Understanding the transition our bodies make from menstruating to menopause isn’t straightforward.
Whilst menopause is defined as the point where it’s been 12 months since your last menstrual bleed, there’s a whole grey area known as perimenopause.
During perimenopause, the timing of which can differ dramatically from person-to-person, you may get all sorts of clues that things are changing, but no definitive diagnosis.
So, it’s a good idea to get familiar with what’s going on during perimenopause, so you can try to manage the symptoms.
What we’ll be looking into:
- What is perimenopause and what’s happening?
- How long does perimenopause last?
- The symptoms of perimenopause
- How to approach making the menopausal transition
What is perimenopause and what’s happening?
The body doesn’t just switch from ovulation and menstruation to menopause, the process is usually quite gradual.
As the levels of oestrogen in the body start to drop, ovarian function changes and the menstrual cycle becomes more erratic.
For some people, disruption to their usual menstrual cycle is the first clue that they’ve entered perimenopause, but that’s not conclusive.
It’s merely one of several symptoms that can present when the body is perimenopausal as the reproductive system starts shutting down.
How long does perimenopause last?
There is no definitive answer on how long perimenopause will last – it can be a wildly different experience from one person to another.
Harvard Medical School experts explain: “The average duration is three to four years, although it can last just a few months or extend as long as a decade.
“Some women feel buffeted by hot flashes [flushes] and wiped out by heavy periods; many have no bothersome symptoms. Periods may end more or less abruptly for some, while others may menstruate erratically for years.”
The symptoms of perimenopause
There are several symptoms that you may experience during perimenopause, and some of them are similar to those that impact menopausal people.
Let’s take a look at the most common ones:
Symptom #1: Irregular periods
When the sex hormone levels in your body change, it’s likely to impact your menstrual cycle.
Not all of us have periods that are as regular as clockwork, but even those with irregular cycles may notice the difference.
One common symptom is heavy bleeding which happens due to the disruptions in the ovulation process.
Speaking to The Guardian, sexual and reproductive health consultant Dr Paula Briggs explained:
“As the body tries to prod faltering ovaries into releasing an egg, oestrogen levels rise, causing the womb lining to thicken; but women who are no longer ovulating regularly don’t always produce enough progesterone to balance out that oestrogen.
“The result is an unusually thick womb lining which sheds chaotically. Women may pass large clots or sudden gushes of blood, forcing them to double up on sanitary protection, or change it hourly or even more often.”
Hormone replacement therapy, oral contraceptives, and lifestyle changes have been shown to minimise period irregularity through perimenopause!
Symptom #2: Vaginal dryness
In some recent research, Dr Cynthia Abraham explains the impact of dwindling oestrogen levels on vaginal health.
Dr Abraham writes: “Oestrogen is a hormone that helps maintain the vagina’s lubrication, elasticity, and thickness.
“Low levels of oestrogen can cause thinning, drying, and inflammation of vaginal walls. This is called vaginal atrophy.”
Not only can this cause discomfort during day-to-day life, but vaginal dryness can also impact your sex life as intercourse becomes painful.
You can combat this by using vaginal moisturisers, lubricants, and hormone treatments.
Symptom #3: Low mood, anxiety, and depression
The physical changes your body is going through can have a significant impact on your mental and emotional wellbeing.
A 2023 survey completed by almost 7,000 perimenopausal women found that 87% experienced mood changes often or all the time.
The Menopause Charity expert Dr Rebecca Lewis explains why hormone changes impact the brain.
Dr Lewis writes: “Oestrogen is vital for brain function and an area of the brain called the limbic system requires oestrogen to function properly. The limbic system has many functions, but it is important in its role in mood, anxiety, memory, and libido.
“Low mood due to hormonal changes is not the same as clinical depression for many women but is often characterised by a flat mood and described as a loss of joy and interest in life.”
Interestingly, Dr Lewis notes that despite guidance to use HRT (hormone-replacement therapies) to help relieve this particular symptom, 66% of women were given anti-depressants to help them cope with perimenopausal mood problems.
Symptom #4: Hot flushes
The infamous hot flush symptom of menopause can happen during the perimenopause stage too.
These moments of intense heat can happen pretty regularly and, in some cases, leave people drenched in sweat.
Not only do some people find this embarrassing when they are in public, hot flushes can seriously impact your ability to function during the day and cause disruption at night.
The US National Institute on Aging offers guidance on how to help alleviate the intensity of hot flushes by making lifestyle changes.
They suggest: “Dress in layers that can be removed at the start of a hot flush.
“Avoid alcohol, spicy foods, and caffeine. Try to maintain a healthy weight. Women who are overweight or obese may experience more frequent and severe hot flushes.”
Although the research is at any early stage, they also suggest looking at mindful meditation and hypnotherapy to help manage hot flushes.
Symptom #5: Sleeping problems
During perimenopause, you may experience serious disruptions to your sleep.
The hormonal changes have an impact on the messages your hormones are sending to your brain, particularly melatonin and oestrogen.
When melatonin levels drop, it can impact your sleep/wake cycle and play merry hell with your slumber habits.
Hot flushes, low mood, anxiety, and irregular periods can all contribute to poor sleep quality too.
Dr Elizabeth Rosen, who advises health company Livi, has some advice on how to combat perimenopause sleep problems.
Dr Rosen said: “Doing physical exercise, sleep meditations and having regular bedtime habits can help.
“Physical exercise can [also] help with night sweats. You should also try keeping your bedroom as cool as you can.”
Symptom #6: Urinary incontinence
As well as having a pivotal role in our reproductive system, oestrogen is also present in the urinary tract.
When the level of oestrogen begins to fall, it can impact urinary continence, and you may experience a leaky bladder during perimenopause.
The National Association for Continence explains: “This decrease in oestrogen causes the vaginal tissues to become less elastic and thin and can weaken your pelvic floor muscles. Without intervention, your muscles also naturally weaken with age.
“Your weakened pelvic floor makes it harder to control your bladder, especially when stress is placed upon it.”
How to approach the menopausal transition
If you suspect you are in perimenopause, or are nearing the age where you think it’s likely to begin, it can feel daunting.
Conversations about menopause are happening more frequently and therefore people are learning more about what to expect and how to manage symptoms.
The truth is that the best way you can prepare for perimenopause is to get yourself into healthy habits.
Being active several times a week, eating a nutritious diet, taking care of your sleep health and looking after your emotional wellbeing will really help.
You don’t know how your body and mind will react to this seismic change in your hormones, so there’s no point in trying to predict anything. It might take some trial and error, but be kind to yourself whilst you explore what works for you.
Let’s advocate for each other
We know that the impact of perimenopause and menopause on people’s lives can be incredibly challenging.
Creating a space to talk openly and discuss strategies to manage the effect of symptoms is vitally important.
In particular, advocating for more understanding and provision in the workplace is critical, so those in menopause won’t miss out or have their careers derailed.
There are plenty of ways for employers to protect the wellbeing of their workers during this stage of life. Give our article about menopause at work a read if you’d like to find out more.
Let’s keep up the pressure for those provisions to be a basic right for all menopausal employees.
Even though perimenopause does not sound like a barrel of laughs, it’s a transition you’ll inevitably experience as a woman. This can be scary, but also empowering. Here at Kari Health, we are here to support you.
Keep an eye out for our upcoming site feature, “Aunt Kari”, where you’ll be able to send in your questions for our experts to answer. These questions will be fully anonymous, and answers will be published weekly on our website.
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