A self-help guide for the perimenopause

The average age for reaching menopause (the cessation of menstrual periods) is 52, but symptoms of perimenopause – also called pre-menopause – can start up to 10 years before, as oestrogen levels drop and hormones are generally disrupted. For many women, the first signs occur about five years before menopause at around 45-47. Here's how you can cope with symptoms from the outset, although you should always consult your GP for a proper diagnosis.

Hot flushes

These often occur by day or by night, but are commonest at night-time meaning your sleep is interrupted. For some women, flushes are accompanied by profuse sweating which, at night, can mean having to change nightclothes or even bed linen. Flushes and sweats in perimenopause affect around three-quarters of women and are c aused by hormonal changes that are thought to disrupt the body’s temperature-regulating mechanism.

What you can do
Dress in light layers by day so you can easily remove some of your outer clothing if you suddenly overheat. Keep a misting water spray in your handbag, too, to spritz your face and upper body for an instant cooler. Ask for a desktop fan at work or invest in your own. For night-time, you can buy a special cooling pillow or pillow pad, which contain a cooling gel that’s activated by contact with your body. They’re not cheap at £20-£30, but probably worth the money for the long haul.

Keep a small, low-noise electric fan by your bedside, too, and make sure your bedroom isn’t too warm in the first place. A cooler bedroom – whether or not you suffer from flushes – has been proven to promote better sleep. The Sleep Council recommends keeping it slightly cool at around 16-18°C (60-65°F). Cutting down on spicy foods, alcohol and caffeine can help, and some women find the herbal remedy black cohosh helpful, too.

Tiredness

Depleting levels of oestrogen, which is responsible for controlling levels of the stress hormones cortisol an adrenaline in the blood, can lead to fatigue that leaves some women totally exhausted day after day. If you’re also suffering disturbed sleep because of night flushes and/or sweats, it’s no wonder you’ll feel sleepy and lacking in energy.

What you can do
Try to get as much rest as you can whenever you can. For some women, a mid-afternoon cat nap (even taken in the loos at work with your mobile phone alarm on a 10-minute timer) can be enough to increase energy levels enough to cope with the rest of the day at work. Try going to bed earlier in case you wake in the night – an hour’s extra sleep earlier in the evening might help compensate for sleep lost in the early hours. Exercising can help to combat fatigue, so try to take a brisk walk or some other form of exercise you enjoy on a daily basis.

Low libido

Reduced oestrogen and androgen levels can lead to a reduction in libido (also called sex drive). This drop-off in the oestrogen levels can also cause physical symptoms that hamper intercourse, such as a dry vagina and a decrease in blood flow to the genitals. This is because the production of secretions that lubricate the vagina, and the engorgement of the vulva, are triggered by the release of oestrogen.

What you can do
Try to create situations that might help you to feel more like making love, like investing in some sexy underwear, reading a racy novel or setting aside an evening for you and your partner to spend pampering each other. Start off with the promise of a mutual massage (with no pressure from either of you to have full sex), then see where things lead.  Or agree just to kiss and cuddle, then if you become aroused take things further. If you’re experiencing uncomfortable dryness, you can buy special lubricating gels over the counter from a pharmacist, or your GP may prescribe a topically applied cream containing oestrogen.

Mood swings

The dreaded hormones are responsible for mood swings, too. If you’re a mum, you’ll remember the emotional upheaval you went through during pregnancy as your hormones surged and dropped at different stages. Just like back then you might find yourself either irritable, weepy or downright angry from time to time – and your changing moods may surprise you as much as they alarm those around you, especially if you’re usually even-tempered and tolerant. Mood swings aren’t usually attributable wholly to perimenopause or menopause, though, and will be exacerbated by life stresses and a struggle to accept advancing age.

What you can do
Being aware of your mood swings can help you to curb your tongue and count to 10 before lashing out at the nearest unsuspecting person. It can help, too, to get your partner on your side so that you’re cut a bit more slack than usual while you go through this phase in your life. Try to find things to do that calm you and that you particularly enjoy, so you can distract yourself when you feel a rage coming on.

Taking yourself out of a heated situation and spending five or 10 minutes meditating or a couple of minutes taking slow, controlled breaths can be enough to diffuse things. Some women find yoga helpful; others find the endorphins (‘feel good’ hormones) produced in response to exercise help to raise their mood considerably. Eating a well-balanced diet will help keep your blood-glucose levels steady, which will prevent the mood dips associated with sugar lows, while getting enough sleep can also have a positive effect.

Weight gain

We’ve all heard of middle-age spread, and a thickening middle is a common complaint of women in their forties and fifties. In fact, although it’s a widespread problem (excuse the pun!) amongst ladies of a certain age, it’s unlikely to be wholly down to the perimenopause or menopause. Our metabolism tends to slow down generally as we age, which means we burn calories more slowly, and if you’re less physically active than when you were younger – perhaps because your kids have grown up and don’t need you to rush around after them any more or your job is less energetic or more sedentary than previously – this will account in part for weight gain.

Of course, losing your figure in your forties or fifties won’t help with general feelings of wellbeing, so it makes sense to try to prevent it from happening so it doesn’t exacerbate the other effects of perimenopause.

What you can do
Stepping up the amount of exercise you do will help to keep your weight in check and raise your wellbeing levels at the same time because of the release of endorphins that occurs after physical exertion. Just 15-30 minute of brisk walking every day (split into 10-minute bursts if that fits in with your day better) will raise your fitness levels and help you to burn calories. Depending on how quickly you move, 30 minutes’ of walking can burn between 90 and.

