Stages of menopause
What is perimenopause?
Perimenopause is the period before the menopause. Perimenopause starts when the amount of oestrogen made by the ovaries begins to decline. It usually begins in your 40s, although it can start earlier.
To manage perimenopause symptoms, you need to be aware of what they are. It is thought that there are at least 35 symptoms of the menopause:
– Hot flushes and night sweats
– Fatigue
– Dizziness
– Loss of libido
– Mood swings
– Irritability
– Hair loss
– Weight gain
– Palpitations
– Bloating
– Headaches
– Tinnitus
– Bladder weakness
– Memory lapses
– Irregular periods
– Itchy skin
– Nausea
– Joint pain
– Anxiety
– Brittle nails
– Digestive problems
– Incontinence
– Low mood
– Cystitis
– Vaginal dryness
– Difficulty concentrating
– Osteoporosis
– Emotional changes
– Depression
– Insomnia
– Aching muscles
– Tender breasts
– Heavy periods
– Skin changes
– Panic attacksWhat is menopause?
The medical definition of menopause is when you have not had your monthly period for at least 12 months. However, menopause is commonly used as a catch-all term to encompass perimenopause and the symptoms that come from the changes in hormone levels, whether this comes naturally or through illness or treatment. Symptoms of the menopause are the same as those of the perimenopause.
The average age of a person going through a natural menopause is 51 years old, but it can happen at any time.
– If you’re younger than 45, it is called an early menopause.
– Before the age of 40, it is known as a premature menopause, or Premature Ovarian Insufficiency (POI).
– By the age of 54, 80% of women will have stopped having periods.
– Perimenopause and menopause symptoms can have a big impact on your life, including relationships and work.Symptoms trackers
Menopause symptoms questionnaire (PDF)
Menopause symptoms diary (PDF)What do these hormones do?
Oestrogen
This is the hormone that protects the arteries in your heart, keeps your bones strong, boosts your brainpower and memory, regulates your mood, and keeps areas which require moisture (such as your joints, eyes and vagina) well lubricated.
Oestrogen leaflet (PDF)
Testosterone
Although you might think of it as a male hormone, testosterone is also produced by the ovaries. In fact, women produce three times as much testosterone as oestrogen before the menopause. Testosterone helps to build muscle, boost your sex drive, improve memory and concentration, and give you more energy.
Testosterone leaflet (PDF)
Progesterone
This hormone helps to regulate periods and also plays an important role during pregnancy.
Progesterone leaflet (PDF)
Treatment for perimenopause and menopause
The main medicine treatment for perimenopause and menopause symptoms is hormone replacement therapy (HRT), which replaces the hormones that are at low levels. There are other treatments if you cannot, or choose not to, have HRT.
Hormone replacement therapy (HRT)
HRT is a safe and effective treatment for most going through perimenopause and menopause. Your GP will discuss any risks with you. HRT involves using oestrogen to replace your body’s own levels around the time of the menopause.
There are different types and doses of HRT. Using the right dose and type usually means your symptoms improve.
Oestrogen comes as:
– skin patches
– a gel or spray to put on the skin
– implants
– tablets
If you have a womb (uterus) you also need to take progesterone to protect your womb lining from the effects of oestrogen. Taking oestrogen and progesterone is called combined HRT.
Progesterone comes as:
– patches, as part of a combined patch with oestrogen
– IUS (intrauterine system, or coil)
– tablets
If you have low sex drive because of menopause and HRT does not improve it, you may be offered testosterone. Testosterone comes as a gel or cream.Pros and Cons of HRT
Benefits of HRT
The main benefit of HRT is that it can help relieve most perimenopause and menopause symptoms, including hot flushes, brain fog, joint pains, mood swings and vaginal dryness. Hot flushes or night sweats often improve within a few weeks. Other symptoms like mood changes and vaginal dryness can take a few months to improve.
Taking HRT can also reduce your risk of hormone-related health problems including:
– Osteoporosis
– Diabetes
– Heart disease
– Osteoarthritis
– Dementia
– Depression
– Death
– Covid
Risks of HRT
The risks of HRT are small and are usually outweighed by the benefits. If you’re interested in HRT, your doctor or nurse can discuss the risks with you.Diet & Lifestyle Changes
Lifestyle changes to help perimenopause and menopause:
– A healthy balanced diet is good for general health.
– Spicy foods, alcohol, caffeine (tea and coffee as well as chocolate and cola drinks) can make hot flushes worse so avoiding these may help.
– Up your intake of vitamins B, C, D and E.
– Drink lots of water, this could be infused with fruit, or sugar free squash, anything which helps you to remain hydrated.
– Take up regular exercise that you enjoy. It needn’t be a chore to move your body, take a walk with a friend, join a class, try relaxing activities like yoga or Pilates.
Regular exercise may improve hot flushes and night sweats and improve sleep as well as helping you maintain or lose weight. Weight bearing exercise such as walking, running and dancing can improve bone strength.
– Take up meditation, breathing exercises or mindfulness.
– Get a good night’s sleep of seven to eight hours a night if you can and if night sweats or insomnia keep you awake, speak to your doctor.Non-hormone medicines
There are non-hormone treatments if your symptoms are having a big impact on your life and you cannot, or choose not to, have HRT.
Hot flushes and night sweats
There are some medicines that can help with hot flushes and night sweats. These include:
– a blood pressure medicine called Clonidine
– an epilepsy medicine called Gabapentin
Talk with a GP about these medicines and their side effects, and if they might be suitable for you.
Mood symptoms
Antidepressants can help with mood symptoms if you’ve been diagnosed with depression or anxiety.
Cognitive behavioural therapy (CBT)
Cognitive behavioural therapy (CBT) is a talking therapy which can help with:
– low mood and anxiety caused by menopause and perimenopause
– some physical symptoms like hot flushes and joint pain