Perimenopause: What symptoms to expect and how to manage them
During perimenopause, you can go months without a menstrual period and have symptoms like hot flashes. Learn what to expect and how to manage your symptoms.
What is perimenopause?
Perimenopause is a natural phase of life for females. While it may seem daunting, know that you're not alone in what you're experiencing and there are plenty of options to help you manage your body's changes.
When your body transitions from its reproductive years to menopause, it doesn't do it all at once. You might start to notice changes in your 40s, and symptoms can last up to 10 years.
During perimenopause, you'll start to have menopause symptoms, but you won't have entirely stopped your menstrual cycle. You can have symptoms like hot flashes, mood swings, brain fog, irregular periods, and anxiety.
These symptoms are caused by changing hormone levels. Your ovaries will produce less oestrogen and progesterone, and constant fluctuations can give you physical and emotional symptoms.
However, everyone experiences perimenopause differently, so your symptoms may not look the same as those of your friends and family.
What are the symptoms of perimenopause?
Perimenopause symptoms are similar to those of menopause. You've probably heard about common ones like mood swings and hot flashes - but you can actually experience a wide range of changes during this stage of life. Some symptoms to look out for include:
- Irregular periods: During perimenopause, your ovaries produce less oestrogen. This can make your menstrual cycles longer, shorter, and less regular. Over time, you might have longer stretches of time between periods.
- Mental health changes: Hormonal changes can affect your mood. You might feel more irritable, anxious, and depressed than usual.
- Hot flashes and night sweats: You might suddenly feel very warm and sweaty both during the day and at night. This is very common and affects anywhere from 30–70% of people during perimenopause. African American women and people at higher BMIs are more likely to have them for longer periods of time.
- Vaginal discomfort: When your oestrogen levels drop, you can experience changes in your vagina. You might have vaginal dryness and thinning of the vaginal tissues. This can cause discomfort in daily life and during sex.
- Difficulty sleeping: Hormonal changes can make it hard to fall asleep, and you might wake up during the night and have difficulty falling back asleep. Night sweats can also affect your sleep.
- Lower libido: Dropping oestrogen levels can affect your sex drive, and you might also have difficulty getting aroused. Other symptoms like vaginal dryness and mood changes can also reduce your libido.
- Other physical symptoms: Some people also have joint pain, sore breasts, heart palpitations, weight gain, sensitive teeth, and urinary tract infections (UTIs).
During perimenopause, you'll start to have menopause symptoms, but you won't have entirely stopped your menstrual cycle.
Treatments for perimenopause symptoms
Hormone replacement therapy
Hormone replacement therapy (HRT) helps to increase your levels of naturally declining oestrogen and progesterone. This can help relieve your symptoms and make you feel a bit better as your body transitions. You'll usually start with a low dose and gradually increase it if you need to.
HRT comes in a few different forms:
- Patches
- Gel
- Tablets
- Implants
- Sprays
Your doctor can help you decide which option is best for you. They'll also advise you on whether or not HRT is a good option, as it's not safe for everyone. You shouldn't use HRT if you:
- Have a history of blood clots
- Have untreated high blood pressure
- Have liver disease
- Have a history of breast cancer
- Are pregnant
If HRT isn't safe for you, your doctor will recommend other treatment options.
Medication and therapy for mental health
If perimenopause is affecting your mental health, know that you're not alone. Fluctuations in your hormones as well as the stress of this period of life can make you feel irritable, anxious, and depressed.
Different forms of therapy, like psychotherapy and cognitive behavioural therapy (CBT), can help. Your doctor might also recommend medications like antidepressants. There’s also some evidence that HRT can help with depression symptoms in perimenopausal women, so they might suggest that as well.
Medication for hot flashes and night sweats
Hot flashes and night sweats can be unpleasant, and they can affect both your sleep and everyday life. If you're finding them hard to manage, your doctor may recommend prescription medication.
Some options include:
- Clonidine, a medication usually used for high blood pressure
- Gabapentin, a medication usually used to treat epilepsy
Oestrogen and vaginal lubricants
You can purchase over-the-counter (OTC) products for vaginal dryness at your local pharmacy. If these don't help, your doctor can give you a prescription for an oestrogen cream, tablet, or ring.
These are inserted into the vagina and can reduce dryness and improve urinary symptoms, such as discomfort when you pee.
Fluctuations in your hormones as well as the stress of this period of life can make you feel irritable, anxious, and depressed.
Can diet and lifestyle changes help?
Diet
During the perimenopause, eating a healthy diet is crucial. Try to eat a balanced diet rich in fruits, vegetables, protein, whole grains, and healthy fats.
Certain nutrients are particularly important during menopause and perimenopause. Making an effort to include these in your diet can help with your symptoms and keep you healthy as your body transitions.
- Calcium and Vitamin D: These are both important for healthy bones. As your oestrogen levels drop, you're at a higher risk of osteoporosis, which makes your bones more fragile. Try to include dairy products, dark leafy greens, and fatty fish.
- Phytoestrogens: These are naturally occurring compounds that mimic the effects of oestrogen in the body. This means they might help with some of your symptoms. You can find them in soya products, flaxseeds, and legumes.
- Healthy Fats: Omega-3 fatty acids are important for hormone health, and they might help with night sweats. You can try eating more fatty fish, nuts, and seeds.
Exercise
Staying active is an important part of a healthy lifestyle, and it can help with improving your mood and weight management during perimenopause. Weight-bearing exercise can also support your bone health.
In addition to cardiovascular exercise like walking, swimming, and running, try to include resistance training like weight lifting and pilates.
Stress management
Perimenopause can be stressful, so taking the time to focus on your mental wellbeing can help you feel better. Try adding practices like yoga, meditation, and guided breathing exercises to your daily routine.
Stay cool
If you're experiencing hot flashes and night sweats, there are steps you can take to stay cool. You can try:
Taking cold showers
- Carrying a mini portable fan with you
- Having cold drinks
- Wearing loose, breathable clothing
- Keeping your bedroom cool at night
- Reducing triggers like alcohol, caffeine, and spicy foods
Fertility during perimenopause
Even though your hormone levels are changing, you can still get pregnant during perimenopause. While it's less likely, you should still use contraception if you don't want to become pregnant. You can either keep using an existing contraceptive method or speak with your doctor about other options.
Transitioning from perimenopause to the menopause
The transition from perimenopause to the menopause usually lasts about 4–8 years. However, it can last up to 14 years. There's no one-size-fits-all time frame.
It can be tricky to know when you're coming closer to the menopause as your menstrual periods become less and less frequent. However, you're officially considered to be in the menopause when you've had no periods for 12 months. You can use a period tracking app or calendar to monitor your cycles.
Why choose Circle Health Group for perimenopause support?
Perimenopause and the menopause are natural stages of life, and going through them doesn't necessarily mean you need to speak with a doctor. However, it may be a good idea if you’re experiencing symptoms that are hard to manage or affecting your daily life. Additionally, if you're having unexplained irregular bleeding, it's a good idea to contact a doctor.
Circle Health Group offers personalised treatment options for perimenopause, and you'll be supported by our network of experienced providers every step of the way.
To learn more about our treatment options, book your appointment online today or call a member of our team directly.
Clinical review and sources
About hormone replacement therapy, NHS
Hormone replacement therapy, NIH
Tags
Sign up to our newsletter
How do I book an appointment?
If you're concerned about symptoms you're experiencing or require further information on this subject, talk to a GP or see an expert consultant at your local Circle Hospital.