Perimenopause: Symptoms can begin long before your periods stop

By Abi Jackson

We’re finally starting to talk more about menopause, but what about perimenopause?

Just like menopause, it can have a significant impact – particularly emotionally and mentally, with 86 per cent of women saying they experienced mental health issues as a result, according to a new survey by Healthandher.com.

For 58 per cent, low energy and motivation were the main issues, while 53 per cent said it was low mood and depression, along with anxiety (50 per cent), anger and mood swings (42 per cent). One in 10 even said they’d had suicidal thoughts, the poll of 2,000 UK women found.

So, what do women need to know? We talked to leading gynaecologist Dr Nitu Bajekal to find out more…

Menopause is generally when your periods stop, and you haven’t had a period for 12 consecutive months. It’s a natural part of ageing that occurs when oestrogen levels drop, but it can cause a host of physical and mental symptoms, ranging from mild to debilitating. “The average age for menopause is anywhere between 45 and 55, with most becoming menopausal around 51,” says Dr Bajekal.

“Perimenopause means ‘menopause in transition’. It’s the time leading up to the complete cessation of periods. This usually lasts around four years but can last anywhere from two to eight years. So, you can see if your periods are going to stop at 45, some women with perimenopause can start to have symptoms in their late-30s.”

The symptoms are basically the same as with menopause – like hot flushes, sleep problems, reduced sex drive, low mood, anxiety and just not feeling like yourself. Some people experience things like brain fog and difficulty concentrating. With perimenopause though, Dr Bajekal says symptoms can “wax and wane”, and your periods may become irregular for a few months, then return to normal for a bit.

This up and down pattern can add to the mental health impact.

“There is a lack of awareness”, among women themselves, Dr Bajekal says, and sometimes healthcare professionals too. This means not only might women be missing out on treatments and advice that could help them, not knowing exactly what’s going on can make issues worse. “Empowering women with knowledge is key, because once you know something, you’re not so scared of it,” says Bajekal. “You’re not overthinking it, your brain isn’t going into overdrive thinking, ‘Oh God, what’s wrong with me?’”

Dr Bajekal says it’s important women don’t feel “fobbed off” by their GPs. But it’s also important doctors investigate any other possible underlying causes if necessary: “Because people may be depressed, for example. But it’s about being open to the idea that perimenopause is something that also needs to get the attention it hasn’t [been getting].”

As mentioned, Dr Bajekal says just having these conversations, and having your worries explained and validated, can be extremely helpful. “It’s about being more aware of the symptoms, the condition, and then women can decide what they need,” she says. “Do I just need to learn more about this so I can feel empowered? Do I need hormone replacement? Do I need to see someone about my mood?”

She is a huge advocate for the role of lifestyle too, citing nutrition, sleep and regular exercise as key. Bajekal says a diet loaded with plants and wholefoods – with plenty of legumes, beans, wholegrains, soya, leafy green veg and fruit – is rich in fibre, nutrients and plant oestrogens. This is good news for health in general and for supporting yourself through perimenopause, helping balance hormones and inflammation.

“And stress,” says Bajekal. “Identify your sources of stress and find ways of managing it, whether it’s through breathwork, yoga, meditation, walking with a friend. Avoiding alcohol and excessive caffeine and smoking; all these can make menopause and perimenopause worse. Whether you take medication or not,” she adds,” lifestyle should always be there – the nutrition, the exercise, the laughing with friends and looking after your mental health.”