Perimenopause – Managing the Symptoms

Perhaps one of the most discussed topics around perimenopause and its stages is the symptoms any and all of us women can and will experience. There is so much power in connecting over a phase of our lives that everyone understands, however, even though perimenopause and menopause is something that everyone goes through, not all experiences are the same. The severity of the symptoms can range from barely noticeable to extreme discomfort but its important to remember that if there is one thing we can do for one another is to hold space for our friends and acquaintances who have decided to be vulnerable with us and share their worries and concerns.

What are the most common symptoms of perimenopause?

Perimenopause symptoms are similar to those of PMS, which can be terrifying since nobody wants to suffer for years on end, however there are solutions to reducing the intensity of some and managing others. While the list is long and individual experiences may vary, the most common symptoms include:

* Irregular periods (different cycle lengths and shorter or longer periods)
* Changes to menstrual bleeding (heavier or lighter than usual)
* Sleep disturbances and night sweats
* Hot flashes
* Mood changes
* Short-term memory problems & brain “fog”
* There can also be potential medical symptoms such as changes in discharge, vaginal dryness, changes in sex drive etc, however it is out of my jurisdiction to give advice on these. If you are having questions on these topics, do contact your GP or trusted health professional for answers.

To discover more symptoms, I recommend reading credible sources online or purchasing a more detailed book or two to really build up your knowledge on the topic. Today, I am going to break down the most common symptoms and share ways on how to minimise the discomfort from these. I will also share my own personal experience for comparison and potentially helpful tips.

SYMPTOMS AND HOW TO MANAGE THEM

• Irregular periods and changes to menstrual bleeding

Although it may come as a surprise to many, both the length of your cycle and the intensity of your period are connected to your bodyfat levels. The higher the bodyfat, the longer and heavier one’s periods are likely to be. Higher bodyfat % is often the cause of hormonal imbalances and chronic inflammation, which can also cause uterine lining dysfunction and heavier periods as the amount of circulating oestrogen is higher than for an individual with lower bodyfat.

How to minimise the effects – adding regular exercise to your week, ensuring resistance training is a big part of it to increase lean mass and reduce bodyfat %. It is aways a good idea to drink more water and try to get adequate sleep.

Personal experience – I wouldn’t say I suffer from this, however in the last two years my periods have gone from a steady 28-day cycle and 5-6 day periods to 21-34 day cycles and 4-7 day periods. I like to say it is ‘predictable in its unpredictability’.

• Sleep disturbances and night sweats

Perimenopause can affect our nights in many ways, all of which result in us not getting enough hours – struggling to fall asleep in the evening, having broken sleep, waking up too early, having bad dreams, night sweats etc. As much as I’d like to assure you that this is a quickly passing symptom, research shows that sleep disturbances affect up to 90% of women and night sweats in particular can impact a fifth of women for any number of years. So the best thing we can do is be knowledgeable about the ins and outs. The reason for night sweats is the ever-changing hormone levels, which makes it difficult for your hypothalamus to regulate your body temperature, leading to sudden bursts of heat and warmth during the night and your body attempting to cool itself down in response to the surge.

How to manage sleep disturbances – To lower the risk of having a restless night, minimise your caffeine and alcohol intake, create a consistent routine around bedtime and maintain a cooler temperature in the bedroom. There is also a growing amount of proof that magnesium can support calmer sleep.

How to manage night sweats – Keep a water bottle by the bed to drink whenever needed and sleep with a lighter duvet or different layers, which you can easily remove or replace. To keep fresh air circulating, you can keep windows open or, if you don’t mind the noise, perhaps you’d like to switch on a fan. If you wear nightgowns or pyjamas, choosing looser fitting garments and those made from easily breathing fabrics will drastically improve your comfort levels. And last but not least, it goes without saying that having more space in your bed is helpful, so if you have the option to “starfish” or to at least occasionally sleep separately, this could really improve the way you feel. Especially when you are experiencing the worst night sweats, being able to roll over to the dry side of the bed is a treat. Alternatively, laying down a soft bath towel can allow you to drift back to sleep more quickly.

My experience – I keep a bottle of water by my bed to avoid having to wander into the kitchen in the middle of the night. I sleep with my windows ajar (with the exception of when the temperature is below zero), so there is always ample air in my room. I sleep in the nude; from May to September I sleep using only the duvet cover; in the winter I don’t put my 7.5 TOG duvet inside the cover but have it on top. This might not be a solution for you but it allows me to push a layer off quickly the moment I start to feel too hot.

• Hot flashes

This ties in largely to the night sweats symptom, however it deserves its own section. While the cause for hot flashes is the same as our sweating at night, this issue brings about its own unique challenges. What to do when you are out and about, visiting a friend or, worse – on a packed tube or at a meeting at work? Feeling hot suddenly and unexpectedly can make you want to remove some layers or to undress immediately to get some relief from the heat surge. The inability to do so can cause overwhelm, claustrophobic sensations and anxiety or panic.

