The big surprise for many women in their 40s and the years leading up to menopause—a period of time also known as perimenopause—is that the symptoms usually associated with menopause can strike much sooner, wreaking physical, mental and emotional havoc on women’s lives and it is one of the most common “conditions” we see in daily community pharmacy life. “Conditions” in quotation marks as it really is not a condition, being a process that the entire female population that lives to middle age will experience.
Perimenopause has been variously defined, but experts generally agree that it begins with irregular menstrual cycles — courtesy of declining ovarian function — and ends a year after the last menstrual period. Perimenopause varies greatly from one woman to the next. The average duration is three to four years, although it can last just a few months or extend for as long as a decade. Some women feel buffeted by hot flashes and wiped out by heavy periods; many have no bothersome symptoms. As a woman gets older, she ovulates less often, which is why fertility levels decrease with age. As a woman approaches menopause, she may not always ovulate, and the release of oestrogen and progesterone can become irregular. The ovaries gradually become less active and oestrogen levels reduce. Eventually the ovaries stop functioning and no more eggs are released. The release of oestrogen and progesterone also virtually stop.
What are the symptoms Associated with perimenopause?
Where do I start?! During the perimenopause, the levels of oestrogen and progesterone in the body fluctuate in a decreasing manner. Women have oestrogen receptors all over their bodies e.g. brain, heart, vagina, and reproductive organs. The decrease in oestrogen levels can have a dramatic effect on the mind and body of a woman.
It is estimated that 8 out of 10 women experience symptoms leading up to and after menopause. Of these, 45% experience very difficult symptoms which greatly impact their lives.
- Hot flashes and night sweats. An estimated 35%–50% of perimenopausal women suffer sudden waves of body heat with sweating and flushing that last 5–10 minutes, often at night as well as during the day. They typically begin in the scalp, face, neck, or chest and can differ dramatically among women who have them; some women feel only slightly warm, while others end up wringing wet. Hot flashes often continue for a year or two after menopause. In up to 10% of women, they persist for years beyond that. Sage tablets are known to be useful in the management of hot flushes and night sweats. In cases where the flushes are intolerable, there is an off-licence use of anti-depressants which may be of benefit.
- Vaginal dryness. During late perimenopause, falling oestrogen levels can cause vaginal tissue to become thinner and drier. Vaginal dryness (which usually becomes even worse after menopause) can cause itching and irritation. Recurrent UTIs are also linked to vaginal dryness. It is important not to ignore these symptoms as it will only get worse if not treated. This symptom can continue for many years after the menopause. There are products available over the counter which can help to lubricate the area. These are available as pessaries and creams which will give moisturisation for several days. If this is not sufficient, your doctor can prescribe locally acting ostrogen gels and pessaries. A year’s use of the localised topical hormone is equivalent to the hormone exposure of one oral contraceptive. It can be of benefit to many women.
- Uterine bleeding problems. With less progesterone to regulate the growth of the endometrium, the uterine lining may become thicker before it is shed, resulting in very heavy periods. In perimenopause, hormonal contraception is commonly prescribed for this condition, if the woman fits the criteria, the hormonal coil being a popular option that can reduce or even completely prevent periods. The woman is at risk of becoming anaemic so a good iron supplement can help boost energy levels at this time.
- Sleep disturbances. About 40% of perimenopausal women have sleep problems. Some studies have shown a relationship between night sweats and disrupted sleep; others have not. The problem is too complex to blame on hormone oscillations alone. Sleep cycles change as we age, and insomnia is a common age-related complaint in both sexes. Magnesium is a popular supplement with perimenopausal women as it can relax muscles and aids in a restful sleep and there are various herbal and over the counter remedies to help with short term sleep disturbances. Have a look at our blog where we have a great blog on sleep hygiene.
- Mood symptoms. Estimates put the number of women who experience mood symptoms during perimenopause at 10%–20%. There are many oestrogen receptors in the brain so when there is a big decrease in levels this can impact mood which can cause anxiety, mood swings, brain fog and low libido. Also sleep disturbances and the other severe symptoms associated with perimenopause can contribute to low mood. Self-help measures such as getting plenty of rest, taking regular exercise and doing relaxing activities such as yoga and tai chi may help. Medicine such as anti-depressants and other treatments are also available, including HRT and cognitive behavioural therapy (CBT).
- Weak Bones. Women who have been through the menopause are at an increased risk of developing weak bones that may break more easily (osteoporosis) as a result of the lower level of oestrogen in the body. It is very important to take a calcium and vit d supplement. Loss of oestrogen accelerates bone bulk loss and osteoporosis. It is important to get a bone density scan if over the age of 50.
- Other problems. Many women complain of short-term memory problems, brain-fog and difficulty concentrating during the menopausal transition. Although oestrogen and progesterone are players in maintaining brain function, there's too little information to separate the effects of aging and psychosocial factors from those related to hormone changes and research is ongoing in the arena.
HRT replaces the hormones that are missing. Most symptoms are caused by low oestrogen levels, so this is the most important hormone to replace. If you have a womb you also need a progestogen to protect the lining of the womb.
HRT is extremely effective at relieving menopausal symptoms.
HRT is available as tablets, skin patches, a gel to rub into the skin or implants.
Benefits and risks of hormone replacement therapy (HRT)
The main benefit of HRT is that it can help relieve most menopausal symptoms, including hot flushes, brain fog, joint pains, mood swings and vaginal dryness.
It can also help prevent thinning of the bones, which can lead to fractures (osteoporosis). Osteoporosis is more common after the menopause.
Some types of HRT can slightly increase the risk of breast cancer and blood clots in some women. You need to discuss whether you have any risk factors with a doctor or nurse.
Evidence says that the risks of HRT are small and usually outweighed by the benefits.
Pop into our physical store in Banagher for a chat or send us a message with our APP or via email and we will be happy to help.
