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Perimenopause, pre-menopause: here's what to expect

Menopause, the point in a woman's life where she stops ovulating, is a known fact of female ageing. What is lesser known about this stage of life, however, is that it is preceded by something called perimenopause: a period of transition where the ovaries gradually start to produce less oestrogen.

A woman is considered perimenopausal until one year has passed since she has last had her period.

Sometimes called 'pre-menopause', 'early menopause', or 'the menopausal transition', the changes in oestrogen levels it brings on may cause number of symptoms including irregular periods, hot flushes, reduced libido, and mood swings. But, like menopause, perimenopause is a natural part of ageing, and is nothing to be afraid of if you're aware of what is going on inside your body during this time, and how to manage your new health needs.

What happens during perimenopause?

Typically starting in a woman's 40s, the precise onset of perimenopause may be difficult to pinpoint. As perimenopause marks a gradual decline in hormones oestrogen and progesterone, the rate at which each woman's levels change, and how she is affected by this over time, is unique to everyone. You might experience perimenopause for two years, or it may go on for ten: again, this is different for every woman. In fact, some women do not even report experiencing perimenopausal symptoms at all!

There is a delicate balance of hormones within a woman's body. As your hormones change during perimenopause, the balance of chemicals within the body changes, which triggers certain responses in the brain as the body naturally adjusts. This can bring on physical as well as emotional symptoms, which vary in nature depending on your particular chemical makeup.

For example, oestrogen stimulates serotonin, a major mood neurotransmitter that brings on feelings of happiness. When your oestrogen levels drop, it can in turn cause a drop in serotonin within your brain, so causing feelings of sadness or depression. Oestrogen and progesterone also work to manage production of cortisol, the hormone that triggers feelings of stress, and so feelings of panic, stress and anxiety may be heightened as these hormone levels change, too.

What are the symptoms of perimenopause?

The first sign of perimenopause is usually irregular periods. You may miss one, or have them too frequently, or have them temporarily regularise before becoming irregular again. Your periods may be heavier than usual, or much lighter. Some women taking birth control pills may not experience irregular periods, but may notice other symptoms such as unexplained mood changes, or hot flushes.

During the last one-two years of perimenopause, oestrogen levels decline at a faster rate, which usually brings on symptoms also experienced by menopausal women. These commonly include:

  • Hot flushes
  • Breast tenderness
  • Lowered libido
  • Fatigue
  • Mood swings
  • Anxiety or depression
  • Difficulty sleeping
  • Weight gain
  • Hair thinning or loss

Not all of these symptoms are experienced by all women, and not all will experience them in the same capacity: it depends on how your body responds to your changes in hormone levels. If you aren't sure whether you're perimenopausal or not, you can go to your GP and get a blood test that will measure your hormone levels.

Is there anything I can do make it easier?

Whilst it's true that you can't prevent your body from going through its natural process of ageing, there are ways you can manage symptoms to support your body as it adjusts to these new changes. Lifestyle factors, particularly nutrition, exercise, and exposure to stress all work to affect our balance of hormones, and so can help to offset some of the discomfort experienced.

For instance, excessive consumption of caffeine and alcohol, known stressors, can exacerbate feelings of anxiety, whilst intake of vitamin E may relieve tension and reduce feelings of stress, due to its antioxidant properties. Omega-3 fats have also been found to help with feelings of depression, as well as prevent hair loss: another symptom of perimenopause.

The key is to be aware of the new health needs wrought by this stage of life, and to support your body through a rich, balanced diet in natural, whole foods, the right supplements, and regular exercise. Menopause may be a concerning point of change for many women, but it's nothing you should fear: just something you'll need to prepare for.

For more advice and information about the menopause, select Menopause from the Your health menu above.

Nothing beats a healthy, balanced diet to provide all the nutrients we need. But when this isn't possible, supplements can help. This article isn't intended to replace medical advice. Please consult your healthcare professional before trying supplements or herbal medicines.