You know how it can be: you’re full-on busy with work, partners, kids and/or fur babies, thinking about what’s for dinner, did I remember to respond to that email about that birthday party, do I need to pay that bill? Have I already paid that bill?
Sometimes, we can be too busy to notice changes in our own body or menstrual cycle—even for normally self-aware and emotionally adept people, sudden or unexpected changes can take us by surprise.
Learning what perimenopause is and how to embrace it in a healthy way can help us cope better or at least understand that it’s okay that our bodies are changing, and we are still able to be powerful women.
[A quick note on terminology. Throughout this blog, we'll use the term ‘woman’ or ‘women’. We use these terms inclusively to mean all people who identify as a woman and recognise that people who do not identify as a woman may still be affected by women’s health issues, such as perimenopause.]
What is perimenopause?
Women experience monthly menstruation for up to 40 years, and during their thirties or forties, their bodies will transition to the end of the reproductive years.
Perimenopause is the natural evolution of a women’s cycle towards menopause.
Women enter this stage eight to ten years ahead of menopause, and it can last for as little as a few months to as long as four years.
Mary-Ann tells her perimenopause story
Mary-Ann is 47-year-old Brisbane designer and photographer, who lives with her husband, Ian, and dog Max.
‘I took the very enlightened approach to pretend all was well around period time and didn’t realise that from the age of 45 I would be going through perimenopause,’ said Mary-Ann.
‘I started to have heavy bleeding and severe cramps, foggy thinking, and memory loss.
‘I struggled to understand what was happening to my body. I didn’t manage the transition through to menopause until I broke my ankle, which forced me to go see the doctor.
‘I then realised other symptoms I had such as migraines, headaches, sore breasts, and the joy of not sleeping well were all part of perimenopause and my journey towards menopause.
‘There were days when my body just ached, and after doing some research, I found out it was because my body was producing less estrogen—one of the sex hormones.’
The orchestra of life
‘Although we live in a digital age, I wasn’t aware that perimenopause could start so young,’ she said.
‘The stigma attached to menopause also held me back from openly discussing this with my doctor or understanding that I didn’t need to go through it alone.
‘My hormones were like an orchestra; all the instruments needed to play together to achieve balance and harmony.
‘It doesn’t take much to throw the hormonal symphony into chaos. If the estrogen is too loud, or the progesterone is too low, all the other hormones may miss their cues and drop notes.’
Knowing what our hormones do can help us understand our life cycle from fertility and pregnancy to perimenopause and menopause, and everything in between. It can also guide us to seek medical help when it is needed.
This time in a woman’s life should offer an opportunity to individually plan for the decades to follow.
It’s (mainly) in the biochemistry
Your hormones can regulate whether you gain or lose weight by regulating your metabolism. They’re also in charge of reproduction, energy levels, digestion, whether you have mood swings once a month, and many other functions.
The sex hormones are estrogen, progesterone, and testosterone.
During perimenopause, your ovaries start to run out of eggs. This causes hormone levels, particularly estrogen, the main female hormone produced in your ovaries, to go up and down more sporadically than a normal 28-day cycle.
During the final stages of perimenopause, your body will produce less and less estrogen.
Once you’ve gone through 12 consecutive months without a menstrual period, you’ve officially reached menopause.
It’s important to remember that every person will be different.
Symptoms
Many of the symptoms of perimenopause are caused by the changing levels of hormones – either higher or lower – that can affect physical and mental health.
Physical symptoms include:
- menstrual changes (irregular periods, changes in flow and cycle length – heavier or lighter, shorter or longer. Some months you may have no period at all.)
- hot flushes and night sweats
- sleep disturbances and tiredness as a result
- headaches
- aches and pains
- vaginal dryness
- sore breasts.
Common emotional symptoms include:
- mood changes
- forgetfulness
- brain fog
- changes in sexual function and desire
- anxiety or depression.
Perimenopause can increase the risk of:
- increased bone loss
- weight gain around the abdomen
- changes in cholesterol levels and sugar metabolism
- certain chronic diseases.
Historically, this stage of a women’s life cycle has not had as much attention as other stages.
Our differing cultural background and belief systems can make it hard to talk about perimenopause, but we need to talk about it more and break down the stigmas, so we can support each other through this stage—even if our symptoms are mild.
To help keep this important conversation going, we're unpausing the topic of menopause in our new season of It Can’t Hurt to Ask. In this podcast, you'll hear real-life stories from women and people navigating menopause, as well as expert clinicians sharing advice, knowledge, and answers to all your menopause questions, concerns, and curiosities.
Managing symptoms
Healthy lifestyle choices can help to improve physical and emotional symptoms at every stage of perimenopause and menopause:
- Eat a balanced diet rich in calcium, vitamin D and phytoestrogens (natural compounds with a similar structure to estrogen found in certain foods, including soy, flax seeds, dairy, grains, apples, pomegranates, grapes, and berries).
- Reduce your consumption of alcohol and caffeine.
- Do regular exercise.
- Therapy by a psychologist or counsellor can help with strategies for managing mood changes and stress.
- Support groups can reduce feelings of isolation and provide emotional support.
- Mindfulness and stress reduction techniques can help manage stress and improve mental health.
Managed appropriately and sensitively, perimenopause gives a woman the opportunity to tailor her physiological and psychological changes to suit her individual lifestyle.
Eating well, being physically active, and working towards strengthening your core by doing yoga or pilates is a great start to taking care of yourself and your emotional wellbeing.
Managing your transition can decrease the likelihood of anxiety, mood changes, sexual disfunction, and chronic diseases, such as osteoporosis or cardiovascular disease.
Your doctor might suggest a range of suitable options to assist with your journey through the transition, which might include menopausal hormone therapy (MHT—formerly called hormone replacement therapy or HRT).
We recommend having a chat with your doctor if you have any questions about treatments and other options to manage this time in your life and your long-term health.