ages to diagnose." 

"Perimenopause started when I was 46 and was confirmed by a blood test. Periods became very heavy and painful, but thankfully I had no other symptoms. I was 55 when I eventually went through menopause so the whole process took more than nine years."

 

Complications 

Due to changing hormone levels, perimenopause can sometimes lead to the following health complications: 

  • Osteoporosis - decreasing levels of oestrogen causes bone loss and increases the risk of fractures and breaks. It is important to include sufficient calcium in your diet.
  • Diabetes - whilst the production of other hormone levels fall, some women develop high levels of testosterone which has an impact on the regulation of blood sugar. This can result in an increased risk of insulin resistance.
  • Prolapsed uterus - oestrogen helps strengthen muscles, which means that decreased levels may result in a 'dropped' uterus as the muscles weaken. 
  • Cardiovascular disease - falling oestrogen levels increase the risk of developing heart and circulatory system disorders such as high blood pressure, stroke, heart disease and high cholesterol levels. This is because oestrogen helps to regulate the blood fat content.

 

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10 ways to ease symptoms

The effects of perimenopause can be more that just annoying - especially if they impact upon your day-to-day life. Luckily, there are some simple methods and lifestyle changes which can ease your symptoms and lead to better health in general.

perimenopause treatments

  • Maintain a healthy diet - here are some helpful tips on how to eat during this transition
  • Be sure to exercise every day as staying fit can significantly help to reduce symptoms. 
  • Try to maintain a healthy weight as your symptoms may worsen with weight gain. Here are some tips to help you keep your weight in check. 
  • Be sure to include enough calcium in your diet.  
  • Discuss the option of multivitamin supplements with your doctor. 
  • Up your water consumption - it may help to relieve hot flushes. 
  • Stop smoking - it is likely to make your symptoms worse and may affect your health dramatically during this time. 
  • Do not give up on sleep - try to find a sleep routine that works for you and stick to it to make sure you get enough rest every night. Here's our advice on how to get a better night's sleep
  • Limit your caffeine and alcohol intake. Both drinks dehydrate you, which will worsen hot flushes and dry skin. 
  • Avoid chemical beauty products that are petroleum-based or contain mineral oil as they could be ageing your skin - here's how to beat the menopause ageing process
     

Gransnetters say:

"For the hot flushes, cut back on alcohol and cream. The difference is incredible." 

"Food helps! Avocados, asparagus, spinach, etc. And only consume caffeine and alcohol with food. Vagifem pessaries certainly help with dry and sore vaginas (they contain a small amount of HRT)... and exercise is essential - particularly walking and strength training."

Perimenopause treatments to consider

If your perimenopause symptoms are severe, you and your GP can discuss a variety of prescribed treatment options. There may be other treatments available that are better customised to your individual needs, so be sure to ask about those too. 

HRT (Hormone Replacement Therapy) can greatly benefit some women, however there are risks involved so be sure you're properly briefed by your GP on potential pros and cons. Bear in mind that HRT won't be an option for women who've had certain health problems in the past.

Vaginal rings or contraceptive patches provide a low dose of oestrogen which can help to control symptoms like hot flushes, but there are also risks associated with these.

Certain antidepressants (SSRIs) have also been shown to mitigate hot flushes and night sweats.

Gransnetters say: 

"The only thing that worked for me in the worst years of the menopause was HRT. All symptoms vanished and I had no side effects."

"The birth control pill really helped my PMT problems and made a huge difference to my mental health until a savvy young doctor picked up on the fact that I had a history of aura migraine and so should not be taking the pill at all due to a double whammy stroke risk. This means that when the time comes, HRT is ruled out for me." 

 

Further advice

Gransnetters have shared some alternative remedies that helped them manage the symptoms of perimenopause, but it can't hurt to mention any supplements you are considering taking to your GP.

perimenopause supplements

Natural supplements like Agnus Castus and Black Cohosh can help to relieve mood-related symptoms, hot flushes and night sweats.

Gransnetters say:

"The best supplements I used were Agnus Castus for hormonal balance and Black Cohosh for 'hotness'. I was fortunate not to experience full blown hot flushes. Try to accept the symptoms even if they seem debilitating or scary, and have a mantra - mine was 'this will pass'." 

"I used to take Black Cohosh tablets from Holland & Barrett which seemed to moderate the flushes a bit."

External remedies such as electric fans and water sprays can help tremendously. Ensure that you wear light, layerable clothing which can help with hot flushes and night sweats.

Gransnetters say:

"Night sweats - get a fan! I found this to be invaluable. I bought a tall freestanding one that had three settings and could be worked by remote control from the bed. I dumped the duvet and used layered cotton sheets/toppers of different weights." 

"For the flushes, I found wearing light cotton clothes helpful. And light cotton nighties rather than pyjamas are best at nighttime. Someone suggested drinking water when a flush started, which also worked for me."

"Oh yes....and get one of those little canisters of water spray! Boots have them. Great for cooling down during a flush." 

"Peel off your outer layer - which needs to undo down the front. Struggling to escape from a woolly jumper tends to make one bad tempered and a tad panicky." 

Visit our health section for more advice on perimenopause and menopause symptoms.

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