Perimenopause: What Every Woman Needs to Know

Hot flashes, night sweats and mood swings – yep, it’s the time in every woman’s life when hormonal changes run rampant. But would you be surprised that I’m not talking about menopause?

Enter perimenopause: the period leading up to menopause. It can start as early as 35, causing all the uncomfortable symptoms we aren’t expecting for another two decades. 

The average age of menopause for Aussie women is 51, so at 42, I assumed I had plenty of time left. After months of headaches and occasional night sweats, a trip to my GP burst the bubble. It turns out that perimenopause causes both of these symptoms and more! 

To learn more about perimenopause, I turned to Dr Rosie Worsley, an endocrinologist specialising in women’s hormone health. Dr Rosie answered all my big questions, like:

• What perimenopause is
• What age it REALLY occurs
• Perimenopause symptoms to spot
• How you can manage them; and
• The truth about HRT

Buckle in for a crash course in perimenopause, including my best tips for relieving perimenopause symptoms naturally. 

Read on to learn all about it!

What is Perimenopause?

Perimenopause is the transition leading up to menopause, where hormone levels fluctuate and our cycle becomes irregular. It lasts between two and eight years.

It’s easy to assume our hormone levels gradually decline as we approach menopause. Instead, it’s more like a rollercoaster ride. In perimenopause, ovulation starts to become erratic as the number of eggs declines. Some months you won’t ovulate, sometimes it will happen early or late, and some months you might double ovulate!

That’s why our hormones are everywhere, and symptoms can pop up sporadically. Dr Rosie compares it to swishing around in a ‘washing machine of hormones’, with symptoms like hot flashes, night sweats, weight gain or loss, mood swings and decreased libido. In fact, the brain is one of the organs most affected by perimenopause.

Hormones also impact our energy levels, and symptoms like disrupted sleep can drain our batteries even more when perimenopause hits.

If you can relate, don’t worry, you’re not going crazy! The only bonkers thing is that we don’t discuss it more. Personally, I was surprised to learn that perimenopause can start so early – more on that below!

What Age Does Perimenopause Usually Start?

The average onset of perimenopause is about 47 years old, but in reality, it can start any time between 35 and 45. Perimenopause symptoms are common for women in their late 30s and early 40s.

“We know that about 1 in 5 women in their early 40s will get night sweats and hot flushes,” says Dr Rosie, which can be shocking to experience.

In fact, hormonal symptoms can start even earlier, when you’re still getting regular periods. This is technically called the ‘late reproductive phase’, but Dr Rosie calls it ‘pre-perimenopause’. This is when you still ovulate monthly, but hormone levels are less stable, leading to bad PMS and menstrual migraines. 

How do you know when you’ll start perimenopause? The main factor is genetics, explains Dr Rosie. If you ask your mum, that’s the best indication!

However, other factors can disrupt the endocrine system and lead to early perimenopause, especially smoking and heavy alcohol consumption. Both are causes of premature aging – another great reason to quit smoking and drink in moderation.

Perimenopause Symptoms: What To Look For

Ten common signs and symptoms of perimenopause include:

• Hot flashes and night sweats: These symptoms can be sporadic during perimenopause, even one or two nights a month. However, they can increase in frequency as time passes. 

• Irregular periods: Periods can be early or late, and you may skip some altogether! On the flip side, you can also experience heavier bleeding than usual. 

• Weight gain: Biological changes like decreased muscle mass make it easier to gain weight during perimenopause. Increased waist circumference may also occur. 

• Cognitive changes: As hormone levels affect the brain, symptoms can include memory issues, struggles with multitasking, and brain fog.

• Mood swings: Irritability is extremely common as it’s harder to cope with day-to-day stress. Perimenopausal women have a much higher risk of anxiety and depression.  

• Libido changes: Some women find that their libido overall is not what it was, or their sex drive can fluctuate with hormonal changes. 

• Vaginal dryness: It can be constant, leading to itching and burning, or it might just mean needing more lube than normal. 

• Headaches: Menstrual migraines may occur for the first time or worsen, and non-migraine headaches are common too. 

• Sleep difficulties: This can include insomnia, waking up at the same time during the night, and struggling to fall asleep again if your sleep is disturbed.

• Joint & muscle pain: Rather than an acute injury, this can feel more like chronic ‘wear and tear’ or achiness.  

If you’re experiencing these symptoms, Dr Rosie also has some good news: there’s plenty we can do to manage them. 

How To Manage Perimenopause Symptoms

If you have terrible perimenopause symptoms, you’ll want to know how to get some relief. 

Here are the common treatments for perimenopause:

Symptom-Specific Treatments

Treating the symptoms is the first port of call for perimenopause. For example, vaginal dryness could be treated with vaginal moisturisers and lubricants rather than hormone treatment. Similarly, doctors can prescribe preventative medications and ‘rescue relief’ for menstrual migraine.

Contraceptive Pill 

The most common perimenopause treatment is actually ‘The Pill’, as it contains both oestrogen and progesterone. Of course, it also prevents you from getting pregnant – and that’s still important! You shouldn’t stop taking The Pill when you reach perimenopause. “We don’t reliably consider you unable to get pregnant until you haven’t had a period for about 12 months,” Dr Rosie explains. That’s why The Pill is still prescribed for people in their late 40s or 50s. 

