A Doctor’s Guide to Menopause & Perimenopause

menopause and perimenopause
What’s the difference between menopause and perimenopause, and what are all the symptoms? Dr Louise Newson tells you everything you need to know.

Can you be menopausal if you still have your period?

What are the real symptoms of menopause? It can be very common to have menopausal symptoms and still have periods. Your periods may become lighter and less frequent or they may become heavier and more frequent. If you are still having periods, then you are perimenopausal. However, when describing symptoms the term menopausal is used which can sometimes be confusing if you are perimenopausal.

When is a good time to start HRT?

It is very important to know that you don’t have to wait until you have finished your periods to start hormone replacement therapy (HRT). In fact, there is increasing evidence that the earlier HRT is started the more benefit it can give.

How long do menopause symptoms last?

The menopause is a natural event: Every woman will go through it at some stage in their lives. You may have no problems. Menopausal symptoms vary tremendously between women.  Some will only experience them for a few months. Others can continue to suffer from symptoms for many years, even after their last period. Around 80% of women experience menopausal symptoms that interfere with the quality of their life. Around 25% of women describe their symptoms as being severe.

Unfortunately, not enough women seek medical help and advice for their symptoms as they do not realise how effective treatment can be for them.

Symptoms of menopause can often have a negative effect on your partner, your family and your work colleagues. It can be common for symptoms to come and go. You may have some months where you feel completely normal. Some months you may experience unpleasant symptoms which affect the quality of your life.


Hot Flushes

Hot flushes are the most common symptoms of the menopause and occur in around three out of four women. They usually come on very suddenly and spread through your body, chest, neck and face. They vary in length from a few minutes to much longer. They can be associated with symptoms such as sweating, dizziness, light-headedness and even palpitations of your heart.

They can occur many times throughout the day and can continue for many years – some women even experience hot flushes in their 80s. They usually occur spontaneously but can come on after drinking certain types of food or drinking alcohol, especially wine.


Night Sweats

These can be very common and very troublesome. Many women find they wake up several times each night and are “drenched” with sweat and need to change their bed clothes and bed linen. This can obviously be very disruptive to your partner too.


Mood Swings

Not all women experience mood swings but for other women they can be very disruptive to home and family life. They can be more common if you have had premenstrual syndrome in the past.


Lack of Sleep and Tiredness

This can be related to disrupted nights’ sleep from the night sweats but many women find that they have more unsettled and less fulfilled nights’ sleep when they are perimenopausal. Even if your sleep is not affected, you may find that you are more tired than normal during the day


Low Libido

Reduced or absent libido (sex drive) occurs when your hormone levels fall. This can also be related to low testosterone levels in your body.


Poor Concentration

It is common to find that you do not concentrate as well as you used to. Many women find that it is harder to multi-task and this can be very frustrating.


Heavy Periods

Other symptoms that many women do not realise are due to their changing hormones levels that commonly occur include heavy periods. Although you may notice that your periods become scantier and lighter, some women find that their periods become closer together and even heavier as you approach the menopause.


Joint Pains

Oestrogen is very important at providing lubrication in your joints and can also reduce any inflammation in your joints. Low levels of oestrogen can lead to many of your joints feeling stiff and aching.


Hair and Skin Changes

Although your skin can change as you become older, the changes in your hormone levels can lead to additional changes to your skin. Oestrogen is important at building collagen, the protein that supports the structure of your skin. Lower levels of oestrogen can lead to skin changes such as reduced elasticity of your skin, dry skin, fine wrinkling of the skin and your skin becoming thinner. Some women find their skin becomes itchier too. Acne and increased facial hair growth can occur during the menopause too. Oestrogen is very important for your hair growth so you may notice that your hair becomes thinner and less glossy.


Problems with Your Mood

Depression, anxiety, panic attacks and irritability – emotional symptoms – during the perimenopause and menopause can really vary between women. Some women find that symptoms of depression, anxiety, panic attacks, anger and irritation worsen so much that they really interfere with the quality of their life. These symptoms can affect your emotional well-being and really add to the stress of life in general.


Poor memory

It can be common to forget words, appointments, birthdays and even doing silly things (for example putting your car keys in the fridge). Many women find that their brain does not feel as engaged as much as it used to and this can really affect your ability to work and function.


Bad premenstrual syndrome (PMS)

Some women find that their PMS symptoms such as bloating, irritability, food cravings, mood swings and lethargy worsen. These symptoms are usually due to the fluctuating levels of progesterone that occur in your body.


Worsening migraines

If you have had migraines in the past, then you may find that your migraines become more severe or closer together. This can be a sign that your hormone levels are changing.


Vaginal dryness, itching or soreness

The lack of oestrogen in your body tends to cause the tissues around your vagina to become thinner, dryer and inflamed. These changes can take months or even years to develop and vary between women.

Your vagina may shrink and expand less easily during sex, making sexual intercourse more painful or uncomfortable. The vulva may become thin, dry and itchy. You may notice that your vulva or vagina has become red and sore. Episodes of thrush may occur more frequently. Many women have symptoms of vaginal pain and discomfort throughout the da. It is often not just a problem to those women who are sexually active.

As the skin around your vagina becomes more sensitive it is more likely to itch. This can make you prone to scratching, which then makes your skin more likely to itch, and so on.


Urinary Symptoms

The low levels of oestrogen in your body can lead to thinning and weakening of the tissues around the neck of your bladder, or around the opening for urine to pass (your urethra). For example, urinary symptoms that may occur include an urgency to get to the toilet and recurring urinary infections or cystitis.

Find out more about Dr Louise Newson and the Newson Health Menopause and Wellbeing Centre at www.menopausedoctor.co.uk

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