Perimenopause is the transitional phase in an individual's life which takes place in the lead-up to menopause, typically starting in their late 30s or early 40s. During this transitional time, hormonal fluctuations will occur and this can cause various physical and emotional changes. This transition phase can be difficult to go through.

• 75% of women have menopausal symptoms
• 25% of women have severe menopause symptoms
• 1 in 3 women have menopause symptoms that last for more than 7 years
• 1 in 100 women experience menopause before they turn 40

These changes can include irregular menstrual cycles, hot flashes, mood swings, and sleep disturbances. Perimenopause marks the gradual decline in fertility and signifies the beginning of an important stage in the reproductive journey of biological females. It's important to understand that perimenopause is different from premature menopause, which is when an individual goes 12 months without having a period, before the age of 40.

In this article, we'll explain what perimenopause is, how it presents itself through symptoms, the causes of those symptoms, and what can be done to help.

The symptoms and signs of perimenopause

Perimenopause is characterised by an array of symptoms that vary widely in both intensity and duration. As you might expect, some perimenopause symptoms overlap with symptoms of menopause.

Some common symptoms include:

Irregular periods (menstrual cycles)

Perimenopause often causes irregular periods or abnormal bleeding patterns, meaning they may become shorter or longer in duration, heavier or lighter in flow, or unpredictable in timing. Irregular bleeding (particularly heavy periods) is unpredictable are can leave you feeling out of control. Try not to panic, and remind yourself that changes to your regular menstrual period and normal patterns of menstrual bleeding are all natural reactions to changes in the body. 

Hot Flashes (or hot flushes) and night sweats

Hot flashes or hot flushes are well-known menopausal symptoms. They are sudden, intense sensations of heat that can also affect someone going through perimenopause. They often begin in the chest or neck and then spread to the face, causing a "hot flash" - a sudden feeling of facial flush and sweat.

A hot flash or hot flush can be a distressing symptom. They can be accompanied by a rapid heartbeat, chills, and feelings of anxiety. They are a result of hormonal fluctuations, particularly a decrease in the hormone oestrogen (or estrogen), and can vary in frequency and severity among people, sometimes disrupting daily activities and sleep. People often say that hot flushes are increased or made worse when they drink alcohol or eat spicy foods!

Mood swings

Hormonal fluctuations can lead to mood swings, irritability, anxiety, and even depression in some cases.

Sleep disturbances

Many people experience sleep problems, including insomnia or disrupted sleep patterns.

Vaginal changes

Thinning of vaginal tissues and decreased lubrication may result in vaginal dryness and discomfort. This can impact an individual's sex life.

Changes in sexual desire

Some women may experience a decrease in libido during perimenopause, which can also impact someone's sex life.

Urinary changes

Increased frequency of needing to wee or urinary incontinence can occur.

Premenstrual syndrome

Lots of people say they feel like a hormonal teenager again and you may find that your usual PMS symptoms worsen.

Weight gain

Hormonal shifts can contribute to weight gain, particularly around the stomach and abdomen area.

Memory and cognitive changes

Some women report difficulties with memory and concentration during perimenopause. A common menopausal symptom, "brain fog" can be frustrating, affecting your capacity to work to your best and most productive

Headaches

Migraines and tension headaches may become more frequent or severe.

Joint and muscle aches

It's important to note that, just as with menopause symptoms, everyone's experience of perimenopause will be unique and the severity and duration of them does vary widely. We understand that all these symptoms can prevent you from getting on with your daily life, affect your mental health, and lower your quality of life overall.

If you suspect you are in perimenopause and are experiencing disruptive perimenopausal symptoms, speak to a healthcare professional or your Fertifa Patient Advisor to discuss your options.

What are the causes?

