The start of symptoms of perimenopause can be difficult to identify as no two women have the same lifestyle or symptoms which can affect how she feels. While the first signs experienced can include mood changes, hot flashes ( hot flushes) , interrupted menstrual cycle or heavier periods many women put these down to tiredness and stress, or other health conditions.
In this article we're going to cover what happens with hormones before perimenopause, what changes during perimenopause, perimenopause symptoms, whether a perimenopause test is possible and the treatment options you have when your hormones start to become less reliable.
Your menstrual cycle before perimenopause
There are four key hormones involved in your menstrual cycle. Oestrogen ( estrogen) and progesterone are the hormones which help a woman to have a potential pregnancy each month by helping to support the menstrual cycle. Follicle stimulating hormone ( FSH ) and Luteinising hormone ( LH ) control oestrogen hormone levels and ovulation.
Follicle stimulating hormone
FSH is the hormone which stimulates the ovaries to produce oestrogen. It is secreted by the pituitary gland in a woman's brain, and switches FSH off when oestrogen levels are optimal. A surge of luteinising hormone ( LH )then follows.
Luteinising hormone stimulates ovulation - the release of an egg from one of the ovaries. The ovary produces progesterone and oestrogen which can support a pregnancy.
Progesterone and oestrogen
Follicle stimulating hormone and luteinising hormones decrease as progesterone and oestrogen levels increase. If pregnancy doesn't occur through the fertilisation of an egg, progesterone levels drop and the menstrual cycle starts again.
What is perimenopause?
Perimenopause is the stage directly before menopause and is when hormones produced by the ovaries start to fluctuate Perimenopause can last for years - the average age of perimenopause is 46 while menopause is 52. That's on average six years. During perimenopause a woman is still ovulating and having periods and is still able to get pregnant - though it is a lot less likely than when hormone levels were more stable.
What happens during perimenopause?
The ovaries start to make make fewer hormones which sets into motion symptoms of perimenopause which can be hard to recognise at first or put down to tiredness, stress and illness.
What are the most common perimenopause symptoms?
One of the most common perimenopause symptoms experienced by women at its onset are changes to their periods - missed periods, heavier periods, longer or shorter periods.
Other common symptoms are weight gain, mood swings, worsening PMT, disrupted sleep, an increase in period pain fatigue and cognitive decline which affects memory - forgetfulness. She can also experience hot flashes and vaginal dryness during perimenopause.
Some perimenopause symptoms carry on into menopause
Some menopause symptoms and perimenopause symptoms can overlap. When periods stop altogether and hormones continue to steadily decline during the menopause transition women can experience more symptoms
Vasomotor symptoms - hot flushes and night sweats. They can still experience weight gain, mood changes, depression and brain fog during menopause as well as many other symptoms like vaginal dryness.
Is a hormone blood test a reliable perimenopause test?
Because women hormones fluctuate for perimenopausal women a hormone blood test isn't reliable to diagnose it's onset. Your doctor or healthcare professional will be able to make a perimenopause diagnosis based on your age and menstrual history. They can also rule out any other causes or health conditions.
When are hormone blood tests used?
Doctors may use a hormone blood test if your period starts to become less reliable or stop before you're 45 or to decide which course of treatment or medications would be best for you.
Early menopause test
Early menopause or premature menopause is when periods stop before the age of 45 and is when a woman's ovaries stop making enough oestrogen to support menstruation. Early menopause brings with it an increased risk of osteoporosis and heart disease.
Thyroid function blood test
Some symptoms which can indicate problems with the thyroid are similar to perimenopause symptoms such as weight gain, tiredness, brain fog and low mood. Thyroid disfunction affects one in 20 people in the UK with women six times more likely to suffer from the condition than men.
Over the counter blood tests
Over the counter blood tests are available to test hormone levels though your doctor or healthcare practitioner may not accept the results from a third party. Some services include personalised comments on the blood test results from a qualified doctor.
- Thriva Womens Hormones Blood Test checks oestrogen, testosterone, LH and FSH levels and Thyroid Stimulating Hormone levels (for underachieve thyroid) and tests for menopause.
