#askdrkris - Perimenopause

ASK DR KRIS..

PERIMENOPAUSE - LIKE A BOX OF CHOCOLATES…

 Well heck Ladies, like I said in the video that was an awful lot of questions!!  It seems perimenopause is not a well understood - nor well liked - condition. Not by women and perhaps even not by Health Professionals.  

There is so much b*llsh*t doing the rounds of social media these days so let's jump in with the facts.  I'm going to give you some basics regarding perimenopause and then we’ll answer more specific questions in some future posts.. because it's certainly gonna take more than one bite to eat this elephant!!

Remember.. these are general answers only.. it's not a specific answer to anyone's  health issues.. we just want to give you more information to go chat with your existing health professionals.. and please, please discuss with your doctor before changing any medication or management plan you may already be on.

Let's start with something important, folks - Perimenopause is NOT a medical condition that needs to be “fixed”. It's a natural biological transition in a woman's life - one that has been historically overlooked, under researched, and generally misunderstood by just about everyone.

The questions we received tell me many women are experiencing changes in their minds and bodies that have left them wondering “what on earth is happening to me?!” Irritable, bursting into tears over TV commercials, waking up drenched in sweat at 3am.. you're not imagining it, you're not going crazy.. and you're definitely not alone.

 My last count has the number of symptoms associated with perimenopause at 147.. and to misquote the words of Forrest Gump.. Perimenopause is like a box of chocolates.. you never know what you're gonna get until you suck it and see! (mixing metaphors there, yep, I know). 

So let's have a look at some basics..

What exactly is Perimenopause?

Menopause is what happens when women stop having a cycle.  But this doesn't just happen overnight.. it's not a switch that gets turned off. Nope, we have the “pleasure” of up to 10, possibly even 15, years of perimenopause..

During this time the hormones in the female body start to reduce.. but not in a nice even reduction.  Nope, it's usually an erratic, uneven reduction over the years. And it's this reduction in hormones that is responsible for many of the symptoms we see in perimenopause.. some of the symptoms caused simply by a drop in hormones.. some symptoms caused by the erratic nature of the hormones.

At its core, perimenopause is characterized by significant hormonal fluctuations, primarily involving estrogen and progesterone. Unlike the relatively predictable hormonal patterns of reproductive years, perimenopause brings erratic hormone production. Estrogen levels may surge dramatically before eventually declining, while progesterone production gradually decreases. This hormonal up and down is responsible for the wide array of physical, emotional, and cognitive symptoms that women may experience.

There are 3 main groups of symptoms in perimenopause 

1. Changes in the menstrual cycle.. The ovaries, which have been releasing eggs on a monthly basis since puberty, begin functioning less predictably during perimenopause. Some months an egg may be released, while other months ovulation may not occur at all. This irregularity directly affects menstrual cycles, which may become shorter, longer, heavier, lighter, or skip entirely. For many women, these changing menstrual patterns are the first noticeable sign of perimenopause. 

Beyond menstrual changes, the fluctuating hormones impact virtually every system in the body.

2. The vasomotor system responds with hot flashes and night sweats, 

3. Mood changes.. changing hormones also affect the central nervous system and may manifest changes in mood, memory, and cognitive function.  Some of these changes are cyclical.. some of them last the whole month, every month.

 In addition to these three primary groups there are many other impacts.. Sexual and urinary health are affected through vaginal dryness and urinary urgency.  Sleep architecture alters, leading to insomnia and disrupted sleep patterns. Even metabolism shifts, often resulting in changes to body composition and weight distribution.

What makes perimenopause particularly challenging is its unpredictable nature. Women may experience symptoms that come and go, vary in intensity, or change entirely over time. Some women navigate this transition with minimal disruption, while others face significant impacts on their quality of life, relationships, work performance, and overall wellbeing.

And all this comes at a time when women are managing multiple other life stressors. Many women find themselves simultaneously managing career demands, family responsibilities, aging parents, and their own evolving health needs at the same time.