Perimenopause is primarily caused by hormonal changes that occur as a natural part of the ageing process in people born female. These hormonal changes are largely driven by a decrease in the production of two key hormones: estrogen (or oestrogen) and progesterone. The main causes and factors contributing to perimenopause include: 

1. Ovarian function: The ovaries play a central role in a female's reproductive system by producing hormones, primarily estrogen and progesterone. As females age, the ovaries start to produce less of these hormones, leading to the hormonal fluctuations that occur during perimenopause.
2. Fluctuating hormone levels: During perimenopause, hormone levels can fluctuate considerably. Changing estrogen levels in particular create a hormonal imbalance that can lead to various physical and emotional symptoms. Urine, saliva and blood samples can all be used to measure estrogen levels.
3. Genetics: Family history can influence the timing and experience of perimenopause. If your mother or other close female relatives experienced perimenopause earlier or later than average, you may follow a similar pattern. We advise all of our patients that the best way to know when you'll experience menopause is to ask your mum or a close female relative.
4. Hysterectomy: People who have undergone a hysterectomy (removal of the uterus) may still experience perimenopause if their ovaries are intact because the ovaries continue to produce hormones.
5. Certain Medical Treatments: Some medical treatments, such as chemotherapy or radiation therapy used for cancer treatments, can induce early menopause or perimenopause.
6. Lifestyle Factors: Smoking and excessive alcohol consumption may contribute to early-onset perimenopause.
7. Autoimmune Disorders: Certain autoimmune disorders and medical conditions can impact hormonal balance and potentially bring forward the age at which perimenopause begins.

Treatment for perimenopause symptoms

Treatment options for perimenopause symptoms will vary depending on the specific symptoms and their severity. Consulting your doctor or nurse and establishing an individualised treatment plans will target your symptoms, and treat them most efficiently.

Here are common approaches to managing perimenopause symptoms:

1. Hormone Replacement Therapy (HRT): A decline in estrogen production is a central cause of perimenopausal symptoms. HRT involves taking estrogen alone or in combination with progesterone to replace declining estrogen levels. Hormone therapy is a proven and effective way to alleviate hot flashes, vaginal dryness, and other symptoms.
2. Non-hormonal medications: Some non-hormonal medications, such as selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs) or even low-dose birth control pills are often prescribed to manage mood swings and hot flashes.
3. Vaginal estrogen: For women with vaginal dryness and discomfort, estrogen therapy can be a great option. Low-dose estrogen creams, rings, or tablets can be applied directly to the vaginal area can help relieve symptoms are stabalise estrogen levels.
4. Lifestyle modifications: Adopting a healthy lifestyle can make a significant difference:
5. Healthy diet
6. Regular exercise 
7. Stress reduction techniques
8. Get plenty of sleep
9. Dietary Supplements: Some people find relief from perimenopause symptoms by taking supplements like black cohosh, evening primrose oil, or vitamin E. However, the efficacy of these supplements varies, and it's important to discuss them with a healthcare provider.
10. Herbal Remedies: Herbal remedies like red clover, soy, and flaxseed may have mild effects on symptom relief. Again, it's crucial to consult with a healthcare provider before using these remedies.
11. Cognitive Behavioural Therapy (CBT): CBT and other psychotherapy techniques can help women manage mood swings, anxiety, and depression associated with perimenopause.
12. Acupuncture and Yoga: Some women find relief from hot flashes and stress through alternative therapies like acupuncture and yoga.

It's important to note that treatment choices should be tailored to the individual, taking into account factors such as overall health, personal preferences, and the specific symptoms experienced. Additionally, the risks and benefits of each treatment should be discussed thoroughly with your doctor to make informed decisions about managing perimenopause symptoms.

Remember, perimenopause is a completely natural process and stage of life.

We know this can be a difficult topic. While the timing and severity of the symptoms of perimenopause may vary, remember that you are not alone and that many other people will be able to relate to, empathise with and support you through menopause. People experiencing troublesome symptoms during perimenopause should speak with their doctor or nurse for guidance on symptom management and potential treatment options 💜