What do you know about perimenopause?

Symptoms of perimenopause

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Every woman goes through menopause but not all women will experience the symptoms associated with perimenopause. We get these symptoms because of the change in hormone levels in our body, especially oestrogen and progesterone.

These are some of the more common perimenopausal symptoms:

hot flushes
night sweats
dry skin
body aches
sore breasts
loss of libido
vaginal dryness
difficulty sleeping
mood changes
memory issues

Associate Professor Ang Seng Bin, Head and Senior Consultant, Menopause Unit and Senior Consultant, Family Medicine Service, KK Women’s and Children’s Hospital, says that the most common symptom involves your cycle.

“The most common symptom of perimenopause is changes to the menses; this may lead to shortened or lengthened cycles,” he explains. “This means if one used to have regular 28-day cycles, one may experience shortened cycles like 21 days or lengthened cycles like 60 days.

“Hot flushes, which is a transient sensation of extreme heat, may also occur in some women. When hot flushes occur at night, it can also cause disturbances to sleep and affect the woman's quality of life,” he adds.

Associate Professor Ang reveals that, for Asian women, other than the usual hot flushes, what appears to be common is body aches and joint pains. Unfortunately, there's nothing in our personal or health history – such as whether or not you have children, or what menopause was like for your mother – that could tell us what perimenopause will be like for us, he adds.

Dealing with this important transition

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The doctor says that while most symptoms are usually tolerable, “there are women who find them extremely troublesome”. Such women will benefit from consulting a doctor for a proper evaluation to exclude other medical conditions that can mimic perimenopausal symptoms such as thyroid disease.

He also suggests adopting lifestyle changes first, like getting regular sleep hours with good sleep hygiene, as well as maintaining a healthy body mass index of 23 and below through healthy eating and regular exercise.

“For those who have tried the above but are still having issues, or those who start menopause at age 45 years and below, they may benefit from menopausal hormone therapy if there are no medical reasons to avoid it,” he adds.

Associate Professor Ang also cautions against taking any over-the-counter or home remedies as there haven't been any good long-term studies for them.

“Placebo effect is high, at close to 50 per cent,” he says. “Women should consult their doctor before they take over-the-counter medications. If the remedies work, they should not exceed the consumption for more than six months as there could be potential long-term risks which have not been evaluated.”

Being prepared for this change

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Julie said that perimenopause is something new to her as none of her older female relatives have mentioned it to her. And what she has experienced so far is making her a bit nervous about what comes next.

“Of course I expected menopause to be a gradual change, not just your period stopping overnight, but now with these symptoms, I'm a bit more worried about menopause. Like, it's so uncomfortable now, will it be worse?” she shares.

She consulted her gynae who said it's all part and parcel of menopause and urged her to exercise more to get better sleep and keep her weight down. No hormone therapy was discussed, as Julie is not open to it yet. She does take the occasional Panadol for headaches and melatonin for insomnia, plus birds nest soup as she was told it would help ease her symptoms.

Natalie acknowledges that she also didn't know much about perimenopause before it happened to her nor does she know a lot more about it now. She doesn't think that “knowing much would solve any of my symptoms so just go with the flow, or lack of”. While she doesn't have any mental or emotional issues about going through it, she admits “it's the physical aspect that is very challenging”.

She has been taking evening primrose oil, which she understands is meant to relieve her symptoms but hasn't felt much of a difference so far. However, she does wonder if her symptoms would be worse if she wasn't taking it.

Sonia has an older sister who went through menopause a few years ago so had some prior knowledge of it. “I haven't had hot flashes even though my sister had them,” she tells us. “And I've got used to not worrying about when my period will come as it's so unpredictable now. But what does annoy me is that I keep waking up most nights and not sleeping through the night really affects my day. I also get a bit stressed lying in bed at 4am wondering when I'm going to get back to sleep.”

*not her real name