Perimenopause a very different ‘beast’ than menopause

ere is however, a vast di erence between the two life phases of menopause and perimenopause, and ‘treatment’ approaches need to honour these di erences, rather than apply a one-size- ts-all approach.

WHAT’S THE DIFFERENCE BETWEEN PERIMENOPAUSE AND MENOPAUSE?

Perimenopause can be described as the time of a woman’s second puberty. Hormones are beginning to change from the regular rhythms of our 20s 30s and early 40s, mirroring our rst puberty where hormones are just starting out. By our late teens, they settle into a pattern that we recognise as a menstrual cycle.

e life phase of perimenopause is the two to ten years before the nal period. By contrast, the graduation into the menopause life phase begins one year after a woman’s nal period.

e normal (yes, normal) age for the nal period is anywhere from 45 to 55, so the normal age for perimenopause is up to ten years before that; as young as 35. at’s why this popular narrative of ‘women are living longer’ and thereby experiencing more menopausal symptoms, is awed. Perimenopause is not about ageing but is instead about an important (and unavoidable) recalibration of the female hormonal system.

WHAT ARE THE HORMONAL CHANGES OF PERIMENOPAUSE?

As we can see in the image, in the early phases of perimenopause, the biggest change is lower progesterone. It takes a nosedive, where oestrogen (oestradiol) remains high. is plummeting progesterone is what contributes to feelings of anxiety, breast pain, heart palpitations, frequent migraines, more heavy periods (progesterone helps to lighten the period ow) and being overwhelmed.

At the same time that progesterone drops away, oestrogen spikes up to three times above normal levels which contributes to irritable mood, breast pain and the heavier periods (as there isn’t su cient progesterone around to counterbalance these oestrogen spikes).

Hot ushes are mostly associated with the withdrawal of these oestrogen spikes. Progesterone and oestrogen levels out during perimenopause. e fact that perimenopausal symptoms stem largely from losing progesterone, rather than oestrogen, is why the former is a more sensible therapy. is is especially helpful in the early phases of perimenopause, together with some highly e ective food supplements that can target these mechanisms and help alleviate symptoms.

The Timing Of Menopause

All women are genetically programmed to graduate into menopause at approximately the age your mother did. If that happened to be on the younger chronological end of normal (mid-40s), it does not mean you’re ageing more rapidly than your friends, it’s a natural – normal recalibration.

If you enter menopause before 40, this is a medical condition of premature menopause or primary ovarian insu ciency.

CAN I GET A DIAGNOSIS OF PERIMENOPAUSE?

Menopause (including early menopause) can be diagnosed by two separate high follicle-stimulating hormone (FSH) readings (more than 40 IU/L) at least a month apart.

Perimenopause cannot be diagnosed by FSH or any other lab test. Instead, it’s best assessed based on age and symptoms. A midlife woman with regular cycles is likely to be in perimenopause if she notices any three of the following nine changes:

• new-onset of heavy and/or longer ow

• menstrual cycles become shorter (<26 days)

• new sore, swollen or lumpy breasts

• new mid-sleep waking

• increased menstrual cramps

• premenstrual night sweats

• new or markedly increased migraine headaches

• new or increased premenstrual mood swings e recent decision by the government to reject the proposal made by the House of Commons Women and Equalities Committee for mandatory menopause education for GPs is disappointing at best.

• weight gain without changes in exercise or eating.

In other words, if you’re older than 37 and have at least three symptoms on this list, you’re likely to be entering second puberty - perimenopause.

Having access to a women’s health literate GP / health care provider who understands and is interested in these important hormonal nuances is every woman’s right.

In 2023 we surely have to move away from a blanket approach to women’s health that has plagued the medical system for too long. Simply turning o hormones with a prescription of the oral contraceptive pill or replacing them with HRT is not good enough. e time for a more sophisticated and bespoke approach to the dance of these beautiful hormones and life phases is well and truly here!

In health Tanya x

Introducing Anna Eliatamby – clinical psychologist and workplace well-being expert who has helped the United Nations and global organisations develop mental health and well-being strategies and tackle toxic behaviours in the workplace. Anna has just published the new Decency Journey Series of pocketbooks to help people flourish in their careers and workplaces.