You can also eat a varied diet containing less fat and sugar without sacrificing taste or enjoyment: choose lean proteins and whole foods, such as wholewheat , wholemeal and wholegrain bread, pasta, rice and cereals, plus plenty of fibrous fruit and veg, all of which keep you feeling fuller for longer.

Brain ‘fog’

If you find yourself becoming increasingly forgetful or struggling to find the right word for everyday objects, the natural response is to think you’re showing early signs of dementia. But according to researchers at New York’s University of Rochester Medical Centre, the parts of the brain which are most dependent on oestrogen are those that govern verbal memory and processing speed, so diminishing oestrogen levels in perimenopause could be responsible for poor memory function. The good news is that the effect is, in most cases, temporary – and that you’re not alone, as plenty of other women are experiencing the same frustrating symptoms.

What you can do
It will help if you can keep your brain as active as possible across a broad set of disciplines. Doing crosswords and number puzzles, such as Sudoku, will exercise a different part of the brain from the part that deals with long- or short-term recall, for instance.  If you’re struggling to remember lists of things without recording them somewhere, try making a story with the items to help with recall.

If you suddenly remember a list of things you need at the shops, for example, try to link them in some way. Say, for instance, you need cat food, bread, kitchen roll, milk and coffee: in your story, the cat could be watching a bird that’s eating the bread you put out for it; the bird could have left some mess on your window that you clean up with kitchen roll; then you could reward yourself with a milky coffee! Sounds crazy, but it does work (as long as you don’t come home with a cat, a canary and a supermarket sandwich…).

Cystitis

The list goes on, doesn’t it! On top of all the previous niggles, we could certainly do without urinary tract infections (UTIs) like cystitis, but they do seem to plague women of a certain age more so than others. This is because diminishing levels of oestrogen curing perimenopause cause the urethra and bladder linings to thin. This makes them more vulnerable to damage and infection. At the same time, the vagina is becoming drier from a lessening of natural secretion, and this makes it easier for bacteria to thrive. All in all, this creates the perfect setting for a case of cystitis.

What you can do
There is some evidence that taking high-dose cranberry supplements can the incidence of UTIs such as cystitis in some women. It’s best to avoid drinking sweetened cranberry juice in any volume, though, as it contains lots of sugar, which encourages bacteria to grow. Other acidic fruit juices should be limited, too, as these can irritate the lining of the bladder. In mild cases of infection, try drinking half a glass of water with one teaspoon of bicarbonate of soda dissolved in it, two to three times a day.

This makes your urine less acidic, so less uncomfortable to pass. In more severe cases, see you GP as early as possible. If you’ve been perimenopausal for some years or you’re nearing the end of menopause, using an oestrogen replacement treatment in the form of a cream or pessary might help prevent cystitis, so ask your GP about this, too.

Headaches

You may already be familiar with menstrual migraines, which are triggered by hormonal changes in the run-up to your period. These hormone-related headaches often worsen in perimenopause, partly because periods come more frequently at first and partly because your normal hormone cycle is disrupted.

What you can do
Try to keep your blood-glucose levels as even as possible, as dips can trigger migraines. So eat snacks in between meals, and make sure these are low on the glycaemic index (GI), which means they release their energy slowly and consistently. Have your last snack just before you go to bed – a piece of wholemeal toast or a small bowl of bran flakes is ideal – and eat a good breakfast every day.

Keep to regular bedtimes and make sure you get enough sleep for you. Exercising can relieve tension that could otherwise trigger migraine, so try to get out for some brisk walks if you’re not a gym bunny or an active sportsperson.

Thinning hair

You may feel your hair is falling out all the time and that you’re going bald, but increased hair loss is another common symptom of perimenopause. In fact, it’s more likely that you’re losing hair at the same times of the month as usual, but that the volume has increased. It’s because of a drop-off in levels of oestrogen and progesterone, and an increase in levels of the male hormone testosterone, and can affect women to differing degrees. Don’t worry about developing male-pattern baldness or alopecia, though – both are relatively rare.

What you can do
Firstly, ask your GP to test your levels of ferritin – a measure of iron. You may be prescribed a supplement if your levels are low. Also, make sure you eat plenty of carbohydrates. Women who are on low-carb diet regimes may find their hair thinning more than others in response to the stress of suddenly losing most of a food group.

Some carbs, especially breads and cereals, are fortified with iron, too, so it’s worth checking the nutrition labels and bringing some of them into your daily diet. Other iron-rich foods include red meat, lentils, soya and green, leafy veg. If your thinning hair is leaving areas of your scalp visible, consult your hairdresser and talk about the best cut to cover these areas and create an illusion of volume.

Palpitations

Some women in perimenopause or menopause notice palpitations, where your heart beats noticeably for a few seconds or minutes. It may feel as if it’s skipping the odd beat, adding in an extra heavy one, pounding generally or fluttering.Palpitations can be caused by hormonal changes and are nothing to worry about. The effect is usually temporary. If your palpitations are ongoing or accompanied by other symptoms, though, you should see your GP to check for any underlying problem.

What you can do
Try to relax and ignore palpitations, reassured that they are usually completely harmless: anxiety won’t help. Cutting down on caffeine, alcohol and other stimulants may also reduce the frequency. If you smoke, consider stopping. Taking more exercise can sometimes eliminate palpitations.

There’s a trick to stopping a palpitation in its track that works for some people: try holding your nose, breathing in through your mouth, clamping your mouth shut and trying to force your breath out. This will make your ears pop, which is why it can be helpful against cabin pressure during take-off and landing when you’re flying, but it also creates pressure in the chest that can stop a palpitation.