Expert / 30 August, 2023 / Dr Raj Arora

What Is Perimenopause? Signs, Symptoms, Treatments & Lifestyle Changes

What is perimenopause?

Perimenopause is the stage of life leading up to your last period (menopause), it is essentially the period of menopause transition. It usually starts in early 40s but can be earlier in some women. During this period, the ovaries begin to make less oestrogen and, therefore can lead to periods becoming irregular. Periods may also become longer or shorter than usual, and bleeding can become lighter or heavier. Many women begin to experience a range of common symptoms such as hot flushes, vaginal dryness, changes in mood, brain fog, digestive issues and poor sleep, amongst others. Most females will begin to experience the symptoms of menopause, although around 1 in 5 women may not experience any symptoms at all. There are approximately 13 million peri or post-menopausal women in the UK.

Common signs/symptoms include:

• Hot flushes
• Mood swings
• Low libido
• Headaches
• Disturbed sleep
• Breast soreness
• Weight gain
• Vaginal dryness
• Tiredness
• Changes to skin
• Sore joints/muscles

Perimenopause often goes undiagnosed or misdiagnosed as there hasn’t been (until recently) enough awareness around this stage of a woman’s life. There are more than 34 symptoms relating to a decline in oestrogen and these symptoms can often impact a woman’s daily activities and in some cases, can have quite a debilitating impact.

During this transitional phase into menopause, there is support and treatment available. See your GP to discuss your symptoms and to decide the best way forward for you.

Preparing for your appointment

With the current NHS pressures, GP appointments can be hard to come by. Whilst you are waiting for your appointment, you can prepare for it. This will allow you to get all your questions answered and to allow for informed choices to be made.

• Take a menstrual diary – keep a journal of your cycles over the past few months. This can include the duration of the cycle and bleeding and how heavy the flow was
• Keep a diary of symptoms – perimenopause can impact individuals in different ways. Some may only experience a few symptoms whilst others may have symptoms that are impacting their daily activities. Keep detailed descriptions so that your doctor can try to offer the best management.
• Medication list – it’s important for doctors to have an up-to-date Current medication list of prescription and non-prescription medications to ensure that medication such as HRT does not interact with your current medications.
• Keep a list of questions – prepare a list of questions so that you can get all your questions answered and leave feeling informed and empowered. Basic questions may include: What are the treatment options? Are the side effects to treatment offered HRT/NON-HRT? How long may your symptoms last? What lifestyle changes can you make to help your symptoms? What online resources and support are available to you?

Lifestyle Changes

• Eat Healthy – During perimenopause/menopause the risk of osteoporosis and heart disease increases. Therefore a healthy balanced diet is super important to keep yourself in good health. Choose a high-fibre diet rich in fruits, vegetables and whole grains. Also, add in calcium-rich foods to support your bones and joints. Try to avoid alcohol or caffeine as these can trigger hot flushes.
• Adopt a more active lifestyle – Exercise has been shown to prevent weight gain, improve sleep and also to improve one’s mood. Aim to exercise for 30 minutes or more for most days of the week and also focus on strengthening exercises to support your joints and bones. Regular exercise has also been shown to reduce the risk of fractures in those going through perimenopause and menopause.
• Sleep hygiene – try to keep a consistent sleep schedule. Avoid caffeine or exercise too close to bedtime, as these can interfere with sleep. Try to keep blue light devices away at least an hour before bedtime and try to practice calming and relaxing activities such as mindfulness, deep breathing or reading before bed.
• Stress reduction. Practicing activities such as yoga, meditation and deep breathing can help to elevate mood but can also help with better sleep.

Treatment

• Hormone therapy – Oestrogen replacement therapy can help ease the symptoms of perimenopause. This can be given in the format of a pill, patch, spray, gel or cream form. Usually at the perimenopausal stage using a gel or cream can be quite effective. If one still has a womb then it will be important to give progesterone replacement also.
• Vaginal oestrogen – can be administered using a pessary or vaginal tablet. This can release a small amount of oestrogen locally into the vagina to ease symptoms of vaginal dryness and discomfort associated with intercourse.
• Antidepressants – Certain groups of antidepressants can help with reducing perimenopausal hot flushes. For those patients with minimal perimenopausal symptoms, these medications can be a great alternative to HRT.

It is important to remember that perimenopause is a normal and natural progression in a woman’s reproductive cycle. It can last from several months to years and should not be ignored or disregarded. There are many resources and lots of help available. If you are suffering, it is important to reach out to your GP and to discuss your options.

Article by Dr. Arora from The Face Bible.

Instagram: @dr_rajarora

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