- Blue Horizon Menopause Matters blood test checks levels of FSH, LH, Oestradiol, Progesterone,Testosterone.
- Forthwithlife Blood Tests offer 14 Female Hormone tests including thyroid, fertility, perimenopause and menopause tests.
What can I do to relieve my perimenopause symptoms?
The good news is that the most common symptoms can be alleviated with a few treatment options which can make everyday life more comfortable. These include nutritional improvements, lifestyle changes and hormone therapy.
Hormone levels can be managed by your doctor by prescribing estrogen therapy, birth control pills, intrauterine devices such as the Mirena coil which is popular for controlling heavy bleeding or a skin patch. Hormone treatment can also help to manage your risk of chronic diseases such as cardiovascular disease.
Over the counter treatments are available to relieve vaginal dryness in the form of creams, pessaries and vaginal rings.
Top tips for a healthy perimenopause and menopause
When your hormones start fluctuating in perimenopause before steadily declining in menopause your body and the way it works changes. Life choices can have a big impact on managing your long term health risk as well as helping to alleviate symptoms and feel a lot better.
- Keep alcohol consumption to recommended guidelines. Alcohol consumption can make symptoms of mood swings and depression much worse and increase your weight and risk of breast cancer.
- Maintain a healthy weight. By keeping your waist circumference and weight within a healthy range you will decrease your risk of chronic diseases like type 2 diabetes. You don't handle sugar as well as you age which can contribute to weight gain. You can try using meal replacements to help get to a healthy weight
- Reduce saturated fat - this includes eating red meat which can increase cholesterol levels. Cholesterol levels naturally rise as you get older when your oestrogen levels stop breaking down as much fatty plaque which helps to keep your cholesterol levels low and decrease your risk of cardiovascular disease.Heart disease rises in women as they age.
- Reduce caffeine - caffeine has lots of good qualities and health benefits but how much you drink and when may need to be reviewed. Caffeine can trigger hot flashes and increase anxiety levels.
- Exercise regularly. Exercise is super important to help to manage weight, anxiety levels and mood - which can all increase during perimenopause and menopause. As you age you experience a natural decline in muscle mass and your body increases fat which tends to gather around your midsection instead of around your hips ad thighs. Abdominal fat should be kept to a minimum. When you have less muscle you burn less calories. Exercise should be a mix of vigorous exercise which increases your heart rate, strength exercises to build muscle and weight bearing exercises to build strong bones.
- Get enough Calcium and vitamin D - one in 2 women will break a bone in menopause due to osteoporosis so perimenopause stage is a great time to start building good foundations for stronger bones. As well as weight bearing exercise to build bone strength ensure you get enough calcium and vitamin D which are essential to help to prevent bone loss and fractures.
- Get enough sleep - Not getting enough sleep can have a really detrimental affect on your health - it's central to our wellbeing. Sleeps helps to repair our bodies, reduce inflammation and is crucial for brain health. Sleep also helps to control blood sugar levels and appetite hormones.
- Eat high fibre foods which include vegetables, whole grains, beans and legumes to support gut health and keep you regular. Your gut helps to regulate your hormone levels and a healthy digestive system gets rid of extra oestrogen via elimination. If you are not going to the toilet regularly this can result in oestrogen dominance which can make symptoms worse.
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The bottom line
When hormones start to decline, symptoms of perimenopause are often misunderstood or go misinterpreted by women. Perimenopause can start at different ages and because hormones like estrogen can fluctuate and a menstrual period cycle can be fine for a few months at a time.
Instead, your doctor can diagnose perimenopause using age, menstrual cycle and medical history to decide whether you are perimenopausal. Blood tests are generally used to look for other conditions like early menopause or thyroid function and to help with cancer treatment for hormone dependent cancers like breast and ovarian cancer.
You can get an insight into your hormone levels using an over the counter blood test which will measure things like follicle stimulating hormone levels ( fsh levels) estrogen and testosterone levels but your doctor or health practitioner may not accept results from a third party.