What the Perimenopause?

Perimenopause refers to the years leading up to menopause. In this stage of our reproductive years women will experience fluctuating hormone levels, often causing a number of troublesome symptoms commonly associated with Menopause.

Perimenopause is best likened to puberty in reverse for women.

Common symptoms include:

• Anxiety

• Mood swings

• Memory loss

• Brain fog

• Increased hunger

• Sleep disturbances

• Hot Flashes

• Joint Pain

• Muscle aches

• Weight gain

• Vaginal dryness

• Low Libido

• Fatigue

• More painful Periods

• Irregular periods

• Itchy skin

• Hair loss

• Changes in sense of taste and smell

*this list is not exhaustive and some women may experience all or none of these symptoms

How long will symptoms last?

Perimenopause will typically last around 5 years, but may range from 4 to 10 years. It is a very individual stage of life and no two bodies are the same!

Is there a blood test to diagnose perimenopause?

In simple terms, a single blood test will not portray accurate results as hormone levels are fluctuating during this time frame.

Menopause, on the other hand, is defined as the period in a woman's life when she has been period free for 12 months and for the remainder of her non-reproductive life. Menopause can be accuartely diagnosed as menstrual cycles have stopped for 12 months.

Of course for every rule there is an exception! A blood test will be useful in determining early onset menopause for women below 40 years of age where perimenopause is suspected. This is only a valid test result in women who are not taking oral contraceptive medications.

Is there anything I can do to help alleviate symptoms?

Perimenopause occurs at a time in life when we are usually already very busy and have a number of external stressors affecting us. Thankfully, there are lots of things we can do to help alleviate some of the more troublesome symptoms and regain control and a sense of wellbeing.

Managing Stress

Stress is going to have a major impact on how we feel and how our body is performing. So with this in mind I would firstly suggest finding ways to manage and alleviate stress that you enjoy. There are plenty of things you could try and you might find a new activity that you really love. Things I would highly recommend that I have tried in the past include meditation, or if this doesn't sound like it's right for you, passive forms of deep relaxation such as sound therapy are a beautiful alternative to help relax the body and calm the mind.

Prioritising time for yourself, away from your busy schedule can be really rejuvenating and is an important step in creating a sustainable means to schedule self care.

Routine

Establishing good routines can be really beneficial and may impact a number of your symptoms, helping you to manage your sleep, nutritional intakes, and may reduce the effect of brain fog.

Good routines include the time you get up each day, eating within 40 minutes of waking, scheduling exercise/self care, and implementing a night time routine each night to wind down before bed.

It's so important to establish a good night time routine if we are experiencing sleep disturbance, this helps to prompt the body that it's time to relax and rest and helps to promote restorative sleep.

Hydration

It is vitally important that we are well hydrated. This helps to flush toxins out of the body, prevents constipation and ensures that our skin is hydrated. Our bodies are mostly made up of water and so it stands to reason that water is essential.

Cups of tea and coffee can contribute to overall fluid intake, having said that, I would recommend at least 2 litres of water a day and more if you're an active person.

Some tips to get adequate water intake are to purchase a large reusable bottle and drink it throughout the day, avoiding onboarding excessive water in one go when we remember it and then rushing to the loo for the next hour!! It does come naturally very quickly so if your water intake needs some attention I promise that if you start slowly and make incremental increases before you know it you’ll be a well hydrated goddess, who feels less bloated with clearer skin in a few short weeks! And the beauty is that once you adapt to the increased intake it's very hard to go backwards!

Caffeine

Excess consumption can have a negative impact on our sleep and so it's advisable to limit intake. The half life of a cup of coffee is 6 hours and so aim to have no more coffee after midday to ensure you have the best chance of achieving a good night's sleep.

Nutrition Tips

• Eat breakfast, every day! It helps to regulate our circadian rhythm and regulates our blood sugars and hunger cues. Think protein and healthy fat to set you up for the day and keep cravings at bay.

• Avoid refined sugars. Our fluctuating hormone levels have an impact on our insulin sensitivity. Go for whole grain varieties and avoid snacking on sugary snacks when the afternoon slump hits!

