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What is perimenopause? Everything to know according to the experts

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  • We need to talk about perimenopause.

    From clever period tracking apps to working to better understand things like PMDD symptoms, we’ve come a long way when it comes to frank discussion about women’s hormonal health. But there are some areas that are still little-discussed, despite affecting almost all women – and perimenopause is one of them.

    Earlier this year, Davina McCall fronted a new hour-long Channel 4 special called Sex, Myths and the Menopause. For 60 minutes, she candidly opened up about her hormone replacement therapy (HRT) and spoke to doctors and professionals about how, for many, menopause, early menopause, perimenopause – and the various treatments for all three – are still seen as taboo.

    So, what exactly is perimenopause, and how do you know if you’re experiencing symptoms?

    We know as well as anyone that female hormones can be a bit of a minefield – so we’ve asked an expert to break it down for you. McCall herself went through perimenopause at 44. To manage her symptoms, she started taking hormone replacement therapy, but shares that, at the time, she found it so embarrassing she told no-one. She was advised not to, as it was ‘ageing and unsavoury’.

    This is the whole point of the documentary – to start breaking down the many menopausal myths and smash the stigma that still surrounds the very natural occurrence.

    Most people who identify as women will go through the menopause at some point in their lives, and so how we talk about it – and treat those experiencing it – has to change. Things are moving in the right direction, and the lack of both education and awareness slowly shifting, but more needs to be done.

    It’s not a simple fight – every year, around 13 million women in the UK experience perimenopause, and many are treated with hormone replacement therapy. Yet, in 2002, a major Women’s Health Initiative (WHI) study suggested that some HRTs increase your risk of breast cancer and heart disease. After the findings were published, the British Medical Journal reported that 58% of women stopped taking HRT.

    Keep reading for everything you need to know about perimenopause, hormone replacement therapy – and guidance on when to see your GP.

    So, what is the perimenopause? 

    According to best-selling author of Mindful Menopause Sophie Fletcher, perimenopause simply refers to the symptoms you’ll experience in the months or years leading up to the menopause.

    As per the NHS website, the ‘duration and severity of symptoms varies from woman to woman’, and symptoms can affect you both before and after you actually go through the menopause. “On average, most symptoms last around four years from your last period. However, around 1 in every 10 women experience them for up to twelve years,” the site reads.

    “During perimenopause, your hormones start to shift,” Fletcher explains. “We are usually familiar with the decline of progesterone and oestrogen, but other hormones such as testosterone also dip and can have an impact on your mood, sex drive and general wellbeing.”

    At what age does the average woman go through perimenopause?

    Good question – although, do note here, it does vary from person to person. “Everyone’s experience is different,” explains Fletcher.

    “1 in 100 women experience it before the age of forty, and some girls go through it as early as their teens, though this is rare,” she shares.

    Although Fletcher explains that it’s not that actually easy to define when your perimenopause starts. “Although hormones may start to decline earlier, most women don’t start to notice physical or emotional changes until their early to mid 40’s,” she explains. “Some people define it as when your periods start to change, but many women can experience effects of lower progesterone, such a low mood or depression, before this happens,” she goes on.

    As per the NHS website, the menopause is normally occurs between the ages of 45 and 55, and the average age the woman reaches menopause is 51.

    What are the main symptoms of the perimenopause? 

    Fletcher stresses that your symptoms – and perimenopause experiences generally – will depend on where in the perimenopause cycle you are.

    However, during perimenopause, as progesterone and then oestrogen drops, she shares that you may experience:

    • heightened anxiety
    • mood swings
    • depression
    • low mood
    • difficulty sleeping
    • heavy periods
    • headaches
    • PMS
    • dry itchy skin
    • hair thinning
    • joint pain
    • weight gain
    • sleep disturbances
    • hot flushes
    • vaginal dryness

    And as perimenopause moves on? “Your oestrogen starts to drop more and other physical symptoms may begin to show,” she explains. She does emphasise that treatment is simple and life-changing, so do visit your GP if you are experiencing any of the above symptoms.

    So, what is hormone replacement therapy – and is it safe? 

    So you know what perimenopause is and how to identify the symptoms. But do you know how to treat your symptoms, should it come to it?

    Again, as per the NHS website, hormone replacement therapy – the same HRT that Davina chats about being on – is often prescribed to ‘relieve’ menopause symptoms. They explain that it works by replacing hormones ‘that are at a lower level as you approach the menopause’.

    It’s thought to help with hot flushes, night sweats, mood swings, loss of libido and more.

    As with any medication, it comes with risks, but the official stance on HRT, despite the 2002 study’s findings, is that HRT ‘does not significantly increase the risk of cardiovascular disease (including heart disease and strokes) when started before 60 years of age’.

    As Davina shares on her page, ‘it’s a really important conversation about the bigger picture and lack of awareness about the benefits of HRT even today.’

    5 tips for managing your perimenopause symptoms

    1. Educate yourself

    You don’t have choices unless you learn about your options, shares Fletcher. “Menopause care can be patchy – being informed means that you can be proactive in asking for the right the support,” she goes on.

    Some experts, like Fletcher, prefer more integrative treatment methods, like meditation and self care. Others, like Davina and the experts in Sex, Myths and the Menopause, will encourage you to opt for HRT.

    Ultimately, it’s up to you what you decide to go for. 

    2. Get moving

    Fletcher shares that your body should respond well to weight bearing exercise during perimenopause.

    “Think strength training, yoga and walking – these are all exercises that can improve both your emotional and physical well-being,” she explains.

    3. Practice self care

    Sounds simple, but can be really effective for dealing with the more annoying symptoms the menopause springs on you.

    “Anything that helps with sleep, reducing anxiety or just generally makes you feel good is a plus,” shares Fletcher. Our guide to the best self-care ideas might help.

    4. Get appy

    Period tracking apps can be a great way to stay in sync with your hormones, and many of them, like Clue and My Moontime, allow you to predict everything from productivity to mood swings based on your cycle.

    5. Get support

    Ultimately, the experts will know how best to help you and your symptoms, so do see your GP or a qualified expert if you need help.

    “Even talking to friends can help – we just don’t talk about it enough,” shares Fletcher. “The more we share, the more we can support each other.”

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