10 things you need to know about perimenopause

Today's topic

Today on A.Vogel Talks Menopause, I take you through 10 things you need to know about perimenopause. I get many contacts from women thinking that they might be in perimenopause but they're not sure. They don't really know what perimenopause means or what symptoms they can expect and how long it will go on for.

So, today I will go through 10 of the common queries that I get from women and things I often tell them about this stage of menopause, as well as what you can do to help yourself.

1. What is perimenopause?

Perimenopause is basically the first stage of menopause before your periods stop for good. In this particular phase, your hormones can start to subtly change, with just very, very tiny changes every month. Although these changes are small, they can still be enough to create symptoms.

2. Symptoms can start in your early 40s

Even though the average age for periods stopping for good is about 48 to 52, symptoms can start in your early 40s. We seem to see a lot of women starting to experience subtle changes in their early 40s.

Perimenopause very often lasts a lot longer than menopause itself and this is why it can be so confusing for a lot of women because they don't actually realise they're in perimenopause at all.

3. You can be perimenopausal and still have regular periods

You can still get perimenopause symptoms even if your periods are completely regular, which can be a really confusing thing. Joint pain is a really good example. Women will start to experience joint pain, go to the doctor, get tests done and the tests will come back completely normal. Nobody will see the association between the hormones.

At this particular stage, if you start to get symptoms even in your early 40s, there is a possibility that it could be linked to very subtle hormonal changes.

4. Common perimenopause symptoms include period changes, hot fushes, night sweats, anxiety, low mood, poor sleep and weight gain

Although for some women, they will get completely regular periods, for others, their period changes. That's often the first indication or sign that you are in the first stage of menopause. Periods can start to get longer or shorter, closer together or further apart. They can get heavier or lighter, or they can start to miss. It can be all of these different combinations. A lot of women tell me they get really confused because one month their period is regular, the next month it's two weeks late, the next month, it's two weeks early. There can be this whole different combination of period changes going on.

Hot flushes and night sweats can start to appear. Low mood and anxiety are really common. Sleep can start to get disrupted. Weight gain can start and it can be more difficult to lose weight at this particular point.

The really important thing to be aware here is that lifestyle can have a big impact on your symptoms. Poor diet, not looking after yourself and feeling stressed can compound everything in the perimenopausal stage.

5. It can be difficult to diagnose perimenopause

If you think that you are in perimenopause and you go to your doctor and ask for a sex hormone test, very often, they will come back inconclusive or you will be told, "No. You're not in perimenopause," when you know that things are starting to change.

The problem here is that the tests are taken on a particular day, and it will be the state of your hormone level on that day that will be tested. In perimenopause, your hormones can go up and down like a yo-yo. You can be tested and your oestrogen level can look good, but within a few days, there can be a big drop, so, the tests are not particularly accurate at this point.

6. You are not considered menopausal until your periods have stopped

The problem here is that you don't know when your periods have stopped for good until you've not had any periods for at least one to two years. We do get women in perimenopause who have missed two or three periods and they think that's it and they're in menopause. Then they get really surprised when the next month, their periods come back. There is quite a specific difference between perimenopause and proper menopause itself.

7. Symptoms can get worse just before a period

If you're already experiencing PMS symptoms, you may find that these tend to get much more exaggerated. If you've got breast tenderness, for example, or bloating or cravings, very often you will find that these will be much worse before a period. They will also start earlier on in the month. Instead of getting PMS maybe 3 or 4 days before a period, your PMS symptoms may start a week, or even 10 days before your periods start.

In our early to mid 40s, we can often think that menopause is something way, way in the distance. For me, my first indication that something was changing was that I ended up getting PMS symptoms. I thought that was really strange because I thought the older you got, the less you were likely to get PMS symptoms.

Sometimes, it can be a certain set of symptoms that suddenly appear or get worse that it finally clicks that this is the start of perimenopause.

8. It can be hard to tell if you are perimenopausal if you are on hormonal contraceptives

It can be really difficult to tell if you're in perimenopause if you are on hormonal contraceptives because they are completely changing your hormonal balance, especially for women who either have the Mirena coil or the progestogen-only pill, as these keep your progesterone levels artificially high. If your oestrogen is starting to change or dip, then the symptoms can sometimes be a bit more exaggerated at that particular point.

A lot of women with this particular contraceptive do notice quite a marked change in their symptoms as a guide here, even though they're not getting missing periods.

9. Symptoms can be are worse in perimenopause than menopause

Although it's horrible at the time, for a lot of women, once your hormones start to settle down when your periods have completely stopped, they find that symptoms will start to ease off.

Hindsight is a wonderful thing, and it wasn't until I started doing a lot of research into this that I realised that a lot of the things I was experiencing were just pure and simple perimenopause symptoms. For a lot of women, their symptoms will be more exaggerated and worse in perimenopause than menopause.

10. Perimenopause is different for every woman

We can only give general advice on what may happen. Some women don't get hot flushes or night sweats. Some women sail through perimenopause, while other women will really struggle through it, so, it's a very different situation for every woman.

I hope this was helpful for you. Obviously, if any of you are a little bit confused about what may be happening, if you are wondering if is it perimenopause, or is it something else, then please ask away and I will be happy to help.

Until then, take care.