Perimenopause symptoms, myths and treatments

The conversation around menopause is opening up, but perimenopause is still something we don’t often talk – or think about – until we’re in it. Which means many of us are clueless about the whats, whens and hows. Menopause expert Dr Louise Newson, founder of Newson Health, The Menopause Charity and the Balance app, is here to clear things up and arm you with intel and strategies to manage the lows, navigate the challenges and sprint into your next chapter.

What is perimenopause?
Peri-menopause is the time between the onset of menopause symptoms and menopause itself – you officially hit menopause one year after your last period. In the UK, the average age of menopause is 51. Perimenopause can go on for up to ten years before your periods stop and is often defined by a dizzying array of symptoms caused by fluctuating and declining levels of key hormones (oestrogen, progesterone and testosterone).

“One of the biggest myths is that women have to notice changes to their periods to be peri-menopausal,” says Louise. “This is not correct. I have seen many peri-menopausal women with regular periods. Most women in their forties are perimenopausal but it can also affect women in their twenties and thirties – no woman is too young to be perimenopausal. If you feel any of your symptoms are related to your changing hormone levels, then speak to a doctor who understands hormones.”

No woman is too young to be perimenopausal

Perimenopause symptoms
“Many symptoms can occur even before periods change in nature or frequency,” Louise explains. “The commonest symptoms are low mood, reduced energy, memory problems, poor sleep, anxiety and reduced libido. Other symptoms such as palpitations, dry skin, urinary symptoms and worsening headaches can also occur.”

Mental health often takes a hit at this time. “Women often experience mood swings, anxiety, low mood, irritability and depressive symptoms during perimenopause,” explains Louise. “These changes occur because our hormones – oestradiol, progesterone and testosterone – can influence brain neurotransmitters like serotonin and dopamine, as well as cortisol regulation. Fluctuations can trigger anything from panic-type symptoms to worsening mood, especially in women with a past history of mental health issues.”

Strong bones, healthy heart
Perimenopause is a critical time for bone health. “Bone density starts to reduce rapidly at this time, because oestradiol, progesterone and testosterone are all really important for building bones and reducing bone loss,” explains Louise. “Around 16% of our bone mass is lost during peri-menopause, which can increase our risk of osteoporosis.”

“Our hormones are also really important in relation to our cardiovascular health,” says Louise. “They work to maintain healthy cholesterol levels, vascular function and insulin sensitivity. When levels of these hormones reduce, women may experience weight gain, raised cholesterol, high blood pressure, and their risk of heart disease increases.”

A doctor’s story
For Louise, perimenopause came in like a tidal wave. “For around six months, I had low mood, anxiety and memory problems,” she shares. “I had worsening migraines and also muscle stiffness and joint pains. I was experiencing night sweats and dreadful palpitations, especially at night. I was really tired. I was also very irritable and often shouted at my husband and children. I was scared and felt alone. I thought about giving up my job, leaving my husband and I often wondered if I was clinically depressed, but I knew I wasn’t. Once I realised these symptoms were all due to my perimenopause, I really struggled to receive the right dose and type of hormones. Once I was finally prescribed all three hormones, my symptoms all improved and it was such a relief to feel well again.”

For around six months, I had low mood, anxiety and memory problems. I was scared and felt alone.

Perimenopause treatments
While a healthy lifestyle is important, Louise emphasises that we can’t improve hormone levels through diet or exercise. “I eat healthily, don’t smoke or drink, do regular yoga and keep active, yet my symptoms were dreadful,” she shares.

What did help was HRT. “HRT, or hormone replacement therapy, is the most effective treatment for easing perimenopausal and menopausal symptoms,” Louise explains. “It usually includes oestradiol, progesterone and testosterone. The type and dose are tailored to each woman – there is no one-size-fits-all approach.”

HRT can also help to guard against future health problems. “Around one in two women over the age of 50 will develop a fracture due to osteoporosis – a condition where the loss of bone density is severe and there is a greater risk of bones breaking,” says Louise. “Taking HRT can help prevent and repair bone loss and reduce the risk of fractures by around 50%. HRT can also reduce the risk of other conditions such as diabetes, depression, bowel cancer and dementia. We prescribe hormones that are the same as our own hormones, so they are safe as well as effective.”