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Perimenopause: recognising the first symptoms

Updated: Sep 27, 2021

The period before the menopause is also known as ‘premenopause’. However, health professionals prefer calling this period perimenopause, which literally means around the menopause, as it refers to the years before menopause, when hormone levels are changing but menstruation is still occurring.

Many symptoms can occur before menopause and make this period difficult for women. Here is a guide to recognising the symptoms you may be facing and some solutions to help you experience your perimenopause better.

What is menopause?

The word 'menopause' comes from the Greek words 'menos', meaning month, and 'pause', meaning to cease. So, menopause literally means the 'monthly' (the period) stops”.

Menopause is therefore the permanent cessation of menstruation in women and the cessation of activity of the ovaries. It most often occurs between the ages of 45 and 55 and is accompanied, in three out of four women, by inconveniences such as hot flashes or mood disturbances. We talk about menopause 12 months after your last menstrual bleeding.

Perimenopause indicates the first changes in the body that accompany hormonal changes, primarily a decrease in oestrogen and progesterone levels, in women. The production of oestrogen and progesterone decreases to extremely low levels, until menopause is reached.

About 1% of women experience early menopause, before the age of 40. It can happen as a result of surgery or medical treatment, and it can sometimes be hereditary.

Some perimenopausal women may notice disrupted menstrual cycles for up to 10 years before the onset of their true menopause.

Irregular menstrual cycles

One of the first symptoms of perimenopause is the menstrual cycle. Usually, cycles tend to shorten, and women may experience small amounts of blood loss or even heavy bleeding. This is linked to the change in hormones.

Resurgence of premenstrual syndrome

Irregular periods may be accompanied by a recurrence or worsening of premenstrual syndrome (PMS), which symptoms include headaches, swelling and pain in the breasts, abdominal bloating, oedema of the extremities and irritability. It starts 10 to 12 days before your period and continues until the end of the cycle. Perimenopause can increase the symptoms of PMS.

Heavy periods

During perimenopause, women may experience a decrease in blood flow or on the contrary an increase in it. These heavy periods appear following hormonal imbalance. The ovaries make too much oestrogen and this affects the flow of menstruation. It is then possible to feel some fatigue.

Symptoms of perimenopause

Many symptoms can be felt for years before menopause, during a period of transition known as perimenopause. Some women will only experience these symptoms for a few years before their period stops completely, but others will experience them for up to ten years.

After stopping periods, 80% of women experience at least one other symptom of menopause. Some symptoms may go away naturally, while others may improve with treatment.

The symptoms of perimenopause vary greatly from woman to woman, but the most common symptoms are:

Hot flashes

This is the most common symptom of menopause worldwide. Doctors do not really know what causes hot flashes, but they are associated with the hormonal changes that accompany menopause.

Hormonal treatment can help reduce hot flashes, as well as many other symptoms of menopause. However, the length and amount of such treatment should be limited as it is associated with the risk of certain serious conditions, including heart disease, stroke, blood clots, breast cancer.

Mood disorders

Hormonal disturbances also lead to emotional disturbances. Women can experience mood disorders ranging from irritability to depression. While some women find the changes due to perimenopause quite difficult to manage, it is important to be aware that these symptoms are caused by hormones and not by some outside factor.

Sleep disturbances and night sweats

Perimenopausal women experience trouble sleeping as they enter the menopausal transition. Sleep is usually more restless during menstruation.

The sleep of postmenopausal women can also be affected by night sweats. Night-time sweating is a major symptom that usually begins during perimenopause. As with hot flashes, the exact cause remains unknown. Cutting down on alcohol and spicy foods may relieve the symptoms, but this varies from woman to woman.

Decreased libido and vaginal dryness

The decrease in hormone levels can also lead to vaginal dryness and low sex drive.

Urinary weakness

During perimenopause, the level of oestrogen in women drops and can cause the urinary tract to change, which in turn loses elasticity, and may be accompanied by stress incontinence. It is possible to fight against these urinary weaknesses through daily pelvic muscle work.

Weight gain

Perimenopause is accompanied in some cases by weight gain. There are many reasons for this: worsening of the pre-menstrual syndrome, a decrease in energy expenditure, an increase in calorie intake, an increase in fat mass and a decrease in lean mass due to age. To fight against this weight gain, the solution is to reduce your calorie intake or increase your energy expenditure by practicing regular physical activity.

In summary, it is important to remember that perimenopause/menopause is a natural process. It is a time to take some much-needed respite by reducing stress and embracing a new and exciting chapter in life.

Dr Ayi

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