Perimenopause and Health

Symptoms of Perimenopause

The symptoms of perimenopause include:

Irregular periods. This is often the first sign of perimenopause. Some women find they go longer between periods, or may skip a period every few months. Others find that their periods become heavier, or lighter, or shorter or longer. It varies widely, and there is often no obvious pattern except irregularity.
Hot flushes or hot flashes. These are also known as vasomotor symptoms, and affect up to 80% of perimenopausal women. They are sudden waves of heat, usually across the upper body and face, often accompanied by sweating. Some women may also experience a rapid heartbeat, or shivers. Hot flashes tend to last a couple of minutes.
Night sweats. These are hot flashes that occur at night, probably because oestrogen is responsible for keeping your body temperature lower at night. They are exactly as they sound—and exactly as unpleasant as they sound.
Sleep disturbances. As if night sweats weren’t bad enough by themselves, many perimenopausal women also find that they have trouble sleeping. They may find it more difficult to fall asleep, and also wake up during the night, or earlier than usual in the morning.
Brain fog. Many perimenopausal women experience problems with concentration, memory or focus, which is often dubbed ‘brain fog’. The direct hormonal cause is not clear, but it is generally agreed that some of the other symptoms of perimenopause may contribute, especially poor sleep quality.
Mood changes. Some perimenopausal women report mood changes, and particularly increased levels of anxiety. Interestingly, women who have previously experienced episodes of anxiety tend not to report more symptoms, but women who have never been anxious before often find that they become more so. Perimenopausal women are also more likely to have an episode of depression.
Vaginal and bladder issues. Many perimenopausal women report experiencing vaginal dryness and infections. They may also experience more bladder infections. Similarly, perimenopausal women may also find that they start to have urinary incontinence (leakage), especially under stress (for example, when sneezing, coughing, laughing or exercising).
Metabolic changes. Perimenopause and menopause are associated with various metabolic changes. A recent study found that post-menopausal women tend to have higher blood pressure and blood sugar, and more body fat, than pre-menopausal women. They certainly seem to show higher blood sugar levels after eating, and have more ‘glucose spikes’ and blood fat spikes. These metabolic changes may also be associated with a greater risk of type 2 diabetes and heart disease.

There is more about glucose spikes in our page on Complex Carbohydrates, Sugar and Diet.
Increased risk of chronic illnesses. Menopause is linked to an increased risk of several chronic conditions, including heart disease and type 2 diabetes. It seems that oestrogen exerts a protective effect against these conditions—and when it is gone, so is that protective effect.
Loss of bone density. Menopause is associated with a loss of bone density that is, in turn, associated with an increased risk of osteoporosis and fractures. This too is because the protective effect of oestrogen has been withdrawn.
Other symptoms. Unfortunately, almost any symptom a woman may experience between the ages of about 35 and 55 could potentially be attributable to perimenopause. Other symptoms include heart palpitations, headaches, joint aches, mood swings and tiredness. There is no obvious way to judge whether these symptoms are caused by hormonal changes or something else, except by investigating other possible causes.

WARNING! Don’t disregard symptoms as ‘just the menopause’

It is true that there is a huge range of symptoms that may be caused by fluctuating hormones. However, many of these symptoms could also have other causes. If you start to experience joint aches, heart palpitations, headaches or other unusual (for you) health issues, go and see a doctor. You might benefit from hormone replacement therapy—but there might also be something else going on that needs treating.

Treating Perimenopausal Symptoms

There are some medical (prescription) treatments available for perimenopausal symptoms.

The best-known is hormone replacement therapy (HRT). This provides replacement hormones—usually oestrogen and progesterone—to help your body to manage the fluctuations and loss of its own production ability. This may be in the form of patches, gels, creams, or even (for progesterone), an intrauterine coil (IUD).

There is some evidence from the recent ZOE study on menopause that HRT can help to control some of the metabolic changes that occur around menopause. For example, women who took HRT after menopause had better blood sugar and blood fat responses to food than women who were not taking HRT. They also had lower body fat.

Is HRT safe?

This is the million-dollar question for most women.

In the past, there have been concerns that HRT was associated with various forms of cancer, especially breast cancer. Many of these concerns have been laid to rest with the introduction of newer forms of HRT, although it still seems to be associated with a higher risk of oestrogen-related cancers.

HRT is also not recommended for women with a history of stroke, heart disease or blood clots, even though some doctors suggest that it may help to reduce the risk of heart disease.

The general advice is that HRT should be provided to relieve the symptoms of perimenopausal and post-menopausal women. It is generally agreed to be ‘safe’ for most people, although it does increase the risk of certain issues among certain women—which is why it is still only available on prescription. There is no evidence for its routine long-term use solely to reduce the risk of heart disease and osteoporosis associated with lower levels of oestrogen. However, there are very few clinical studies of post-menopausal and perimenopausal women, so perhaps the position will change in future.

Women who experience vaginal dryness and repeated infections are often prescribed topical oestrogen: creams to use on their vagina. Over-the-counter lubricants can also help. In the US, women may also be prescribed a particular type of antidepressant, selective serotonin reuptake inhibitors (SSRIs) to treat hot flashes.