How to handle these situations – Staying calm is so very important, which is why focusing on your breathing can help you talk yourself through a severe hot flash, especially when in an inconvenient public setting. Naturally, heart palpitations accompany a hot flash, which is why allowing yourself to become agitated will only cause further distress, so I would like to remind you to fully focus on yourself in those moments. Excuse yourself from the company and find an open, well ventilated space and sit down if possible. Loosen buttons or remove layers, baring your hands and feet if needed to allow the body to efficiently lower its temperature quickly. Reminding yourself that this is only 5-15 minutes of discomfort, you can talk yourself through the surge and keep your composure. Should you be on busy public transport with no immediate option to get off, do ask for a seat and try to settle into your breathing. These moments may be upsetting to some, so please don’t feel embarrassed if you do feel emotional. I highly recommend keeping on you a carbohydrate rich snack or drink (watery fruit or juices) to hydrate and stabilise your blood sugars in those moments.

How to minimise the effects – Both our habits and the environment can impact the way our body responds. Potential triggers for hot flashes are tobacco, alcohol, spicy foods, cigarette smoke, tight clothing and high temperatures or hot beverages. Minimising the toxins in our diet and triggers in our lifestyle is a fairly easy way to improve our experience.

My experience – I often dress lighter than the average person and although I love being warm (surely everyone does?), I would rather be cold than too hot. I utilise layers as when a real hot flash arrives, you’ll feel like you want to take off everything you’re wearing. If you decide to dress light like me, the only downside is people constantly asking: “Are you not cold in this?” but it’s a small price to pay for being comfortable.

• Short-term memory problems & brain “fog”

This one here is a really fickle beast because it can leave you feeling frustrated and not like yourself at all, especially if you are used to staying on top of things. The same hormonal changes that cause us to sweat or have poor sleep will affect our memory, both directly and indirectly. If you struggle to regularly get a healthy amount of sleep, this can affect your brain function and make you forget names, dates, events etc. Although it’s always temporary, such discrepancies can be extremely frustrating but it’s important to remember to be kind to yourself.

How to manage this symptom – Good hydration, ample sleep, regular exercise and breaks in a busy schedule are all important to minimise stress and to allow your brain to catch up and organise information in order to feel like yourself again. It is also recommended to take up activities that would help train one’s focus, association skills, reaction speed etc. I believe it is also healthy to mention what you’re going through to people around you so they can be understanding and, this way, you will not have to force yourself to keep up appearances on days when you feel a little less ‘on it’.

My experience – I have always kept all my tasks and responsibilities written down and I highly recommend you use this method – the minute something needs remembering, write it down instantly. Where possible, avoid working on admin tasks too early in the morning or too late at night as this can cause you to make mistakes. If your thoughts run away from you and you are finding it hard to get the right words out, allow yourself time to process what needs to be said. To avoid feeling overwhelmed, take time for yourself, minimise the need to hold small talk or conversation and avoid needing to be constantly switched on for the entertainment of others.

• Mood changes

Just like during late luteal phase, mood changes during perimenopause are something that one has little control over, however, here are two reminders, one for men and one for women. Gentlemen, it is never good etiquette to point out when you think your mother/sister/wife/co-worker is acting differently ie more emotional or perhaps needing more assurance. The chances are they already know and are not particularly enjoying themselves. And ladies, just because it explains it, that doesn’t mean it excuses it. We must never allow hormonal changes to be the reason to be rude to someone. The discomfort we feel is internal, it is brief phase where we might feel either more vulnerable or, quite the opposite – headstrong and powerful, but we shouldn’t walk over people.

How to manage this symptom? – Reminding yourself that any feelings of self-doubt or frustration are directly triggered by changing hormones, sleep routine and eating habits. Knowing that your body is changing can be concerning for some and it might feel like you are not in control – but this is why you are here, reading this blog right now. Because you want to know more and you are aware that these answers will allow you to go through these experiences with more confidence. Knowing that your brain is making up stories that are not true is your best way to approach any such wobbles. You are allowed to feel all the emotions, but I am here to urge you not to allow these to take over and stay too long – it is all temporary.

Personal experience – Over the years I have learned to recognise when my emotions are not my own, so it has become easier to dismiss feelings of self-doubt or frustration that can creep in during the last few days of my cycle. When I find myself impatient and easily frustrated, I remove myself from the situation to cool off and have to remember to pause before I respond to avoid misunderstandings. Should I feel vulnerable instead, I usually ensure I plan fun activities like going to the cinema or catching up with friends – they can remind you of how awesome you are during the moments when you are quite not so sure!

PMT OR PERIMENOPAUSE?

The main thing to remember – if you are confused as to what you are experiencing (as most of us will be at first), always contact your trusted health professional to ask questions, have blood tests done and to get some answers. Medically, the standard practice is to first rule out all other issues that could cause similar symptoms; please remember this does not mean that they don’t believe you. However, I will remind you all that since we still have so little scientific data on the woman’s experience in life, sport and through perimenopause, sometimes the best source is your own lived experience.

The same goes for sharing our stories with others. Because perimenopause comes with so much irregularity, there can be plenty of speculation around ‘Is it?’ or ‘Is it not?’. I would like to remind everyone that if someone shares their story/thoughts/worries with you, that’s all it is. Please don’t compare, minimise or disregard what is being said just because you may not have experienced the same symptoms. It is not a competition and we are all different, but the one thing we can do is allow this universal experience to bring us closer together.

I really hope you have found this blog insightful and helpful. Do share this with your friends who may also be having questions about what they are going through or what they have to look forward to. At the end of the day, knowledge is power and the more we know and the more we share with each other, the better the experience for all of us.

Have a wonderful new week,
Rahel xx