Identifying and Managing Perimenopause Symptoms
-
Dr Philippa Kaye, GP and author of The Science of Menopause, shares her advice on spotting perimenopause symptoms and managing them in the right way for you
-
We have therapists who specialise in supporting women through the menopause – find them here
Just as the first period is just one moment in all the hormonal, physical and psychological changes of puberty, the final period which is the menopause is one moment in a time of hormonal change. The menopause is a diagnosis of retrospect, and is defined when you have not had a period for twelve months, but the perimenopause is the time leading up to that final period, where symptoms can occur even if periods are irregular, or in some cases more frequent and heavier than previously!
Not all women will get symptoms of the perimenopause and menopause; approximately 1 in 4 or 5 will have no or very few symptoms. About half will have moderate symptoms and the remaining quarter will have severe symptoms, which affect their quality of life, to the extent that approximately 1 in 10 women will have thoughts of suicide.
We have receptors for oestrogen from the hair on our head to the skin on our feet and the fluctuating and lowering hormone levels can therefore cause symptoms in any and every part of the body. Physical symptoms include perhaps the most famous of perimenopause/menopause symptoms, hot flushes and night sweats, but also joint aches and pains, headaches, dry itchy skin and more.
Psychological symptoms can include worsening of premenstrual syndrome (PMS), low mood, depression, anxiety, irritability and what is often called menopausal ‘brain fog’, an umbrella term to cover difficulties with memory and concentration. As ever, there is crossover and overlap between psychological and physical symptoms with symptoms such as insomnia, fatigue and loss of libido being related to many underlying conditions, not all of which are always related to the perimenopause!
Brain changes are seen on imaging around this time, levels of grey matter in the brain fall but then recover after the menopause, particularly in areas related to memory. There are also changes in the volume of white matter in the brain, and although this doesn’t recover, women appear to have more connectivity in the white matter compared to men of the same age.
The symptoms are related to lower hormone levels, for example progesterone acts on receptors for the neurotransmitter GABA. Low levels of GABA activity are associated with low mood and irritability, so lower progesterone may be part of this, and oestrogen has various roles within the brain including being involved with serotonin.
The impact of these symptoms cannot be underestimated, in one UK survey over half of women reported that the menopause had negatively affected their lives. One in two reported their home lives and sex lives were affected, 1 in 3 felt that they were less outgoing than before and 1 in 4 women reported they had become more isolated.
Just under half (45%) of women reported that their work lives were affected, and it is known that women turn down promotions, choose to work part time, or even give up their jobs due to symptoms of the perimenopause and menopause. The personal and economic cost of these symptoms is very real. And symptoms don’t only affect the women themselves, with 40% of partners reporting that they felt helpless around how best to support their partners during this time.
Irrespective of gender we all need to know about each other’s health to be able to best support each other and help women support themselves.
The first step is, as it is often, to get informed. Having an understanding of what is happening, why it is happening, what the symptoms might be and what treatment options are available is essential, not just for you to be able to advocate for yourself, but also to be able to feel empowered to make decisions about your own health. That is why I wrote The Science of Menopause, in order to empower people about what is happening to their bodies.
There is a lot of information currently available about the menopause, and while social media and the internet has helped keep us connected and has many advantages, one of its disadvantages is that there is also a lot of misinformation available!
For example, lifestyle changes and HRT are often put in opposition to each other, I am often asked if I am pro or anti HRT. I find this a strange question, I am pro what helps my patients! It should not be a question of lifestyle modifications OR medications, it should always be lifestyle modifications AND, if needed, medications!
As for all health conditions, lifestyle is important, looking at diet, sleep, alcohol, caffeine and smoking can all affect symptoms. Physical activity helps both physical and psychological symptoms and helps protect your bones for the future. HRT does what it says on the tin, it replaces hormones and is effective. If given within a decade of the menopause for most women, who can and want to take it, effective and generally safe, with small risks to be weighed against potential significant benefits. But for women who don’t want, or can’t have HRT there are many other options, from non-hormonal prescribable treatments to cognitive behavioural therapy (CBT).
We must be informed, with correct, evidence-based information, based on evidence-based guidelines. Only then can we be empowered to get the help that we need.
Dr Philippa Kaye is a GP and the author of The Science of Menopause
