Peri-Menopause

What is Perimenopause? 

Perimenopause, often referred to as the menopausal transition, is the period leading up to menopause when a woman's body undergoes a series of hormonal changes as it prepares for the cessation of menstrual cycles and the end of fertility. 

Perimenopause typically begins in a woman's 40s, although it can start in the late 30s or even earlier in some cases. The average duration of perimenopause is about four years, but it can vary widely.

Causes and Factors for Early Perimenopause

Every woman will eventually go through perimenopause and menopause unless they have a medical condition or surgical intervention that affects their reproductive system. 

The primary cause of perimenopause is the natural ageing process. As women age, their ovaries gradually produce fewer hormones, particularly oestrogen and progesterone. This decline in hormone production leads to the symptoms and changes associated with perimenopause. Other factors influencing the timing and severity of perimenopause include genetics, lifestyle factors (such as smoking and diet), and underlying medical conditions.

Doctors with an interest in natural therapies, like Dr Samra, can significantly help those suffering the worst symptoms using vitamins, minerals, and herbal supplements and by prescribing bio-identical hormone supplements when testing indicates that they may be helpful. These require a doctor’s prescription and are usually dispensed by a compounding chemist.

Symptoms of Perimenopause

Various physical and emotional symptoms characterise Perimenopause due to hormonal fluctuations. These symptoms can vary from woman to woman but may include:

• Irregular Menstrual Cycles: One of the most common signs is changes in the menstrual cycle, such as shorter or longer cycles, heavier or lighter periods, or missed periods.
• Hot Flashes: Sudden and intense feelings of heat, often accompanied by sweating and flushing of the face and neck.
• Night Sweats: Hot flashes that occur at night, leading to disrupted sleep.
• Mood Swings: Emotional changes, including irritability, mood swings, and increased anxiety or depression.
• Sleep Disturbances: Difficulty falling asleep or staying asleep, which can lead to fatigue and daytime sleepiness.
• Changes in Libido: A decrease in sexual desire or changes in sexual function, often related to vaginal dryness.
• Vaginal Dryness: Reduced vaginal lubrication, which can lead to discomfort or pain during intercourse.
• Urinary Changes: An increased frequency of urination or urinary incontinence.
• Weight Gain: Some women may experience weight gain, particularly around the abdomen.
• Hair and Skin Changes: Thinning hair, dry skin, and changes in skin elasticity.
• Breast Tenderness: Increased sensitivity or discomfort in the breasts.
• Memory and Concentration Issues: Some women may experience cognitive changes, including forgetfulness or difficulty concentrating.

Stages of Perimenopause

Perimenopause itself can be divided into three stages:

• Early Perimenopause: This stage can begin in a woman's late 30s or early 40s. During early perimenopause, menstrual cycles may become irregular, and hormone levels, particularly oestrogen, begin to fluctuate. Some women may start experiencing mild symptoms like hot flashes or mood swings.
• Middle Perimenopause typically occurs in a woman's mid to late 40s. Menstrual irregularities become more pronounced, and symptoms like hot flashes and night sweats can intensify. Hormone levels fluctuate, and women may experience a wider range of symptoms.
• Late Perimenopause: Late perimenopause, also known as the late transition, occurs in the year or two leading up to menopause (when menstrual periods have ceased for 12 consecutive months). Menstrual cycles often become highly irregular, and symptoms can be at their most severe during this stage. Once menopause is reached, many of these symptoms begin to subside.

Diagnosis of Perimenopause

Perimenopause is typically diagnosed based on a woman's age, reported symptoms, and changes in her menstrual cycle. A doctor will often start by taking a thorough medical history and performing a physical examination. They may also order blood tests to check hormone levels, such as follicle-stimulating hormone (FSH) and estradiol (a form of oestrogen). Elevated FSH levels and low estradiol levels can be indicative of perimenopause.

In some cases, if there is uncertainty about the diagnosis or if symptoms are severe, a doctor may use additional tests, such as an ultrasound or endometrial biopsy, to rule out other potential causes of symptoms or to assess the health of the uterus and ovaries.

Treatment of Perimenopause

During this transition, perimenopause treatment focuses on managing symptoms and improving a woman's overall quality of life. Treatment options can vary depending on the severity of symptoms and a woman's preferences and medical history. Some common approaches to managing perimenopausal symptoms include:

• Hormone Replacement Therapy (HRT) involves taking medications containing hormones (such as oestrogen and/or progesterone) to replace the declining hormones in the body. HRT can relieve symptoms like hot flashes, night sweats, and vaginal dryness. However, it's not suitable for everyone, and the decision to use HRT should be made in consultation with a doctor.
• Non-Hormonal Medications: Some women may choose or require non-hormonal medications to manage specific symptoms. For example, selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs) may be prescribed to alleviate mood swings and depression. Low-dose antidepressants can also help reduce hot flashes.
• Lifestyle Changes: Adopting a healthy lifestyle can help alleviate some symptoms of perimenopause. Recommendations include regular exercise, a balanced diet, stress reduction techniques, and adequate sleep.
• Vaginal Oestrogen: For women experiencing vaginal dryness, discomfort, or urinary symptoms, localised oestrogen therapy in the form of creams, tablets, or rings may be prescribed. This therapy can help restore vaginal tissue health.
• Alternative and Complementary Therapies: Some women explore alternative therapies such as acupuncture, herbal supplements, and dietary changes. While these options may offer relief for some, their effectiveness can vary, and it's important to consult with a doctor before trying them.

What if Perimenopause is Untreated?

If perimenopause is left untreated, many women will still naturally progress through this life stage. However, untreated perimenopause can result in prolonged and severe symptoms that can significantly impact a woman's quality of life. For example:

• Reduced Quality of Life: Untreated perimenopausal symptoms, such as severe hot flashes, mood swings, and sleep disturbances, can reduce overall well-being and daily functioning.
• Bone Health: The hormonal changes of perimenopause and menopause can increase the risk of osteoporosis (bone loss). Treatment options, including hormone therapy or calcium and vitamin D supplementation, can help maintain bone health.
• Cardiovascular Health: Oestrogen has a protective effect on the cardiovascular system. Untreated perimenopause may increase the risk of heart disease and related conditions. Managing risk factors through lifestyle changes and, in some cases, hormone therapy can help mitigate these risks.
• Vaginal and Sexual Health: Untreated vaginal dryness and changes in sexual function can lead to discomfort during intercourse and a reduced quality of sexual life.

Perimenopause is a normal phase of life, and various treatment options are available to help manage symptoms and maintain overall health and well-being. Women experiencing perimenopausal symptoms should consult a doctor to discuss their needs and preferences for managing this transition.