A GP unpacks the perimenopause treatments every woman should know about.

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We hear a lot about menopause, but what about perimenopause?

Perimenopause is the transitional time in a woman's life prior to menopause, when the supply of oocytes (eggs) in the ovaries is almost exhausted.

Some months, a woman may still ovulate and produce normal levels of oestrogen and progesterone, while other months, ovulation may not occur meaning levels of oestrogen and progesterone will be lower — this reduction in hormone levels is what causes the symptoms of perimenopause.

The information below provides an understanding of the most common perimenopause symptoms, plus an overview of perimenopause treatment options available.

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When does perimenopause start?

For most women, perimenopause occurs in their 40s, but it can start earlier or later.

On average, perimenopause lasts four to six years, but the duration could last anywhere between one and 10 years.

As for when perimenopause becomes menopause, women transition to menopause when it has been 12 months since their last menstrual period.

Common perimenopause symptoms.

There are a vast range of physical and emotional symptoms that women experience during perimenopause. These symptoms are different for every woman and may be mild, moderate or more severe in nature.

Perimenopause symptoms include:

• Temperature changes, such as hot flushes or night sweats

• Periods may become irregular, lighter or heavier in nature, or become more painful

• Disturbed sleep or insomnia

• Muscle and/or joint aches and pains

• Heart palpitations

• Cognitive effects such as brain fog or difficulty with memory

• Loss of libido and reduced sexual arousal

• Vaginal dryness causing itch and painful sex

• Anxiety, impatience, rage and mood disturbance

• Fatigue and loss of motivation

• Urinary changes such as urinary frequency or hesitancy and urinary tract infections

• Weight gain, particularly centrally to the breasts, abdomen and hips

• New onset headaches or dizziness

• Dry and itchy skin

• Gut issues including heartburn or bowel habit change

A good checklist that you can fill in and take to your doctor can be found on the Jean Hailes website.

When should I seek professional help for perimenopause symptoms?

If you are experiencing symptoms of perimenopause, particularly if they are impacting on your quality of life, then you should make an appointment with your GP for a review and to discuss treatment options (see below).

There is also the option to see a doctor (either a GP, gynaecologist or endocrinologist) with a special interest in perimenopause and menopause management. The Australian Menopause Society has a list of practitioners if you need help locating a doctor in your area.

How will I know if I am perimenopausal?

There are no tests needed for a diagnosis of perimenopause, but a diagnosis can be made with an assessment of symptoms alone.

A thorough assessment of symptoms is important, as there are some conditions that may mimic perimenopause, including thyroid disorders and iron deficiency as well as uterine fibroids or endometrial hyperplasia.

Therefore, if there is uncertainty about whether perimenopause is the cause of your symptoms, your doctor may choose to send you for bloods tests or a pelvic ultrasound to help with a diagnosis.

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What are the treatment options for perimenopause?

There are many treatment options available for women during perimenopause; it is important to discuss the options with your doctor to ensure you have the management plan that is right for you and your individual needs.

Treatment options can be broken down into lifestyle measures, allied health support, non-hormonal medications and hormonal medications.

1. Lifestyle measures.

It is important to remain active during this time of transition, with regular cardiovascular and weight based exercise each week. Research shows that yoga is also beneficial for improving the musculoskeletal and psychological effects of perimenopause.

A Mediterranean style diet has benefits for reducing the risk of heart attack and stroke, as well as providing adequate amounts of protein and nutrients that we need during perimenopause.

Smoking and drinking alcohol can exacerbate the symptoms of perimenopause, as well as have harmful effects on our health. It is recommended to quit smoking and reduce alcohol consumption - speak to your doctor if you need help with these measures.

Adequate sleep and reducing stress can also ease the symptoms of perimenopause, so working with your doctor or psychologist can be useful to ensure you get a good night's sleep and have support in reducing your stress levels.

2. Allied health support.

Some women benefit from the support and advice of a dietitian or exercise physiologist to tailor their diet and exercise program to their perimenopause needs.

If you are having urinary symptoms, symptoms of a pelvic organ prolapse, bowel symptoms or pain on intercourse, then seeing a women's health physiotherapist can provide you with some much-needed relief.

Cognitive behavioural therapy with a psychologist or through online modules has also been shown to help with anxiety and mood symptoms, as well as providing coping strategies for the physical changes during perimenopause. Hypnosis and acupuncture can also be beneficial.

3. Non-hormonal medication.

Non-hormonal medications can be used to treat hot flushes, sweats, mood symptoms and sleep disturbance. They are an excellent option for women who may not be able to have hormone therapy due to past or present medical concerns.

4. Hormone therapy.

Women with perimenopause symptoms may opt for hormone therapy with oestrogen and progesterone (and sometimes testosterone) and there are various options for the delivery of this medication including patches, gels, intrauterine devices and oral medication.

It is decreasing levels of oestrogen that cause the majority of symptoms in perimenopause, therefore it is oestrogen therapy that helps ease symptoms including hot flushes, night sweats and vaginal dryness.

Progesterone is used in women who still have a uterus to prevent the lining of the uterus becoming thickened in response to oestrogen therapy. A thickened lining can cause abnormal vaginal bleeding as well as an increased risk of endometrial cancer – therefore progesterone therapy is a must if you are commencing oestrogen therapy and still have a uterus.

Progesterone therapy may also have positive effects including improving sleep and mood, as well as managing irregular and heavy periods. Testosterone is used to assist with reduced sexual arousal that many women experience during perimenopause.

Finally, even though your periods may be irregular and you feel like your body is changing, there is still a possibility that you can get pregnant during perimenopause.

Not all hormonal therapy options are effective as contraception, so if you do need contraception during this time make sure you mention this to your doctor so that options for this can be discussed as part of your plan.

Download the perimenopause fact sheet here.

For more resources, check out the Australian Menopause Society fact sheets and Jean Hailes fact sheets.

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