Hormone Replacement Therapy (HRT)

HRT is similar to ‘The Pill’, in that it helps regulate your hormones, but is typically a lower dose. “If people have really heavy bleeding, then you’d probably be looking at something like a Marina IUD,” explains Dr Rosie. “And then you could have something like an oestrogen patch to help with hot flashes and symptoms like that.” 

HRT can have a bad reputation, but is it really something to avoid? You can hear what Dr Rosie has to say below. 

HRT for Perimenopause: Is It Right For Me? 

Hormone Replacement Therapy (HRT) can help to replace or supplement hormones during perimenopause, reducing the symptoms. It’s not the solution for everyone, but for women with debilitating perimenopause symptoms, HRT can be life-changing. Symptoms like hot flashes can be reduced by up to 80%, and it’s also very effective for mood changes, such as irritability. 

“I’ve certainly met women who’ve had to give up working because they’ve had what are essentially really bad menopausal symptoms,” she recalls. “And you put them on HRT and they’re able to function again. It’s very much about the individual, and is it the right treatment for them?”

HRT also reduces the risk of other conditions like endometrial and colon cancer, says Dr Rosie. It also leads to lower rates of osteoporosis and fractures, and reduces rates of cardiovascular disease and diabetes. 

Risks of HRT for Perimenopause 

If you’ve heard about cancer risks, Dr Rosie explains that today’s hormone replacement therapy is much safer than before.

Modern HRT is closer to the body’s own oestrogen and uses actual progesterone rather than synthetic progesterone. “We think that’s likely to be much safer than the older versions,” Dr Rosie confirms. 

Older HRT studies did show a link with breast cancer, but these were conducted with outdated forms of HRT, over five years of exposure – longer than the typical duration of HRT for perimenopause. Experts now consider the risks highly exaggerated, especially with delivery through a patch or gel. 

For the majority of women, though, the benefits outweigh the risks. “We now know that one year of HRT really doesn’t affect breast cancer risk at all, which is reassuring,” Dr Rosie says. Low-dose HRT, like vaginal creams, are also not associated with cancer risk factors. 

Doctors will always look at the individual’s overall risk factors to determine whether HRT is safe. If you suffer from perimenopause symptoms, it’s worth asking if hormone therapy can help. 

How to Relieve Perimenopause Symptoms Naturally

Lifestyle changes can help reduce the severity and frequency of perimenopause symptoms.

Here are my top tips for natural perimenopause relief:

• Eat a nutritious diet: You can relieve perimenopause symptoms and balance your hormones through diet. This includes eliminating or reducing gluten, dairy and refined sugars. Aim to get enough protein and good fats. Add leafy greens and probiotics for gut health, too!

• Exercise regularly: Exercise is excellent for reducing stress, managing weight and boosting energy levels – three major goalposts for perimenopause treatment! Regular exercise also helps reduce the risk of depression and helps regulate mood swings.

• Get enough restful sleep: There are many great strategies to reduce insomnia and improve sleep quality during perimenopause – including a regular routine, avoiding exercise or large meals after 7 pm, and watching your caffeine intake. Sleep tracking can help pinpoint which changes are working and which aren’t. 

• Limit caffeine and alcohol consumption: Excess alcohol disrupts hormones, increases cortisol and stress levels, and contributes to weight gain – all things to avoid during perimenopause. Caffeine and alcohol disrupt sleep cycles, making it harder to get a good night’s rest. 

• Quit smoking: Smoking not only leads to early menopause but also worsens symptoms like hot flashes, as nicotine affects how oestrogen is metabolised in the liver. Studies suggest that current smokers have double the risk of premature menopause compared to current smokers – so the sooner you quit, the better!  

• Manage weight: Biological changes during perimenopause mean we need to adjust our nutrition to maintain a healthy weight – including eating more protein and fewer calories. Dr Rosie shares that women who are overweight also have more severe perimenopause symptoms.

• Manage stress and relax: It’s easier said than done, but stress is a major concern during perimenopause. These days, it often strikes when we’re busiest, managing a career, kids and our health too. Stress relief helps regulate your moods and reduce the risk of perimenopausal depression. 

• Herbal supplements: If you’re still struggling, a nutritionist or naturopath can recommend supplements suitable for perimenopause. This may include practitioner-only omega-3, vitamin D, maca powder or other remedies – but always get professional advice first! Supplementation should always be based on your individual needs, or it can do more harm than good. 
  

Takeaways 

Our 30s and 40s are when our old habits start to let us down. We may have been skating by with poor sleep, too much alcohol and not enough green veg – but once we reach perimenopause, it all starts taking a toll. 

One of the struggles is that perimenopause symptoms hit us when we can least afford to take care of ourselves. These days, we’re often still looking after young or school-aged children, juggling motherhood and a career, dealing with ageing parents and our own relationships too. In other words, it’s a pressure cooker of stress!

Having a full plate can make symptoms like irritability overwhelming to manage, and it’s so hard to make time for our wellbeing. If you’re experiencing perimenopause symptoms, take this as a message from your body: it’s time to take care of yourself too!

Listen to the full interview with Dr Rosie Worsley on my Healthy Her podcast.