Search and Hit Enter

Perimenopause

As there isn’t enough awareness on the menopause out there even within women themselves…

…it’s safe to say that people really don’t know enough about perimenopause. They don’t know enough about menopause itself, so you can imagine how much they know about something that comes even before the menopause.

It is estimated that perimenopause affects more or less 1.5 million women every year. Hot flushes are reported by up to 85% of menopausal women. Hot flushes are present in as many as 55% of women even before the onset of the menstrual irregularity that usually defines officially the entry into the menopausal transition and their incidence and severity increases as women traverse the menopause, peaking in the late part of the transition and tapering off within the next several years.

A meta-analysis of 35,445 women taken from different studies confirmed a 4-year average duration of hot flushes, with the most annoying and bothering symptoms beginning about 1 year before the final menstrual period and declining thereafter. Talking about menopause and workplace, 73% of women reported having hot flushes, while 63% said they regularly felt tired or drowsy. 48% suffered with low mood, 47% struggled to concentrate and 43% had trouble with their memory. As a result of this, 34% of women said that they had developed depression and anxiety, while 29% had significantly lost self-confidence. Only 6% of the whole sample group said that they did not experience any menopause symptoms at work. So, a quiet powerful overview of how much perimenopause and menopause can affect women’s life. 

Only 6% of the whole sample group said that they did not experience any menopause symptoms at work.

So, if menopause is sometimes treated like it does not exist, peri-menopause can be totally ignored or treated like a myth.  So, what is it? Perimenopause medically begins (on average) four years before the menopause, and lasts until the menopause begins. But this varies greatly between women, therefore this is just an estimate. Perimenopause corresponds to the time when your body gradually begins to make less oestrogen. In fact, many menopausal symptoms, such as fatigue, hot flushes, loss of libido, and trouble sleeping, are common during perimenopause as they are caused by hormonal fluctuation. This decrease in oestrogen is not to be intended as a steady and progressive decline. It would be probably ok for our body if it was this way, as it would give the body plenty of time to adjust to the new hormonal levels. Instead, oestrogen reduction during menopause is a fluctuation. The hormone fluctuates (meaning that one day the level can be normal and the day after very low) strongly before stabilising on the “new” level after the menopause starts. For some, perimenopause can be a relatively painless transition into the menopause. But for others, perimenopause severely affects their body, mind, and life.

For all the reasons above it’s important to be well-informed and aware of perimenopausal symptoms, not to scare yourself but just to make sure that you’re prepared for whatever may come. As I think, knowing is better than wondering, you might find yourself with a plethora of new symptoms wondering what they are, why you are having them and where they come from. Perimenopause can be a difficult time, particularly because it’s the first step into the menopause and it’s hard to diagnose.

Perimenopause represents the first of many changes for women and it can be difficult to accept. During the menopause, blood tests can usually confirm that you’re approaching menopause by testing for low hormone levels. Sometimes, elevated levels of follicle-stimulating hormone (FSH) are measured to confirm menopause. When a woman’s FSH blood level is consistently elevated to approximately 30 mIU/mL or higher, and she has not had a menstrual period for a year, it is generally accepted that she has reached menopause. FSH levels can be very high one day and very low the next day, so it is not very easy to use it as a definitive measure of menopausal state. When FSH levels are high, the ovaries make more oestrogen. When FSH levels drop, oestrogen levels drop. These changes in FSH and oestrogen can happen months to years before menopause. 

However, especially for the first few years of perimenopause, your hormone levels fluctuate so a blood test might not immediately provide you with an answer, as it might not pick up the window in which your hormone levels is low or different. Yet, perimenopausal symptoms can be very painful and uncomfortable, which can come as a shock to many! As it can be hard to diagnose, many perimenopausal women won’t be put on HRT (Hormone Replacement Therapy) or given adequate treatment for their symptoms, which of course only makes the transition even worse. On top of this, many women are not even heard as sometimes symptoms are vague and not persistent and therefore they are left alone to tackle the problem.

Perimenopause can start occurring even 10 years before the menopause starts

Additionally, perimenopause can start occurring even 10 years before the menopause starts, when the menopause is absolutely not on your radar or even in your mind.  As always, it’s important to be well-informed and aware of all perimenopausal symptoms, not to scare yourself but just to make sure that you’re prepared for whatever may come. Firstly, perimenopause often starts with irregular periods. This it is usually the very first sign that something is changing. Until you’ve gone a full 12 months without your period, you’re perimenopausal, and therefore will still experience periods, maybe not every month and not with the same “intensity” (and of course, can still get pregnant). But your menstrual cycle in fact is likely to change. It’s not just shorter, lighter periods. It can be heavier, longer, late, early or even skipped periods! It can fluctuate and differ every month, and if you have PMS, the symptoms can worsen. These changes are a clearer sign of perimenopause (compared to say, mood swings or trouble sleeping), and should provide an indication of perimenopause. Likewise, dryness (especially eye dryness) and weight-gain (around your waist) are similarly some of the first symptoms of perimenopause. Nonetheless, everyone experiences perimenopause differently, and the symptoms are similar to those of the menopause.

It’s best not to go through years of misdiagnosis, assuming your symptoms are indicative of more serious mental or physical conditions. You need to get to your GP and be strict about being seen from a specialist. It is not a good idea to wait to take HRT or any other treatments if your symptoms are severe, because it is unnecessary and painful, mentally and physically.