Dear Dr Nina: I'm cranky all the time – is it perimenopause?
Q I have been reading a lot about perimenopause and a lot of what I read seemed familiar to me. I am 45 years old, working full-time in a demanding job with three children under five. I am exhausted and cranky all the time.
Part of me wonders if perimenopause is something dreamed up as a marketing tool or to deflect from how unhealthy our modern lifestyle is but if there is a reason and a solution maybe that’s a good thing. Should I get tested for perimenopause – are there things you can take to alleviate symptoms?
Dr Nina replies: Menopause occurs between the ages of 40 and 58 with the average age being 51. Many women enter menopause not knowing what to expect or how long it will last. This lack of information can lead to fear and anxiety, which can make the whole experience worse. Menopause is, by definition, the end of menstruation but the process itself may start many years before and extend many after.
Perimenopause starts years prior to the end of menstruation. During this time, periods may change or become more erratic. Your cycle may be longer or shorter and periods may be heavier or lighter. Symptoms in perimenopause may closely resemble either menopause or PMS and it may be hard to tell one from the other. For PMS to be diagnosed, the symptoms must disappear with menstruation. If physical or emotional changes or fatigue are present throughout the month, then perimenopause could be considered.
A simple blood test taken around day three of your menstrual cycle will help clarify the issue for you. In perimenopause, the hormone levels will start to change, though this alone is not diagnostic. Menstruation will not occur if you are fully menopausal.
Menopausal hot flushes can occur quite frequently and may cause night sweats, which disrupt sleep. Other common symptoms include urinary symptoms, vaginal dryness, skin changes, weight gain, and mood changes.
Perimenopause may start up to 10 years before the end of menstruation. Relief from symptoms can become a crusade for some. HRT really helps in some cases, but it is not for everyone. The greatest risk is in those women on treatment for more than five and especially 10 years. HRT is safest as at the lowest dose effective for the shortest time possible. Regular health checks are advised.
Lifestyle measures can help with hormonal symptoms. Wearing loose cotton layers, using fans, avoiding spicy foods and taking a cold drink may help manage hot flushes. Women who partake in regular moderate exercise have less troubling menopausal symptoms. Maintaining a normal BMI and keeping alcohol to less than 11 standard drinks a week also helps. Significant mood and memory changes are not a normal part of menopause.
Phytoestrogens are a popular alternative remedy, while acupuncture can help in some women.
If you have symptoms that are affecting your quality of life, be they premenstrual or perimenopausal, don’t suffer in silence. Your GP can direct you towards a treatment plan that fits.
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