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Perimenopause – a period of transition

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Perimenopause – a period of transition

What is perimenopause?

The definition of menopause (as we’ve explained in The New Hot) is the cessation of periods but to be defined as being ‘in menopause’ you have to have had no periods for at least a year. The perimenopause is the phase leading up to this point. The phase of ‘post-menopause’ begins after you have had no periods for a year.

The perimenopause (peri, Greek for “around” or “near” + menopause) is a prolonged transition state (sometimes called “the menopausal transition”). Technically, the transition ends 12 months earlier than perimenopause). The average duration is three to four years. However, it can last only a few months or last up to 10 years.

Perimenopause begins with irregular menstrual cycles – due to the deteriorating ovarian function – and ends one year after the last menstrual period.

Symptoms of perimenopause

It could be tricky to distinguish hormonal-based symptoms of perimenopause from more general changes due to ageing or common middle-aged events. Things like children leaving home, career changes, parental illness or divorce can cause significant levels of distress and cause mood swings and anxiety which are also common in perimenopause.

Here is what women in perimenopause tend to experience:

Changing levels of oestrogen

The changes in the circulating oestrogen levels greatly affect the way we feel.

During our fertile years, the amount of oestrogen in the bloodstream increases and decreases quite predictably throughout the menstrual cycle. Oestrogen levels are largely controlled by two hormones, follicle-stimulating hormone (FSH) and luteinising hormone (LH). FSH stimulates the follicles – the fluid-filled sacs in the ovaries that contain the eggs – to produce oestrogen. When oestrogen reaches a certain level, the brain signals the pituitary gland to turn off FSH and produce a surge of LH. This in turn stimulates the ovary to release the egg from its follicle (ovulation). The residual follicle produces progesterone, in addition to oestrogen, in preparation for pregnancy. As the levels of these hormones increase, the levels of FSH and LH decrease. If pregnancy does not occur, progesterone falls, menstruation occurs and the cycle begins again.

Hot flushes during perimenopause

Most women assume they won’t experience any hot flushes until they reach the menopause, so it can be surprising when this actually happens.

Hot flushes come unexpectedly and can last from one to five minutes. They can feel like a fleeting feeling of warmth or an intense sensation like burning from the inside. You might experience redness on your face and upper body, sweating and chills. When these appear during an important moment such as giving a presentation or conducting an important meeting, it’s normal to feel awkward and embarrassed.

What helps is eliminating or reducing hot temperatures, hot drinks and spicy foods. You can try to dress in layers so you can take off your clothes if necessary

Sleep problems

About 40% of perimenopausal women have trouble sleeping. problem is too complex to be due solely to hormonal fluctuations. Sleep cycles change with age, and insomnia is a common age-related complaint.  The most difficult part of not sleeping is that it impacts every part of your life. Your concentration, memory (that is already struggling after menopause onset), mood, appetite and energy levels are all drastically affected by a lack of sleep.

The hormone melatonin plays an important role in controlling our sleep and wake cycles. As we get older, our melatonin levels start to decrease. Therefore, it starts getting harder and harder to fall asleep and stay asleep. Progesterone also has a sleep-inducing effect and declining levels mean a decline in sleep quality.

Mood symptoms

The unpredictability of perimenopause can be stressful and can provoke episodes of irritability. Some women may be more vulnerable than others to hormone-related mood swings. The best predictors of mood symptoms in middle age are stress in life, poor overall health and a history of depression.

Vaginal dryness

During late perimenopause, declining oestrogen levels can cause vaginal tissue to become thinner and drier. Vaginal dryness (which usually gets worse after menopause) can cause itching and irritation. It can also be a source of pain during intercourse and therefore decreased libido. You can try using products such as Blossom Balm Intimate Skin Moisturiser which helps keep the vagina moist. You can also try our water-based Motion Lotion is formulated to provide extra silky lubrication that helps alleviate discomfort.

Irregular menstruation and heavy bleeding

You have irregular periods if the length of your menstrual cycle keeps changing. The average menstrual cycle lasts 28 days, however, it’s normal for it to be a bit shorter or longer than this.

If you have irregular bleeding and do not want to get pregnant, low doses of birth control pills are a good choice. By suppressing ovulation, they modulate menstrual flow, regulate menstruation and stabilize endometriosis. They also protect against endometrial and ovarian cancer, prevent hot flushes, reduce vaginal dryness and prevent bone loss. If you have unusual bleeding, such as daily or very heavy bleeding, see your gynaecologist.

Foggy brain

Many women have trouble with their short-term memory and find it difficult to concentrate. You suddenly forget where you put your glasses or can’t remember whether you locked the door or switched off the lights.

Things that can help include writing things down, avoiding alcohol, doing physical and mental exercises and taking vitamins such as Meno Blend.

What to do about the symptoms of perimenopause

There are several treatments that can help with your perimenopausal symptoms, the most popular one being HRT.

Hormone Replacement Therapy (HRT) is a way of replacing the hormone levels that fall with menopause. It helps balance out the rollercoaster of hormones during the perimenopause and increases hormone levels when they are low post-menopause.

Women with severe hot flushes who do not want or cannot take HRT may get some relief from certain types, some selective serotonin reuptake inhibitors (SSRIs), the epilepsy drug Neurontin (gabapentin)  or clonidine, a medicine for blood pressure. Some of these drugs have side effects that may limit their usefulness. Please consult your doctor before trying any drugs! And remember, most importantly be patient with your body and all the changes it’s going through.

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Meg's Quote

If you are depressed,
you are living in the past.
If you are anxious,
you are living in the future.
If you are at peace,
you are living in the present.
– Lao Tzu –

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