Are you just tired …or could it be the perimenopause?
In an extract from her new book, Dr Louise Newson reveals the telltale signs that are often dismissed as the stresses of a busy life
You bump into an old school friend and feel embarrassed when you can’t recall their name. You put it down to a lack of sleep – after all, it’s been weeks since you managed a night without waking up at least once, hasn’t it? Maybe you don’t make the connection between all these events, but one thing is for sure: you don’t feel quite like “you”.
What I have described here is a fairly typical experience of the perimenopause, the stage directly before the menopause. With so much emphasis on the menopause itself, you could be forgiven for not realising how disruptive the perimenopause can actually be. Not openly discussing it can add up to a potential physical and mental health timebomb for women, both now and in later life.
Doctors frequently misdiagnose it. Research has shown that more than one-third of perimenopausal and menopausal women in the UK wait at least a year to receive adequate treatment for their symptoms; and for one in 10 women, it takes more than nine doctor’s appointments even to make the diagnosis.
We need to start destigmatising the menopause, so that all women have a better understanding of it and greater control over their own bodies. I’m passionate that women can have access to clear, unbiased information and support, whatever lifestage they are at. It is never too late – or too early – to be perimenopause, and menopause, savvy.
How to tell if you’re perimenopausal
Your menopause occurs when your ovaries stop producing eggs and, as a result, levels of hormones called oestrogen and progesterone fall and your periods stop. During the perimenopause, you experience menopausal symptoms due to declining levels of these hormones, but still have your periods, which are changing in nature or frequency.
This can last for many months or years. Like the menopause, there is no set age at which the perimenopause will start. For most women, it is likely to be around 45 years of age, but many women in their twenties, thirties and forties will be perimenopausal without even realising it.
Typically, the first sign may be changes to the frequency, duration or flow of your periods. But it isn’t always easy to make the connection. Because hormone levels are fluctuating, many women will have a completely normal period one month, then it can be heavier or is missed altogether, before going back to normal again for a few months. Things may settle down for a while, but a few months down the line you may find it increasingly hard to concentrate at work, and feel irritable at home. You might generally feel that life is a bit more of a struggle than it used to be.
So many of us put these symptoms down to the stress of our busy lives.
Take my experience, for example: before I realised I was perimenopausal, I found myself forgetting the names of different medications and I was terrified of making an error at work. This was so frightening to experience. In hindsight, I realise it was all too easy to put this down to a busy work and home life.
From headaches to low libido, don’t wait to seek help
Along with changes to your periods, the knock-on effect of fluctuating oestrogen and progesterone levels can trigger a host of symptoms throughout the body – including your heart beating quickly or strongly, trouble sleeping, feeling unhappy or irritable, headaches, muscle or joint pain, hot flushes, night sweats, vaginal dryness and a loss of interest in sex. A list can be found on my website (tinyurl.com/menopausedoctor-symptomsheet). If you suspect you might be perimenopausal, keeping a record of your symptoms, and how they change over time, can help aid a diagnosis.
As with the menopause, if you are 45 or older, a healthcare professional should be able to make a diagnosis on account of changes to your periods and any other symptoms that you may be experiencing. You do not need a hormone blood test (which will be unreliable anyway).
There is a common misconception that you can only start treatment once you are actually in the menopause. This isn’t true: if your symptoms are affecting your day-to day life, don’t wait. The earlier a woman receives treatment, the more benefits to her future health there will be. Many symptoms of the perimenopause and menopause overlap, so this means that you will usually benefit from the same advice and treatments offered during the menopause. Treatments might include the combined oral contraceptive pill, local oestrogen delivered with a pessary, cream or ring, or HRT.
Good menopausal care isn’t just about medicine. Use this period in your life to reflect on your overall health and well-being. A good diet and regular exercise are an integral part of managing your perimenopause and menopause. Don’t neglect your mental health – book in regular time out to do things that you enjoy and help you relax.
HRT is not just for the menopause
HRT remains the goldstandard treatment for the
perimenopause and menopause. It eases symptoms and helps protect against the long-term health risks of hormone deficiency, which include osteoporosis and cardiovascular disease. The earlier it is taken, the sooner it will work to improve your symptoms and boost your future health.
For the majority of women, the benefits outweigh any risks. Yet for many years, women, healthcare professionals and the media have been given incorrect information about HRT – for example, over reported links with breast cancer.
So often, women tell me their perimenopausal or menopausal symptoms have caused them to comfort eat and put on weight, stop exercising, or drink more alcohol. Such lifestyle changes are associated with a higher risk of developing breast cancer than the risk involved in taking any type of HRT. Women who are under 51 and taking any type of HRT do not have an increased risk of developing breast cancer, as they are simply replacing their missing hormones.
Regain your confidence
Claire, a patient of mine, had always been fit, healthy and a cup half full kind of woman, but on turning 40, everything changed. For the first time in her life, she began suffering unbearable migraines and heart palpitations. She had terrible anxiety that came from nowhere, was irritable with her husband and two children and felt zapped of energy.
Over the course of several GP appointments, she was prescribed sumatriptan for her migraines, which made her feel sick and groggy, then an anti-anxiety medication which made no difference, and then beta-blockers which left her feeling spaced out.
It was during a routine asthma check-up for her son at the same surgery that the penny dropped, when she overhead a lady in the waiting room talking about her menopause. Tearfully, Claire told a friendly nurse about her symptoms.
“You’re not going crazy – you’re perimenopausal,” the nurse said, explaining how her symptoms were probably due to changing hormone levels.
At first, Claire dismissed the idea as she was only 41, surely too young to be perimenopausal. She was prescribed the progestogen-only pill, but although this helped with the migraines and the anxiety, it caused heavy bleeding (the progestogen-only pill is not a treatment for the perimenopause).
It was at this point that Claire came to see me. Looking at her long list of symptoms, I could see that she was perimenopausal and I prescribed HRT.
It has now been almost a year since Claire started taking HRT and she says the difference has been incredible. Her symptoms have subsided, and instead of feeling as if her best years were behind her, she is looking forward to what the future holds.
I witness such transformations every day in my clinic. Women who had been on the verge of quitting their jobs, or ending relationships, regain their confidence and zest for life within a few months.
The days of struggling on in silence must be put behind us. No matter your age or your symptom, if it is affecting your life, please see a healthcare professional. Never wait until your symptoms become unbearable. You are the expert when it comes to your mind and body.
‘Before I realised I was perimenopausal, I was forgetting the names of medications’
Extract taken from Preparing for the Perimenopause and Menopause by Dr Louise Newson (Penguin Life, £9.99), which is published on Thursday. Order now for £8.99 at books.telegraph.co.uk, or call 0844 871 1514 To download Dr Newson’s app, go to balance-app.com