What is perimenopause, and what are the symptoms and treatment?

Nicola Bulley’s family have described how she experienced brain fog and poor sleep from the perimenopause and headaches from the HRT she was taking for her symptoms. What is the perimenopause and how can symptoms best be managed?

What is the perimenopause?

Perimenopause is when the body starts the transition to menopause. It’s caused by the ovaries producing less hormone, which in turn has an impact on the menstrual cycle, often making periods more erratic. It normally starts in the mid-40s but some have their first symptoms between a decade earlier and a decade later. It’s often a rocky road, lasting anywhere from two to 10 years, though four is more common. Perimenopause ends with the menopause, when levels of oestrogen, a major female hormone, fall low enough to stop periods for a full year.

What are the symptoms?

For most, the first sign of perimenopause is a shift from fairly regular periods to a less predictable cycle. But a raft of other symptoms can come on too. Hot flushes, or flashes, are sudden waves of heat that spread across the body for five to ten minutes. The severity varies enormously: at worst, people can feel as if they are burning from inside. Many wake up in the night drenched in sweat. The perimenopause often disrupts sleep, and can cause mood swings and depression. It can also affect memory and concentration. Sometimes, symptoms last a few months, but they can go on for years.

Are there any treatments?

There isn’t a “cure” that stops perimenopause, it’s a natural part of life. But doctors do prescribe drugs for particular symptoms. Antidepressants can help with mood swings and depression, for example, while hormone therapy aims to stabilise oestrogen levels. Hormone therapy can alleviate a lof of symptoms in weeks to months, and comes in tablets, skin patches, implants, or gels and sprays for the skin.

Does HRT have side-effects?

It can, though they tend to improve after a few months. The main side-effects from oestrogen are bloating and swelling, and having leg cramps, headaches, indigestion and feeling sick. The indigestion and sickness tend to be less severe if the therapy is taken with food. Doctors recommend regular exercise and stretching to help with leg cramps.

What else can help?

Beyond drugs for specific symptoms, the NHS says that a healthy lifestyle can help to relieve the symptoms. That means no smoking and not drinking too much alcohol, and eating calcium-rich food like milk, yoghurt and kale. Walking, hiking, and strength training are also helpful, as is maintaining a healthy weight and getting a good night’s sleep.