Perimenopause: Hot flushes, night sweats and mood swings before ‘the change’ – Health



There’s something Kim Berry wants women going through perimenopause to know: you don’t have to suffer in silence.

“One of the things my mum said to me is that when she went through it, no-one talked to each other about it,” she said.

“I think it’s such an important thing for women to have that sense of community around them — to know [they’re] not actually going mad.”

Like many women, Ms Berry started to experience the symptoms of menopause in her 40s, well before menopause had actually kicked in.

“The tiredness, the itchy skin, the completely terrible sleep patterns, the moodiness … then there’s the hot flushes, which would hang around until I was really uncomfortable and sweating profusely, and then just sort of wash away,” she said.

When Ms Berry realised she was in the midst perimenopause (the stage before menopause), she started her own podcast, because she felt like no-one was talking about it.

“There are so many effects of perimenopause … that you can sort of excuse away,” she said.

“But once you realise, ‘Oh I’m actually perimenopausal’, it can be both a relief — and also a whole adjustment.”

The change before ‘the change’

The average age of menopause — a woman’s final menstrual period — is 51.

For many women, however, the hormonal fluctuations experienced in the years leading up to menopause can become quite erratic and feel chaotic.

This stage — known as perimenopause — is the natural transition that occurs before menopause when a woman’s ovaries are winding down.

It usually lasts an average of four to six years, but can be as short as one year, or as long as 10, said Rosie Worsley, an endocrinologist from Jean Hailes for Women’s Health.

“What’s happening during this time is that your hormone levels are fluctuating wildly, so sometimes you have super high levels of oestrogen and progesterone, and other times you have practically none at all,” Dr Worsley said.

This means for the 20 per cent of women who experience moderate to severe symptoms of perimenopause, the symptoms can often come in waves.

“Sometimes you can have symptoms of excess oestrogen, like real breast tenderness, and then other times you’ve got symptoms of oestrogen deficiency, like hot flushes,” Dr Worsley said.

“It’s highly erratic and becomes really unpredictable … so symptoms during perimenopause can also be really unpredictable.”

According to Dr Worsley, one of the most telling signs of perimenopause is when a woman’s menstrual cycle starts to change.

“You might have a period every two weeks, then you won’t have one for a couple of months, and then you might have a normal cycle,” she said.

Periods may become lighter or heavier, last for longer, or finish earlier than they used to.

The experience of perimenopause varies significantly from person to person. Some women may find they menstruate erratically for years, while for others, their period may end more or less abruptly.

Fertility drops off

Perimenopause can also affect a woman’s mental health.

According to Jean Hailes, mood changes — including feeling more teary or irritable — are a common symptom during perimenopause, and chronic or increased anxiety may also occur.

There is also research to show women are at an increased risk of experiencing depression.

“Some studies suggest women are two to four times more prone to depression in perimenopause, and we think that one of the major factors is this hormonal instability,” Dr Worsley said.

For some women, the onset of perimenopause can also be difficult because it means grappling with their declining fertility.

Aisha, who was just 33 when she began experiencing symptoms of perimenopause, said it was difficult to take in the diagnosis at the time.

“Being in my 30s, I felt quite alone,” she said.

“My mum was going through it at the same time, so I felt a real sense of injustice.

Aisha said she was now “in a more positive place”, but that it took some time.

“It was really difficult, emotionally … and I did have a lot of anxiety,” she said.

“I have one beautiful daughter and I’m very lucky to have had her.

“But that grief — it was the end of my childbearing years.”

Easing the symptoms

There are a number of treatments available that can help provide relief for symptoms of perimenopause, Dr Worsley said.

“It really depends on what your particular symptoms are and what the priority is for you to get treated,” she said.

For things like hot flushes and night sweats, Dr Worsley said hormone therapy was most likely to help.

“That could either be in the form of an oestrogen and progesterone tablet, or for some women, it might actually be a low dose oral contraceptive pill,” she said.

Hormone replacement therapy (HRT; now sometimes referred to as menopause hormone therapy) is the medical replacement of oestrogen and progesterone.

Despite widespread concern in 2002 over the safety of HRT, Dr Worsley said current evidence shows the benefits of the treatment far outweigh the risks in healthy women.

“It’s about using the right type of HRT in the right person at the right dose,” she said.

According to Jean Hailes, maintaining a healthy lifestyle — including making healthy food choices and engaging in regular physical activity — can also help support your body through the changes of perimenopause.

Both Dr Worsley and Kim said if symptoms of perimenopause disrupted your quality of life, it was important to see your GP.

“I’d encourage women to find a really good, integrative GP that understands women’s health,” Ms Berry said.

She added that one of most helpful things other people can do to support women experiencing perimenopause is simply to “cut them some slack”.

“Perimenopause often happens at a point your life where you have teenage kids and rapidly ageing parents, and you’re probably working full time,” she said.

“Women are tired … and still, we’re holding it together. So just cut us some slack.”

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