Are you going through ‘second puberty'
From mood swings to acne, Luisa Metcalfe counts the ways perimenopause can feel like adolescence – and finds out how to soothe your symptoms
With its emotional angst, mood swings, acne and severe period pains, it’s no wonder that most women are delighted to have left the ups and downs of adolescence far behind.
So, imagine their distress when those same symptoms reappear decades later during middle age – but this time caused by perimenopause.
This is the transition to menopause and a time of hormonal change that mimics those spotty, emotional teen years so well that it’s being dubbed “second puberty” on social media.
Wellbeing expert Erin Wiebend recently went viral on TikTok with a three-part video series titled “second puberty”.
Then, menopause specialist Jill Gustafson posted on Instagram: “Did you know that the hormonal changes in the decade before your final period amount to a second puberty?”
And Lara Briden, author of the Hormone Repair Manual, reassured her 150,000 Instagram followers that, “second puberty is perimenopause and is temporary”, explaining that – like the transition from childhood to adulthood – this second time of hormonal disruption will pass.
However, other experts warn that while the phrase sums up the feeling of out-of-kilter hormones during perimenopause, it doesn’t accurately describe what is happening in the body.
“Second puberty isn’t a term that we use within the medical field,” says gynaecologist Tania Adib, who leads the menopause clinic at the Lister Hospital in London. “But it’s quite apt because the transition from your fertile reproductive life to the menopause doesn’t feel dissimilar to puberty.
“Perimenopause can be a real roller coaster, just like puberty. In both you have these waves of hormone imbalance and the hormones can knock you off course.
“You get these terrible mood swings, insomnia, depression, anxiety, and sometimes really heavy periods.”
Many 40-something perimenopausal mothers, who are feeling scatty and out of sorts, may recognise that they’re suffering similar symptoms to their teenage girls.
“If you’re hormonally unstable you’re not in a great place to remember things and be organised, and you’re not feeling great, whether that’s puberty or perimenopause,” says Miss Adib.
So how do these two stages compare physically?
“In puberty the ovaries are waking up,” says consultant endocrinologist Dr Annice Mukherjee.
“It takes two to four years on average for a girl’s ovaries to wake to full potential and for periods to start.
“In perimenopause the opposite is occurring. Perimenopause is what happens when a woman’s eggs eventually run out.
“But they don’t just stop overnight, just as a girl doesn’t turn into a woman overnight. Some women will stop their periods quickly, others will take several years for it to finish.”
During perimenopause, the ovaries – which are responsible for menstruation and ovulation – start to shut down. This means the level of oestrogen starts to decrease as the body prepares to stop releasing eggs
‘‘ The transition from fertile reproductive life to the menopause is like puberty
entirely, potentially causing menopause-like symptoms such as hot flushes, anxiety, mood swings, low libido, intensified PMS (pre-menstrual syndrome) and insomnia.
Reduced levels of progesterone can cause feelings of depression and anxiety, while other symptoms include fatique, low libido, vaginal dryness, joint pain, headaches, weight gain and cyclical bloating, says Miss Adib.
"Every single woman experiences perimenopause differently,” says Dr Mukherjee. “The majority of women who are perimenopausal will have irregular periods but it’s possible to be perimenopausal with no symptoms and regular periods.”
She also says there’s a flipside to the wider discussion of menopause women now enjoy, with celebrities such as Davina McCall and Louise Minchin campaigning for greater awareness.
"Awareness is brilliant and menopause is being spoken about at the moment,” she says. “But often women will watch videos on TikTok or Instagram and put two and two together and get seven. There’s a feeling that with the right hormones everything will feel normal again, but it’s an oversimplification.”
She points to the unique stresses and strains for women in mid-life.
“A woman in her mid-40s can come and see me, complaining of low mood and thinking that it’s a symptom of perimenopause.
“The patient might be going through financial difficulties or a divorce or have difficult teenagers. In that situation, you can take hormone replacement therapy (HRT) but you won’t feel better because there are other causes for that anxiety.”
Dr Mukherjee also stresses that there is no test to diagnose perimenopause, unlike puberty which can be diagnosed with hormone tests and looking at the precise stages of the body’s development. “If I’ve got a woman who’s 39 or older, has regular periods and no risk factors for early menopause, I’d take a history and look exactly at what her symptoms are and when they’re occurring,” she says.
“If that suggests perimenopause, I’d look at a full history. There are other hormonal conditions that can cause similar symptoms to perimenopause, such as thyroid problems, so I’d rule those out first.
“If a woman is truly having perimenopause symptoms, hormone therapy does help,” she says.
“That’s the same if someone is having real problems in puberty – often the GP will put them on the Pill to smooth out their hormones.”
Doctors often prescribe HRT, which is a combination of oestrogen and progestogen (the synthetic form of progesterone).
But Miss Adib, who practises privately, says: “If you’re not ovulating efficiently or effectively you’re not producing enough progesterone. If I see a woman in her 40s in perimenopause, I don’t give her HRT, I’ll give her progesterone in the last two weeks of the cycle to rebalance it.
“Oestrogen stimulates and increases serotonin levels and progesterone balances that. It lowers anxiety so she’ll feel calm and centred again.”
Both doctors stress the importance of women overhauling their diet and day-to-day routine to support their bodies through perimenopause, adding that these measures can help girls going through puberty too.
“A lifestyle approach is really important,” says Dr Mukherjee.
“Regular movement, weight-bearing exercise, unprocessed food and good sleep patterns will help regulate your hormones, reduce stress and improve overall health.
“Studies have shown that women suffering menopause symptoms who exercise have a far better quality of life than those who don’t.”