GP and menopause specialist, Dr. Louise Newson, answers your essential questions about perimenopause, early menopause, and Premature Ovarian Insufficiency or POI.

What is perimenopause?

The menopause is when a woman’s ovaries stop working, she stops having periods and can no longer conceive a baby naturally.  The term ‘perimenopause’ refers to the time leading up to periods completely stopping; when women might notice periods changing and start having menopausal symptoms such as headaches, joint pains, mood swings, difficulty sleeping or hot flushes.

When does perimenopause start and how long does it last for?

Perimenopause most commonly begins in women in their mid-40s, but it is not unusual for symptoms and period changes to occur in a woman’s late 30s. Signs that hormones are fluctuating and then declining, as the ovaries start to slow down production, can last for 5, or even 10 years in some women, before their periods stop altogether.

Once the periods stop, it doesn’t mean symptoms go away, unfortunately. Women can experience symptoms such as headaches, anxiety, low mood, memory problems, poor sleep, joint pains, insomnia, urinary problems, vaginal dryness and discomfort for many years after their menopause if left untreated.

There are also health consequences of living with low (or no) sex hormones, such as osteoporosis, heart disease, type 2 diabetes, depression, and dementia. Hormone replacement therapy (HRT) is the treatment of choice for the majority of perimenopausal and menopausal women. It contains hormones which can be oestrogen, progesterone and testosterone. The dose and type of HRT is usually varied according to the individual woman. Taking HRT can help prevent these diseases from occurring, as well as bring relief from symptoms. For most women, the benefits of taking HRT outweigh any risks. HRT can usually be taken forever.

Early menopause and POI

Medically speaking, the menopause is when you haven’t had a period for 12 months. This is usually around 51 years. If this point comes and you’re under 45 years, it’s classed as an early menopause. If you’re under 40 years and you haven’t had a period for a year or have not had surgery or medication that has affected your ovaries, it is referred to as Premature Ovarian Insufficiency (POI). This affects 1 in 100 women under 40 years, and 1 in 1000 women under 30 years.

Unlike menopause in older women, the ovaries often don’t completely stop working in women with POI. This means that ovarian function can fluctuate over time, and this might cause a period, ovulation (when an egg is released) or even a pregnancy. This occasional release of an egg leads to around 5-10% of women with POI to become pregnant. Women who take HRT often find that their fertility improves.

How do I know if I’m going through the perimenopause?

It’s a good idea to be aware of all the symptoms of perimenopause because it’s not just about hot flushes! My free app, ‘balance’, has period and symptom trackers to help you find out if you’re starting the perimenopause, as well as lots of information on ways to help symptoms and advice about treatments.

You may notice your periods become heavier, lighter, more irregular or closer together. You may start to feel emotions more frequently or ones you don’t normally feel, such as being worried, feeling low, irritable, stressed, or a loss of confidence.

You may not be in the mood for sex very often, your sleep might be more disturbed, you might need to wee more often, or have leaks of urine when you laugh or cough. Many women find they have headaches or migraines, and get joint pains and stiffness. For others, they may notice skin and hair changes, such as dry or itchy skin or hair thinning. Sleep disturbance is also very common.

The main thing is to know what to look out for, and remember hormone changes can affect all areas of your body. Go and see your doctor if you think you’re showing signs of perimenopause to discuss treatment options if you want symptom relief and talk through any implications of perimenopause, especially if you’re trying to conceive.

What does perimenopause mean for my fertility?

If you’re going through the perimenopause, your egg count and their quality will usually begin to decrease, and this may lower your chances of conceiving a baby naturally. Women are advised to take extra care of their health and wellbeing, so that they can produce the best possible quality of eggs to improve chances of conception.

A healthy lifestyle is really important. Stopping smoking, eating a healthy, balanced diet and limiting alcohol can all be beneficial, as well as regular exercise and time spent relaxing and doing things you enjoy.

Many women find that they experience anxiety or depression when they show signs of the perimenopause earlier than they thought it would happen. You should not be ashamed of this, and it’s really important to talk about any symptoms you may be experiencing with your doctor, as there is usually effective treatment available to help you. HRT can be taken to help your perimenopause even if you are also trying to conceive and are having, or hope to start, fertility treatments.

If you are trying to become pregnant and you think you are in the perimenopause, talk to your GP or visit a fertility clinic to find out the best options for you.

Can a blood test tell me if I am perimenopausal?

Perimenopause is a gradual transition as the ovaries slow down and eventually stop working. Because of this, there isn’t one reliable or specific test that helps determine if you are going through it. Hormones, especially estrogen, can fluctuate so much throughout each month and this can make tests an unreliable marker for the perimenopause. A diagnosis should be made based on your symptoms and what you’re experiencing, rather than hormone levels in the blood.

If you are under 45 years (and especially if you’re trying to conceive), your doctor may want to refer you for hormone blood tests, and this information can be used, as well as looking at your age, medical history and menstrual cycle, to help determine if the perimenopause has started.

Dr. Louise Newson is a leading menopause specialist and GP. She is the founder of www.balance-app.com which offers free support for menopausal women. 

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