• Fibre - look for high fibre whole grain foods to prevent constipation. This helps to ensure that excess and waste hormones are excreted. If we are constipated these hormones, and other toxins, could be re-absorbed and circulated around the body.

• Ensure you eat your 5 a day, minimum, these foods are full of antioxidants, fibre, water, micronutrients like magnesium, (found in nuts and seeds), which may help with joint aches and pains and cramps. Vegetable proteins also help us to meet our overall protein intake each day.

• Include protein in every meal. This macronutrient is often under-consumed and is important for muscle functioning and repair of tissue. The process of repair and rebuilding muscle slows with age and is impacted by our fluctuating hormone levels, increasing the risk of sarcopenia.

• Calcium and Vitamin D. Both are important for bone health. Ensure you are meeting the daily requirements. Vitamin D can be lacking in our winter months in Ireland and if you have any concerns it would be advisable to contact your GP to assess for deficiencies. Our bone mass reduces during menopause as we are no longer building new bone as efficiently, which can lead to osteoporosis in the longer term increasing our risk of fractures.

• Iron. Again ensure an adequate intake daily to prevent deficiencies. During perimenopause women may experience heavier menstrual cycles which increases our risk of deficiencies and anaemia.

Exercise Tips

Pick activities you enjoy to create a healthy routine, which in turn alleviates stress!!

• Exercise at this stage of life helps to reduce a woman's risk of heart disease, which increases during menopause and is a major case of mortality

• Aim for the recommended 150 minutes per week

• For those wishing to return to exercise or begin a new exercise routine contact your GP or engage with a personal trainer to ensure you can participate safely

• Resistance training should be performed 2-3 times per week, this can contribute to our total 150 minutes of exercise each week

Resistance training will help to support a healthy weight, maintain lean muscle mass, and protect our bones. It can also be a great way to boost your confidence and body image in the longer term.

Resistance training doesn't have to mean lifting weight, so don't be put off if you're reading this and thinking that going into a weights room in a gym is your idea of a nightmare! Resistance training, put simply is exercising against gravity and takes many forms, including jogging, dancing and performing body weight exercises to name a few examples that don't involve the weights room! Don't be afraid to try new things, plenty of classes and meet ups are happening which provide an opportunity to both exercise and socialise in a friendly environment.

• Perimenopause can be a hugely positive life stage. By communicating, setting up good social networks and breaking taboo we have the power to regain control in a period of flux. Setting good routines and habits during the perimenopaue paves the path for healthy ageing into older age, preventing some of the risk factors women are predisposed to as we enter our menopause

• The science in the area of the hot flashes remains unclear, but it is possible that exercise can help with this symptom by reducing overall stress and cortisol levels.

• Yoga incorporates breathing practices, promoting relaxation. Yoga takes many various forms and speaking to a local instructor might be a good place to begin if you're considering giving yoga a go! It's great for strengthening the body, promoting mobility and restoring balance.

Bibliography

• Chapra S et al. 2019. Weight management for perimenopausal women. Journal of Mid life health 10 (4) pp. 165-172.

• Dabrowska-Galas & Drosdzol Cop, 2022. The relationship between postmenoapusal women's Self Esteem and Physical Activity Level- A survey study from Poland. International journal of environmental research and health. 19.

• IINH Smart Eating for Perimenopause: A Nutrition and Lifestyle Guide.

• International Menopause Society www.imsociety.org

• Irish Heart Foundation www.irishheart.ie

• Nancy E et. al, 2014. A Pilot Study of Integral Yoga for Menopausal Hot Flashes. Menopause 21(8) pp. 846-854. International Menopause Society .

• Researching the value of sport in Ireland. 2021.

• Suss H, Elhert U. 2020. Psychological Resilience during the perimenopause. Maturitas Vol 131. Pp. 48-56.

• Suss H et al. 2021. Psychological factors affecting resilience during the menopausal transition. Archives of Women's Health. Vo. 24 pp. 231-241.