So, in this the first post, let's deal with the basics… 

1. Perimenopause can start anytime from your mid to late 30’s.. it's unlikely you are going through early menopause (although there are always one or two who do). You may just have some early hormone changes.

2. These changes are, in the most part, totally normal.. functional even. Some women even describe improvements in periods and mood!  Some women don't even get a hot flush.. ever!!

3. In general these symptoms do not require medical attention if they are manageable and mild.. but in a future post I'll give you some simple ideas for managing the milder symptoms.  

The times you do need to see a doctor?

1. If you haven't finished (or started) having children yet. Please make an appt to see your GP.. or a doctor who specialises in women's health or fertility. We know that rates of fertility start to drop after 35 and, while it's unlikely your symptoms are going to cause problems it's worth making sure everything is okay.. and these days there is a lot to offer to assist with pregnancy if your hormones are beginning to drop.

2. If your mood changes are really severe or affecting your quality of life.  You don't need to put up with that. Doctors, Counsellors, Natural options all have a lot they can offer to help with your mood and enjoyment of life.

 3. If anything is impacting on your way of life.. hot flushes, vaginal dryness, loss of libido, bladder issues - like mood changes, you don't have to put up with them.. or any other symptoms causing you grief or discomfort. We have medical options, natural options, functional options (physiotherapy, behavioural changes) - there is a full range of help and ideas available from a variety of sources.

 I guess that's a point itself - the answers to perimenopause are not just medical. We're not going to give you a pat on the back and a script for artificial hormones (and if someone does try that.. get out.. find someone else who will be in your corner!!). Perimenopause is a team game with you as coach, centre and star player. Search around.. find what does suit you.. what fits your preference.. what gives you relief.

 Somewhere in there a woman will go through menopause. And in true female fashion, the diagnosis of menopause is not cut and dried - we can't actually diagnose that you've gone through menopause until you haven't had a period for 12 months.  Only then can we tell you that you became “menopausal” 12 months ago!  

 But does it matter? And does it end at Menopause?  Well, no.. Because peri means around menopause.. or both sides of menopause. You can still have symptoms continuing after menopause and management is effectively the same - keeping the symptoms under control to provide quality of life through a variety of different options.

 Do you need blood tests? Well, that's a postal by itself as well isn't it!! But the short answer is, in the majority, perimenopause and menopause can be managed by adjusting therapies and treatments based on how you feel and how your body responds. Hormone levels fluctuate widely between individuals and through out the cycle - they offer little unless symptoms are severe and not responding.

 Above all perimenopause is normal and, most of the time, easily managed. But if you have anything you're concerned about see your Doctor.  It's very easy for us to ensure there's nothing nasty happening and help you work out the right path to managing the symptoms and improving quality of life.  

 Hope this helps. But I bet it just generated heaps more questions. Go DM us via the Facebook story or send us an email - aislinn@bostonbaycollective.com.au.. we’ll cue them for future posts..  and please, please read the disclaimer below (again 😎)

Dr Kris xx

 DISCLAIMER

 We've been planning to write some health discussions for a while now. There's a need for good, unbiased information that shows both/all sides of the story - but that's just what this is.. information. Please don't think it's medical advice. Please do not stop any medications or change your treatment plan without discussing it with your own doctor first. We are just helping you find the right questions to ask to get greater control and understanding of your own health and wellbeing.  Please feel free to ask us anything of a general nature - we’ll endeavour to get a post up on that topic.. whatever you want to know, we're pretty sure there's 100 others want to know it also! But we can not answer specific personal questions for you and we can not give you specific medical advice.. that's for your own doctor.

 Please be aware that any negative or argumentative comments will be removed. We are aware that some people have totally opposite views to what we discuss here.  Everyone has their own opinions - heck we've seen that emerge in bucket loads since the pandemic.  This is simply a general education chat where we present a broad brush picture - you are free to research further as much as you like.

AND..

Just in case you didn't believe me.. here's the 147 list!! As you can see some of these symptoms maybe related to other conditions that do require medical advice or treatment. If worried please see your GP.

