by Dr Deborah Lee, Dr Fox Online Pharmacy
Image by Silviarita – https://pixabay.com/users/silviarita-3142410/?utm_source=link-attribution&utm_medium=referral&utm_campaign=image&utm_content=2634391
It can be confusing trying to understand the changes that occur around the time of menopause, and the medical terms that are used. One of these is the term ‘perimenopause.’
– Just what is the perimenopause?
– How would you know if you are going through it?
What is the menopause?
The word menopause means the last menstrual period. However, most women will not know when the have had their last period, until long after the event.
The menopause is said to have happened if you are aged over 50 and have had no periods for 1 year, or aged under 50 and had no periods for 2 years.
At menopause, the ovaries stop working. This is due to ovarian failure. As the ovaries age, they become less responsive to the natural rise and fall of reproductive hormones that occurs in each menstrual cycle. Eventually, they stop responding altogether, ovulation ceases, and periods stop.
The current average age of menopause – as in the last menstrual period – is age 51 years. However, this differs for everyone and may happen at any time between the age of 45 and 55 years. After the last period, you are now postmenopausal.
If periods stop before the age of 40, and some would say 45, this is a premature menopause – often called premature ovarian failure (POI). This is a special type of menopause and always needs specialist support.
What is the perimenopause?
In fact, the ovaries start to fail long before the last period. Women in their 40’s will start to experience signs of ovarian failure – that is ten years before the last menstrual period. These changes are most obvious in the five years or so before the last period. This is called the perimenopausal transition – or perimenopause.
The perimenopausal transition is a number of years during which women have slowly declining ovarian activity.
Women in their 40’s, and especially those aged 45 and above, should look out for symptoms and signs that are suggestive of the perimenopause.
Symptoms of the perimenopause
Below are listed some of the symptoms of perimenopause.
- Hot flushes and night sweats – 80% of women suffer these miserable, hot episodes, in which they suddenly feel hot, often go red in the face, and start to sweat. Often, they feel dizzy, light-headed and unwell. Some women also have night sweats – waking at night, drenched in perspiration.
- Irregular periods – As the ovaries become less responsive, ovulation occurs less often, and periods become irregular, often closer together, then spaced further apart. Bleeding may be light, or heavy and prolonged.
- Psychological symptoms– Depression and anxiety are more common around the time of menopause, although the reasons for this are unclear. It may be due to psychosocial factors rather than due to the hormonal changes themselves.
- Difficulty sleeping – Insomnia and disordered sleep are common. Night sweats also disturb sleep. This leads to tiredness and exhaustion.
- Loss of libido – This is common, and probably due to a combination of low hormone levels, tiredness from lack of sleep, anxiety and depression, and sexual discomfort due to vaginal dryness.
- Vaginal dryness – Low levels of estrogen at the perimenopause can result in vaginal dryness, and this can make sex painful.
- Changes to hair, skin, and nails – Estrogen stimulates the production of collagen, the major protein in skin, hair and nails. Hence many perimenopausal women notice changes such as dry skin, brittle nails, and thinning hair.
Perimenopause treatment
Women have very differing views on how to manage their menopause. Some regard it as natural and want to tough it out. Some have such severe symptoms they need to ask for help. Others prefer a more medical route and are keen to find out about treatments, including hormone replacement therapy HRT.
It’s important to realise that there was a huge amount of negative publicity about HRT in the past 10-20 years, most of which was sensationalist reporting. The pendulum has now swung in the opposite direction.
For the majority of healthy women, the benefits of HRT will outweigh the risks. The benefits of HRT for long term protection from cardiovascular disease and osteoporosis, have now been recognised. However, there is a ‘window of opportunity’ meaning to get the best protective effects, HRT should be started during the perimenopausal period and continued for 5-10 years. If it is started too late, the disease may already have set in, and it is too late for HRT to affect the outcome.
There is a possibility that HRT may help protect against the onset of Alzheimer’s Disease and Parkinson’s Disease.
- If you have troublesome perimenopausal symptoms, go and speak to your GP.
- Find out as much as you can, for example – Women’s Health Concern – The Menopause.
- If you are having specific problems with your menopause, you can ask to be referred to an NHS Menopause clinic.
- If you are going through or have had a premature menopause, get specialist help without delay. Take a look at The Daisy Network, for women with premature ovarian failure.