Understanding the Menopause
The menopause technically marks a year after your last period. However, in the years leading up to this point, many women experience a range of symptoms. Some of these, like changes in menstrual patterns, hot flushes, vaginal dryness, and mood swings, are often recognised as typical perimenopausal symptoms. Yet, other symptoms might be less obvious and can be mistakenly attributed to other causes.
Women often describe feelings of tearfulness, irritability, loss of joy, waning confidence, brain fog, and a sense of detachment from their surroundings. These psychological symptoms often manifest first and, in my experience over many years, can be the most distressing. Women may also experience physical symptoms such as dry skin, headaches, dizziness, joint pains, or tingling in their extremities. The range of symptoms is extensive, and every woman's perimenopausal experience is unique. It's important to note that approximately 70-80% of women experience these symptoms, and for about 25%, they can be quite severe.
What complicates the diagnosis of perimenopause, in addition to the myriad of symptoms, is the stage of life at which this typically occurs. In my clinic, which serves both NHS and private patients, I primarily see women in their 40s who are significantly impacted by their symptoms. These women often juggle teenagers, demanding careers, and elderly parents, creating a hectic phase of life where it's easy to attribute feelings of being overwhelmed to external stressors rather than hormonal changes. This can lead to some women being prescribed antidepressants or anxiety medications, while the underlying hormonal issues go unnoticed. Many might undergo multiple hormone and other tests that return as normal. This can be further frustrating for women who might be told that they can't be perimenopausal because they are still menstruating. Numerous barriers exist to women seeking help for this phase, underscoring the importance of self-empowerment through knowledge and conversations with friends and colleagues who may also be navigating perimenopause. Remember, you are not alone!
Raising Awareness of Premature Ovarian Insufficiency
Additionally, it's important to raise awareness of premature ovarian insufficiency, a condition that leads to menopause before the age of 40 and affects about 1 in 100 women. These women often face delays in diagnosis, compounding the challenges they experience.
Menopause and Exercise
During perimenopause, palpitations, fatigue, insomnia, weight changes, and loss of lean muscle mass can affect our ability to exercise. Joint pain is also a common early symptom that might not be immediately linked to perimenopause. These physical and emotional symptoms can lead to mood disturbances and low self-esteem. It's essential to remember that regular exercise can be a powerful tool for mitigating perimenopausal symptoms and maintaining long-term health.
Research has indicated that sedentary women tend to experience more severe menopausal symptoms than active women. Conversely, physically active women tend to experience fewer sleep disturbances, mood disruptions, and weight gain during the menopausal transition. Physical activity stands as the most crucial thing we can do during this time.
Training during Perimenopause
In perimenopause, listening to your body becomes increasingly important. There will be days when running your usual 5k might not align with your body's needs. Being flexible with your training routine and incorporating strength exercises alongside running can be highly effective. Strength training helps preserve or build muscle mass, promoting a healthy body composition, reducing injury risks, and aiding recovery.
Nutrition and supplementation also warrant greater attention. Vitamin D and sufficient calcium are recommended, and protein intake may need to increase. If your periods have become heavier, you may be at risk of iron deficiency and might require supplementation.
Injuries are more common in perimenopause, with studies highlighting an increased risk of tendinopathy due to reduced estrogen levels. Greater trochanteric pain syndrome is also more prevalent during this phase.
Hormone Replacement Therapy (HRT)
The benefits of HRT often outweigh the risks for most women. HRT can protect bone and heart health and is usually highly effective in alleviating symptoms.
Body-identical HRT involves transdermal estrogen applied to the skin, often via a patch, gel, or spray. If you still have a uterus, transdermal estrogen is typically accompanied by micronized progesterone (Utrogestan) taken orally. Combined patches and tablets are available but are less commonly prescribed. The Mirena coil is another popular choice during this stage, as it not only provides contraception but also delivers the progesterone required for HRT.
Deciding whether to pursue HRT is a deeply personal choice. However, if your symptoms are significantly affecting your quality of life and your ability to exercise, it's important to consult with your doctor about whether HRT could be beneficial.
If you are feeling unlike yourself and suspect perimenopause, consider scheduling an appointment with a GP or menopause specialist to discuss your symptoms. Tracking these symptoms, perhaps with the help of the Balance App, can provide valuable insights into their impact on your life.