1. Irregular periods (changing frequency)

2. Heavier periods

3. Lighter periods

4. Shorter menstrual cycles

5. Longer menstrual cycles

6. Skipped periods

7. Hot flashes

8. Night sweats

9. Cold flashes

10. Insomnia

11. Difficulty falling asleep

12. Difficulty staying asleep

13. Early morning waking

14. Fatigue

15. Exhaustion

16. Mood swings

17. Irritability

18. Anxiety

19. Depression

20. Panic attacks

21. Rage or anger outbursts

22. Tearfulness

23. Vaginal dryness

24. Painful intercourse (dyspareunia)

25. Decreased libido

26. Increased libido (in some women)

27. Vaginal atrophy

28. Vaginal itching

29. Urinary urgency

30. Urinary frequency

31. Urinary incontinence

32. Recurrent urinary tract infections

33. Memory lapses

34. Difficulty concentrating

35. Brain fog

36. Word-finding difficulties

37. Difficulty multitasking

38. Headaches

39. Migraines

40. Breast tenderness

41. Breast swelling

42. Changes in breast tissue

43. Heart palpitations

44. Rapid heartbeat

45. Joint pain

46. Muscle aches

47. Muscle tension

48. Muscle twitches

49. Weight gain

50. Increased abdominal fat

51. Bloating

52. Water retention

53. Digestive issues

54. Constipation

55. Diarrhea

56. Gas and flatulence

57. Nausea

58. Acid reflux

59. Food intolerances (new or increased)

60. Changes in appetite

61. Food cravings

62. Hair thinning

63. Hair loss

64. Facial hair growth

65. Body hair changes

66. Dry skin

67. Itchy skin

68. Crawling skin sensation (formication)

69. Flushed skin

70. Acne

71. Skin tags

72. Hyperpigmentation

73. Loss of skin elasticity

74. Brittle nails

75. Ridged nails

76. Dry eyes

77. Blurry vision

78. Light sensitivity

79. Floaters in vision

80. Dry mouth

81. Burning mouth syndrome

82. Metallic taste

83. Altered taste perception

84. Changes in body odor

85. Increased sweating

86. Night-time teeth grinding (bruxism)

87. Temporomandibular joint (TMJ) pain

88. Gum sensitivity

89. Tooth sensitivity

90. Tinnitus (ringing in ears)

91. Dizziness

92. Vertigo

93. Electric shock sensations

94. Tingling extremities

95. Numbness in extremities

96. Restless legs syndrome

97. Foot pain

98. Increased allergies

99. New allergies

100. Postnasal drip

101. Sinus issues

102. Snoring (new or increased)

103. Throat discomfort

104. Voice changes

105. Difficulty swallowing

106. Increased susceptibility to illness

107. Slower recovery from illness

108. Decreased stress tolerance

109. Increased inflammation

110. Frequent infections

111. Autoimmune flare-ups

112. Body temperature fluctuations

113. Feeling of internal vibration

114. Burning sensations in body

115. Osteopenia or decreased bone density

116. Increased cholesterol levels

117. Changes in blood pressure

118. Changes in blood sugar regulation

119. Insulin resistance

120. Loss of confidence

121. Social anxiety

122. Reduced motivation

123. Loss of joy in previously enjoyed activities

124. Feelings of isolation

125. Changes in spatial awareness

126. Clumsiness

127. Decreased coordination

128. Changes in fingernail growth

129. Increased or new sensitivities to chemicals/fragrances

130. Increased environmental sensitivities

131. Changes in alcohol tolerance

132. Changes in medication effectiveness

133. Iron deficiency symptoms

134. Vitamin D deficiency symptoms

135. B vitamin deficiency symptoms

136. Thyroid function changes

137. Adrenal fatigue symptoms

138. Heavy limbs sensation

139. Unexplained weight fluctuations

140. Body aches similar to flu symptoms

141. Increased pain sensitivity

142. Decreased wound healing

143. Changes in dreams or dream intensity

144. Loss of mental sharpness

145. Changes in handwriting

146. Gait changes

147. Changes in breathing patterns