What is perimenopause?
Have you heard of perimenopause?
It’s when your hormones start to play havoc, one minute you are a raging bitch with night sweats and cannot sleep to the next where you are anxious, depressed and experience heavy periods like never before.
And sorry to be the bearer of bad news, but this is just the start of the transitional phase between your reproductive years and menopause (12 months without a period). It is an unavoidable recalibration of the female hormonal system which can last anywhere from 2-10 years so strap yourself in for the ride!
Genetics play a key role as to when you will achieve menopause (usually around the age your mother or other female relatives transitioned) and what your experience will be like so blame your mother!
Below is a pictorial of what is occurring with your hormones during perimenopause so you can understand why you feel like you do! It is characterised by a decline in ovarian function resulting in wildly fluctuating oestrogen and decline of progesterone. Progesterone is your “feel happy” hormone so you can see why you experience mood swings, anxiety and depression during this time!
Generally, perimenopause follows a chain of events:
Progesterone levels decrease
Estrogen fluctuates between high and low
Estrogen levels decrease
Potential onset of insulin resistance (abdominal weight gain)
Exceptions arise where you reach menopause prior to 40 years of age (premature ovarian insufficiency or early menopause), or your menopause is a result of surgical or medical intervention. Whilst these situations may sound ideal, they bring with them other health challenges often resulting in more severe symptoms with sudden onset requiring hormonal support.
These hormonal changes can affect you in a variety of physical and physiological ways, with some being very unpleasant! And again, some women can breeze through this period with no symptoms (bitches!) and others experience some or all of them!
Whilst many factors influence hormone levels including genetic background and body weight; obesity has been linked to lower oestrogen and progesterone secretion as well as lower levels of luteinising (LH) and follicle stimulating hormone (FSH) which can lead to experiencing more severe symptoms so it may be worth considering if your body weight is contributing to your symptoms.
Common symptoms
Hot flushes and night sweats (referred to as vasomotor symptoms)
Irregular menstrual bleeding
Heavy menstrual bleeding
Spotting
Mood changes/Irritability
Anxiety/Depression
Sleep disturbances
Sexual dysfunction
Vaginal dryness
Insulin resistance
What are they
Vasomotor Symptoms
Hot flushes are described as an intense feeling of warmth (lets be real … you feel like a furnace and break out in a sweat when no-one else is hot!) – they can last anywhere from a few seconds to many minutes. They usually involve the face, neck or chest and can often be preceded or followed by a chill. They are thought to be linked to a sudden decrease in oestrogen or increased levels of FSH but who really cares what causes them… you just want them to stop! They can occur day and night and are a called “night sweats” during sleep; often waking you in a pool of sweat!
Up to 80% of women will experience vasomotor symptoms during perimenopause with an increased risk and more severe symptoms in those with a higher BMI, a smoker, have a regular intake of alcohol and depressive symptoms.
Vaginal and Sexual Symptoms
Vaginal dryness and atrophy are one of the more unpleasant side effects of declining estrogen leading to sexual dysfunction due to ongoing pelvic pain before, during and after intercourse … can make for an unhappy partner! These changes can also affect the urinary tract causing increased urinary tract infections and increased need to pee!
Sleep and Mood Changes
Interrupted sleep is common in perimenopause along with trouble falling asleep and waking early. These sleep disturbances are often caused by those dreaded “night sweats” but can also be linked to stress and lifestyle factors. Poor sleep habits prior to perimenopause may result in worsening symptoms.
Anxiety and depression often increase during the perimenopausal predominantly due to quality of life; symptoms impacting quality of life include sleep, fatigue, weight changes, loss of interest and social and occupational support. Decreasing levels of progesterone and then estrogen destabilise your nervous system and brain and will need time to recalibrate. Good news … finally … once your hormones stabilise your mood also stabilises!
Bleeding
During the perimenopausal stage, changes in bleeding patterns occur, from irregular periods, spotting, heavier and longer periods, cramping and painful periods linked to the fluctuating levels of estrogen and progesterone. Whilst they are inconvenient during this period… they will stop eventually!
Insulin Resistance
Insulin stimulates the take-up of glucose into the cells and when in the right balance turn food into energy, promote muscle growth and supports a healthy menstrual cycle. Insulin resistance is where the body has chronically elevated levels of insulin changing these functions and increasing inflammation. This inflammation can lead to abdominal weight gain, increased hot flushes, uterine fibroids, abnormal bleeding, facial hair, high cholesterol and an increased risk of breast cancer. Are you having fun yet!
What can you do?
While you may feel like you are on an emotional roller coaster, and there is no magic “fix”, these symptoms do not last forever!
There are however some strategies that can help so would you like to:
Feel empowered and in control of what is happening with your body, mind, health, including those pesky hormones!
Wake up feeling refreshed after a good night’s sleep with plenty of energy?
Feel fabulous in everything you pull out of your wardrobe instead of hiding behind layers?
Let me tell you, it is possible! Click here to book in with me.
References:
Briden, L. (2021). Hormone Repair Manual (1st ed.). Pan Macmillan Australia Pty Ltd.
Delamater MD, Lara, & Santoro MD, N. (2018). Management of the Perimenopause. Clinical Obstetrics and Gynecology, 61(3), 419–432. https://doi.org/10.1097/GRF.0000000000000389.Management
Mcnamara, M. (2017). Perimenopause. Annals of Internal Medicine, 1–16.
Willi, J., Süss, H., & Ehlert, U. (2020). The Swiss Perimenopause Study – study protocol of a longitudinal prospective study in perimenopausal women. Women’s Midlife Health, 6(1), 1–13. https://doi.org/10.1186/s40695-020-00052-1
Zhao, D., Liu, C., Feng, X., Hou, F., Xu, X., & Li, P. (2019). Menopausal symptoms in different substages of perimenopause and their relationships with social support and resilience. Menopause, 26(3), 233–239. https://doi.org/10.1097/GME.0000000000001208