You’ve almost certainly heard of menopause, the end of a woman’s reproductive years, which is reached when you stop having any periods or vaginal spotting for a 12-month period. I’ve noticed (and welcome!) the fact that we’re now talking more about perimenopause – the time leading up to menopause.
I’ve personally seen a lot more patients in my clinic who want to know what to expect and what they can do to manage symptoms and actively reduce their risk of other chronic health conditions in the perimenopausal period.
What happens during perimenopause?
In the lead-up to menopause, hormones like oestrogen and progesterone fluctuate and decline because the ovaries (which normally release eggs every month, leading to a period) start to slow down.
The symptoms of perimenopause typically begin in mid to late 40s, though they can start earlier for some people. If symptoms commence before 40 it is referred to as premature menopause. Premature menopause can have significant repercussions for bone and heart health, so I highly recommend anyone undergoing premature menopause see their GP who can further investigate for underlying causes and instigate management to reduce the risk of complications.
Understanding the symptoms
Perimenopause can be a tumultuous time. The transition can come with huge hormonal shifts (like the ones experienced in the adolescent period) that can have physical and emotional impacts.
One of the most common symptoms of perimenopause is a change in the menstrual cycle; it might lengthen or result in heavier or skipped periods. Eventually, periods stop altogether. And after 12 months, you’re considered to have reached menopause.
Patients can also experience mood fluctuations, hot flushes, skin changes (like dryness or itchiness) and vaginal dryness (which can impact sexual activity and thus relationships). For some, the symptoms of perimenopause last several years. For others, they may last a year or months. Around 20 per cent of patients have no symptoms at all. It differs from person to person.
How to manage symptoms
The emotional symptoms of perimenopause can be misunderstood and misdiagnosed. Irritability for instance may be a feature of perimenopause and not an underlying mood disorder. It’s worth considering that peri- and post-menopausal women make up 40% of all healthcare visits in Australia1.
I find people tend to sit with mood changes (including irritability and teariness) and accept them as the norm. As a GP, however, I encourage you to chat to your doctor for support as soon you notice symptoms. There are plenty of things that can help.
Simple lifestyle interventions like regular physical activity, meditation, sleep hygiene measures, and caffeine and alcohol reduction can go a long way to help patients experiencing perimenopausal symptoms such as emotional lability, interrupted sleep and hot flushes.
If required, there are also prescribed medication options that can be considered depending on symptoms. For hot flushes, for instance, specific anti-depressant therapies can be helpful. Hormone replacement therapy is also an option for people who have a range of persistent symptoms. Vaginal oestrogen can also be considered (if safe) for those experiencing vaginal dryness impacting sex. There are options galore!
It is worth being cautious of “natural” therapies – lots of them lack proper scientific evidence and can cause harmful side effects, so always consult your doctor or pharmacist first.
A trigger for health checks
If you start experiencing symptoms of perimenopause, it’s a good reminder to check in with your GP to make sure you’re up to date with all your preventative health checks.
The risk for diabetes and cancers of the cervix, bowel and breast start to climb around the typical age people experience perimenopause, and there are effective screening tests for these conditions. I also ensure the patient has undergone a recent cardiovascular risk assessment (which includes measuring blood pressure and blood tests to check cholesterol and fasting sugars).
Perimenopause is a natural part of a woman’s lifecycle. While there’s no need to panic, it’s important to recognise the symptoms, understand how to manage them and check in with your GP to get your other preventative health checks in order.
