Dr Michelle O'Driscoll: Signs that you could be experiencing perimenopause

We’re now more than a month into the new Hormone Replacement Therapy scheme in Ireland whereby women can collect most medications for perimenopause, menopause and post-menopause from the pharmacy free of charge.

This is a really positive step forward for women’s healthcare, that acknowledges the significant physical and emotional toll that this life transition can potentially have on over 50% of the population directly at a certain stage of their lives, and almost everybody else indirectly through their relationships with that person.

Furthermore, it seeks to address the financial barrier that for so long has made HRT inaccessible to some of those that need it the most.

Before ever deciding that HRT is actually what you need, or even realising that you’ve started on this hormonal journey, there are certain signs that can give you a hint that things are starting to change.

Perimenopause can begin up to ten years before menopause, the date of your last period. There can be very subtle signs, or there can be what feels like a tornado of misalignment and proverbial chaos, with your body no longer feeling like your own. All of these changes are due to the depleting number of eggs left to be released, and a resulting decline in oestrogen and progesterone that previously kept things on a relatively even keel.

From late thirties to early forties, it is a very real possibility that perimenopause could be rearing its head.

While some people may experience ‘classic’ perimenopausal symptoms such as hot flashes or missing periods, there are other symptoms that are not as obvious.

Here are some of the things to watch for that could be indicating perimenopause:

Irregular periods

Due to the hormonal changes that occur, it’s not just periods late arriving that can indicate perimenopause, it’s lots of different menstrual changes.

Periods can become very heavy for example, in women that previously didn’t have any issue in this regard. They can also become irregular, and begin to happen closer together. Somebody with a previously text-book 28 day cycle could experience gaps of just 21 days.

Any change in this area is something that should raise awareness of what the cause might be. Perimenopause is just one possible reason, but as part of the jigsaw, it might give you important information. Tracking your period using a simple app or Notes section on your phone will make any changes more apparent.

Mood swings

Perimenopause affects those who are at a really busy time of their lives – careers have progressed, children are still young, they’re firing on all cylinders to keep the house functioning.

It can be easy to attribute mood fluctuations, anxiety and depression to these circumstances, but what if it’s more than that?

Perimenopause can be a cause for these changes, particularly obvious if you’ve been managing these demands well previously, or hadn’t ever before struggled with your head.

The hormonal decline can leave you struggling in the mental health department, and wondering what’s going on. If you’re experiencing increased irritability, feelings of dread, or brain fog affecting your concentration – consider whether it might be perimenopause.

Meditation and/or exercise can be helpful starting points, but certainly not to replace additional support if needed.

Sleep Problems

Hot flashes aside, some women experience a disturbance in their sleep during perimenopause that leads to them feeling unrefreshed and needing a recharge.

For many, it’s not being able to get to sleep, or waking in the middle of the night, and being unable to fall back to sleep despite best efforts. Tossing and turning makes it worse, and the next day can leave you feeling almost hungover from the tiredness.

If this is only starting to occur for you now, or is getting significantly worse than what you would have experienced in the past, ask yourself or your healthcare professionals whether this could be related to hormone changes.

Having strict bedtime routines, avoiding things like caffeine or alcohol in the evening, and having a cool bedroom can help, but you may need more support than this. You might be a candidate for something like magnesium to support sleep, but get advice on this first.

Anything else!

The list of other things that might be due to hormonal changes can include changes in hair, skin, nails, reduced libido, shoulder tip pain and joint pain.Vague complaints could point to perimenopause.

If there’s anything you’re experiencing that is extreme, or is affecting your daily life, make sure to follow up, and not suffer in silence. Symptoms might sometimes overlap with other health conditions, so further input is important.

It may be that HRT, in addition to some key lifestyle changes, is the way forward, and the current HRT medication scheme means that this is now accessible to all.