When we are girls, we are told that we will start having periods when we’re in puberty, and that then we’ll reach menopause in our 50s at which point we may have a few hot flushes and then our periods will end. Throughout our fertile years, we tend not to think too much about this end of periods time, we’re too focused on getting pregnant, raising children, or avoiding getting pregnant to think about what might happen in the future.
Then one day in our late 30s or early 40s we start noticing that things are changing. Huh? What’s that about. Why can’t I remember what I was talking about – am I developing early onset dementia? How come I’m gaining weight around my middle, despite not changing my diet or exercise – do I need to restrict my calories or try some new diet? What on earth is going on with my period – one month it’s heavy and painful, then 2 weeks later I get another, and then I go 6 weeks without one. And as for my energy levels and libido, well lets just say I’m exhausted and have no interest in sex.
If any of this sounds familiar, you may well be in perimenopause. This is the stage before menopause when your hormone levels start to change.
Let’s look at the semantics briefly: menopause is officially when you have had no period for 12 months (or 24 months if you’re under 50). So it’s basically one day. Yup, you read that right. All the time before that while we’re experiencing all the symptoms of hormonal change is the perimenopause, and once we’re period-free for the correct amount of time we’re into menopause.
The list of symptoms experienced in perimenopause is long, and includes night sweats, hot flushes, weight gain, low libido, recurrent UTIs, vaginal dryness, poor concentration, memory issues, fatigue, anxiety, and oh so many more. But most importantly this is all happening while you still have periods, which are becoming more irregular over time.
What Can You Do To Manage Your Symptoms?
Well, your first step should be a visit to your GP, where ideally you will have blood tests to rule out other conditions that show similar symptoms (thyroid issues, low vitamin D, low iron, among others). Once these other things have been ruled out, the GP should look at your symptoms to diagnose perimenopause, although they may test hormone levels (in particular FSH – Follicle Stimulating Hormone). Unfortunately, our hormone levels vary throughout even a normal cycle, so when we’re in a stage of change these tests can be unreliable. Indeed the NICE guidelines state that in women over 45 perimenopause should be diagnosed on symptoms alone.
Once you are in agreement that this is what’s going on in your body, you have several choices:
- You can manage symptoms with diet and exercise.
- You can start taking HRT.
- You can address lifestyle choices.
- You can take supplements to support your endocrine system.
And so on. There are many, many ways to navigate your way through this stage, and ultimately you will need to decide which symptoms you find are affecting your life the most, and therefore which you wish to tackle.
There have been some headlines over the years that suggest risks with HRT, however, there are more and more options available nowadays, so fewer people are on the “really can’t take this” list.
Ultimately, the perimenopause is our second puberty, and is the stepping stone to the rest of our life. Yes the symptoms can be horrible, and yes for many women there is a sense of mourning their fertile years, but if we just stop and look at our life and see what is no longer serving us, the perimenopause can be a great opportunity to make the 2nd half of our lives epic.
Emily Barclay is a perimenopausal woman who, after 4 years of not understanding the changes in her body finally realised it was perimenopause and set about bringing together experts in the field who can help support all women to find the route through that suits them best. The result of this is perimenopausehub.com. Emily lives in Norfolk with her partner and their 6 dogs.