Lifestyle and Perimenopause

There are some aspects of lifestyle that can improve (or worsen) perimenopausal symptoms.

These are worth considering as a first option, especially if you have fairly mild symptoms, or do not wish or are unable to take HRT.

Factors that can affect perimenopausal symptoms include:

1. Exercise

Exercise is generally good for you (as our page on The Importance of Exercise makes clear). It can help you to sleep better, and is good for your mood, heart and general health. Building exercise into your schedule is good at any time of life, but can be especially important during perimenopause.

Our page on Types of Exercise contains some advice about different types of exercise.

From perimenopause onwards, it is particularly important to spend time on strength or resistance training. This reduces the muscle loss associated with aging and hormonal changes, and enables people to keep functioning independently for longer. It can also help to decrease the loss of bone density seen after menopause, and therefore the risk of osteoporosis and fractures.

It’s never too late to start!

Studies have found that starting to do resistance training can help you to build strength in just a few weeks—even if you were already frail. In other words, when you start resistance training, whatever your age, you can become less frail as a result. It’s never too late!

For more about how to start to exercise, and particularly staying safe while exercising, you may be interested in our page on Exercising Safely and Effectively.

2. Diet

The ZOE study has examined metabolic changes during perimenopause, and particularly those associated with risk of chronic conditions such as type 2 diabetes and heart disease. Recently published findings suggested that diet could help to counteract some of those changes. In particular, the authors of the study suggested that women should eat:

More plant-based foods, and especially foods with plenty of fibre and complex carbohydrates such as vegetables, legumes and whole grains.
More soy-based foods such as natto and tofu.
More fermented foods, for example, kombucha and kefir.
Fewer sweet foods, ideally keeping these as an occasional treat only.
Fewer spicy foods, because in some women these seem to make hot flashes worse. It may be worth reducing your level of spicy food if you eat spices regularly and experience hot flashes.
Fewer ultraprocessed foods, because these seem to exacerbate the symptoms of perimenopause.

There is more about these foods in our pages on What is Fibre? and What are Carbohydrates?. You may also be interested to read our page on Understanding and Improving your Gut Microbiome, because that seems to be key to these changes.

Diet and hot flashes

A recent study from the ZOE team found that what you eat seems to have a direct effect on hot flashes and night sweats. This means that you can reduce the symptoms by changing your diet. In particular, the study recommended eating more phytoestrogens.

These are compounds found in plant-based foods that mimic the effect of oestrogen on your body. In other words, they are almost a form of natural HRT. Foods that contain plenty of phytoestrogens include:

Soybeans, which contain both of the main types of phytoestrogen (lignans and isoflavones);
Whole grains, especially rye, oats, wheat, spelt and buckwheat;
Cashew nuts;
Fruits especially apricots, pears, kiwis and grapes;
Vegetables, especially green beans, carrots, courgettes and sweet peppers (bell peppers).

The so-called ‘Mediterranean diet’, which is high in vegetables, nuts, legumes and olive oil, seems to reduce hot flashes. Similarly, drinking small amounts of cold water before going to bed also seems to reduce night sweats.

There is also some suggestion that perimenopausal and post-menopausal women might benefit from eating more protein, because their muscle mass naturally diminishes. Eating more protein may therefore help to prevent this loss. This is particularly important if you start to do the recommended resistance (strength) training, because you will need more protein to maintain your muscle mass.

It is also worth eating foods that are high in Omega-3 fatty acids such as oily fish, and Vitamin D, such as dairy products and oily fish. Both these may help to counteract some of the symptoms and effects of hormonal changes.

To supplement or not to supplement?

Should you take supplements to increase your levels of Vitamin D and Omega-3 fatty acids?

Generally speaking, the evidence says no, don’t take supplements. Instead, change your diet to incorporate more foods that are rich in the substances you need, because this is more beneficial. Supplements do not necessarily have the desired effect, and can even be harmful.

Our page on Dietary Supplements provides more information about this contentious issue.

3. Smoking

Smoking has consistently been found to increase hot flashes. If you are a smoker, it is worth trying to quit if you are finding hot flashes are an issue for you.

4. Alcohol and caffeine

Both alcohol and caffeine are thought to trigger hot flashes. They may also irritate the lining of the bladder, making it more likely that you will wake in the night needing to pee. Consider trying to reduce your alcohol intake, and perhaps switching to decaffeinated alternatives, to see if that has any effect on your symptoms.

5. Sleep and sleep hygiene

Getting enough sleep is important, but may be even more challenging during perimenopause. Try improving your ‘sleep hygiene’ to see if it makes any difference.

Our page on The Importance of Sleep provides some advice on sleep hygiene.

A Final Thought

It is interesting that there is generally very little information available about how to stay healthy during a period (perimenopause) that affects 50% of the population.

Fortunately, the situation is changing thanks to studies like those from ZOE. There is now growing awareness and evidence about changes that women can make to improve and manage their symptoms around this period. Given the rapid changes in understanding of this area, it is worth staying alert to news reports, so that you can follow best practice to keep yourself healthy.

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