Let's Talk... Perimenopause
Menopause, typically a taboo topic associated with women aging and unpleasant symptoms, has recently been spotlighted in primetime documentaries on BBC and Channel 4. Alongside celebrities discussing their own candid experiences, more discussions and conversation on social media have certainly raised an awareness, gradually normalising the natural process that impacts women physically, mentally, and emotionally.
The Menopausal Transition
The menopause is established 12 months from the last menstruation period, a process all women will experience at one stage in their lives.1 Yet, the stage not often talked about is the perimenopause, defined as the stage that precedes the menopause and may affect some women as early as in their mid 30s. The perimenopause meaning ‘about the time’ is known as the menopausal transition, the body’s natural shift in hormones from the reproductive phase to the non-reproductive phase. Women often assume and misconstrue the biological changes experienced in the late 30s and during their 40s as menopausal symptoms or even a part of aging, when in fact, this stage leading up to the end of their period is the perimenopause. The transitional stage can last several years, and the change in hormones can cause an array of varying symptoms amongst women before the menstruation cycle ceases. Perimenopause may begin with a change to the flow or duration of the menstrual period and is signalled by the onset of irregular cycles until the last menstruation period. Women may also experience symptoms that are usually associated in the years post menopause such as hot flushes, night sweats, heart palpitations, bloating, changes in blood pressure, sleeplessness, anxiety, low mood, vaginal dryness, brain fog, low sex drive, weight gain and osteoporosis (2).
What’s the cause?
You may have learned at school the basics of the female reproductive life cycle experienced during puberty. However, despite the significance of the menopause and the physiological changes it has on a woman's life, very little formal education is given on the hormonal change at the end of the reproductive cycle. Both stages of puberty and perimenopause are affected by a change in the production of the luteinizing hormone (LH) and the follicle stimulating hormone (FSH).1 During puberty, the LH and FSH hormones stimulate the ovaries to produce the sex hormone oestrogen and progesterone preparing the body for reproductive development. Whilst in perimenopause, the ovaries produce less oestrogen and progesterone, and the levels fluctuate and gradually decline prompting the varying symptoms experienced. There is also growing research to link both stages to an increase in levels of the stress hormone cortisol, suggesting a plausible link to increased vulnerability and sensitivity that could trigger low mood and anxiety experienced by many women during puberty and perimenopause. 2
While changing hormones levels may be responsible for most of the symptoms experienced during perimenopause, lifestyle patterns and age may also contribute to the perception of symptoms.3 Women naturally experience an increase in their abdominal fat as they age, this is thought to be attributed to the psychological effects of perimenopausal symptoms, reduced exercise, responsibilities, anxiety and caring for families which can cause stress and lead to comfort eating and drinking. Yet, there is strong evidence to suggest weight gain during perimenopause is a precursor of menopause and unrelated to age.4 A study conducted in the US found decreasing oestrogen levels during perimenopause did increase the accumulation of fat in the abdomen. Although, a decrease in exercise and sleep was also considered to contribute to the overall weight gain.4
What can be done?
If you think you are experiencing perimenopausal symptoms, making some small, gradual changes to your lifestyle may help manage your symptoms and reduce the risk of metabolic conditions caused by abdominal weight gain, loss of muscle mass and loss of bone density.
· Consume less alcohol and caffeine – caffeine and alcohol can trigger hot flushes and disrupt sleep
· Avoid spicy food – spicy food can trigger hot flushes
· Practice meditation, yoga, mindfulness – to alleviate stress and help hot flushes
· A healthy balanced diet, including at least 5 portions of different fruits and vegetables, fish, nuts, seeds, legumes, calcium-rich foods (diary and dark green leafy vegetables), reducing salty snacks and processed foods
· Incorporating daily moderate exercise that you enjoy for 30 minutes, and strength exercises at least twice a week
· Foods containing oestrogens consumed few times a day may relieve some symptoms
· Foods’s high in vitamin D – vitamin D is important for bone health, the main source of vitamin D is sunlight, however in the UK we are recommended to take a daily Vitamin D supplement during the winter months. Seek advice for supplements from your GP or dietitian
·Foods high in magnesium - there is evidence that magnesium can help improve low mood and bone health. Seek advice for supplements from your GP or dietitian
· Hormone Replacement Therapy (HRT) – low-dose oestrogen can be provided in gels and patches within HRT and can help ease severe perimenopausal symptoms. When lifestyle changes are not relieving your symptoms, do seek advice and discuss the risks and benefits of HRT with your GP.
It is still possible to become pregnant during perimenopause. Despite irregular menstruation cycles and fluctuating hormone levels during the menopause transition stage, your ovaries are still releasing eggs and thus it is still possible to become pregnant.
What can be done?
Recent findings from UK Menopause Support found that only 59% of universities with medical programmes in the UK offer formal training on the menopause to their students.5 This, as well as an absence of longitudinal data on women’s symptoms in many studies, has resulted in a lack of awareness amongst healthcare professionals in identifying and diagnosing perimenopause. A report conducted on behalf of the British Menopause Society found that 50% of women surveyed experience symptoms without seeking support from a healthcare professional.6 Instead women tend to resort to self-care approaches, over the counter treatments and alternative therapy to manage their symptoms.3
Although there may not be a lot of support for women experiencing symptoms, with more attention and awareness the help and information is becoming available. The National Institute for Health and Care Excellence (NICE) published their first guidelines on the Menopause in 2015, which appropriates treatment options available for women experiencing symptoms.7 In addition, a recent published Government report highlights the guidelines to help manage menopause at work.8
The more it is discussed, the more awareness and attention will be brought to support the women experiencing symptoms. And lastly, more education is needed for healthcare professionals, girls and women to overcome the stigma attached to perimenopause and its symptoms.
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Written by: Rumana Dhanji (ANutr)