Perimenopause
"My periods are still coming, so this can't be menopause, right?", is a question I hear often in my clinic. And it reflects one of the most common misconceptions about the menopausal transition: that menopause begins only when periods stop and hence it can be treated only after that.
While Menopause is a point in time-defined as 12 consecutive months without a menstrual period, Perimenopause, is a transition. The years leading up to menopause, known as the perimenopause, can be a time of considerable hormonal change. Periods may still occur, but their pattern can change. They may become heavier or lighter, arrive earlier or later, become irregular or occasionally be skipped.
But menstrual changes are only one part of the picture.
A woman in her 40s may suddenly find herself waking at 3 a.m. and struggling to fall asleep again. She may experience hot flashes, night sweats, anxiety, irritability, mood changes, headaches, palpitations or difficulty concentrating. Some women describe it as "brain fog"-forgetting words, losing their train of thought or finding it harder to multitask.
Others notice changes in their body: increasing abdominal weight, reduced muscle strength, joint aches or changes in sexual wellbeing. Vaginal dryness and urinary symptoms can also become troublesome.
Because these symptoms can affect different parts of the body, connecting the dots and recognising that they may stem from the same underlying hormonal changes is often difficult. To make matters more confusing, they rarely follow a predictable pattern. A woman may feel completely herself for weeks, only to suddenly find herself dealing with several symptoms at once-leaving her wondering why she no longer feels quite like herself.
Why does this happen?
During perimenopause, ovarian function becomes increasingly unpredictable. Ovulation may not occur regularly, progesterone levels might fall and oestrogen levels can fluctuate considerably. It is therefore not simply a story of hormones steadily "falling". The fluctuations themselves can contribute to some of the symptoms women experience.
Perimenopause may often be missed and a woman may be told that her fatigue is due to work, her poor sleep is because of family responsibilities, her anxiety is "just stress", or that weight gain is simply a consequence of getting older. These may sometimes be contributing factors-but perimenopause can be part of the picture too.
Importantly, it is also important to note that not every symptom in a woman in her 40s is caused by menopause. Thyroid disorders, anaemia, sleep disorders, nutritional deficiencies, mental health conditions and several other medical problems can produce similar symptoms. A thoughtful medical assessment is therefore important, especially because there is no single test that helps diagnose perimenopause. As the hormones in perimenopause are fluctuating and hormonal assessment may not help diagnose it correctly. And hence, perimenopause is almost entirely a clinical diagnosis.
All is not lost!
Perimenopause can be bothersome, but it can be looked at as an opportunity-not only to address symptoms that are affecting daily life, but also to reassess sleep, nutrition, physical activity, muscle and bone health, blood pressure, blood sugar and cardiovascular risk.
Perhaps the most important message is this: you do not have to wait for your periods to stop before taking menopause-related symptoms seriously.
