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An introduction to perimenopause

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As women, we know our fertility span is finite. It begins just before our first period and will end sometime in our early 50s (on average) with menopause. But just as our first periods took a while to settle into a regular rhythm, our final ones will take a while (sometimes up to 10 years) to bow out. Living Well’s Vanessa Young looks into this perimenopause phase of life.

Some women can start noticing changes in their menstrual cycle (often a shorter cycle and heavier periods), along with other symptoms such as hot flushes, mood swings, sore breasts and weight gain as early as in their late 30s or early 40s.

Dr Beverley Lawton, Director of the Women’s Health Research Centre at Otago University in Wellington, says these changes are a natural part of perimenopause – the period around menopause.

“The average age of menopause is 51 but women can experience symptoms five to 10 years either side of this – 80 per cent of women will have hot flushes, mood swings and irregular periods. It’s a roller coaster for some women.”

She says if these symptoms are affecting a women’s quality of life, she should talk with her GP. “For the 20 per cent of women with moderate to severe symptoms, one option is hormone replacement therapy (HRT), where a woman takes oestrogen to alleviate symptoms. Women with a uterus also need to take a progesterone-like therapy to protect the uterus.”


HRT copped a lot of bad press in 2002 when a study was terminated early because of an increased incidence of breast cancer in the women taking the hormones.

“When women think of HRT they remember the 2002 study but they don’t remember that the study was looking at the long-term benefits of HRT for chronic disease in much older women. It was not looking at menopausal symptoms. The average age of the women in the study was 63."

Dr Lawton says women having moderate to severe hot flushes and night sweats need to weigh up the benefits and risks. “Women taking HRT have a small, increased risk of blood clotting and stroke. For women with a uterus, after five years of taking both oestrogen and progesterone there appears to be an increased risk of breast cancer. But usually women only need to be on HRT for 18 months to two years, and then can slowly come off. Each woman has to weigh up the benefits and risks for herself with advice from her doctor.”

Nicole’s experience

Nicole was 38 with two young children when she noticed she was starting to feel premenstrual all the time. Her breasts were sore, her stomach bloated and her skin would break out. But the worst part was the way it affected her mood.

“I felt as though I was living under a black cloud. I was unmotivated, very forgetful, insecure and anxious. And I would get irritated at the smallest things. Blood tests led to a diagnosis of perimenopause.”

In addition to the physical symptoms, entering perimenopause can make women feel very alone.

Nicole says, “You don’t think you’re going to get these changes when you have young kids. Mine were aged five and 10 and I thought the kids would be in a different phase when I hit this one. I didn’t feel emotionally ready to let go of my periods.”

Nicole found relief for her hot flushes from a herbal formula containing Vitex (Chasteberry) which may increase progesterone and melatonin and can help support sleep as well as the other symptoms. She also takes vitamin D throughout the winter. Now 42, Nicole said she noticed an improvement straight away.

Eva’s experience

Eva was 41 when her periods became irregular and she developed hot flushes. She also began waking every two hours throughout the night, unable to go back to sleep. “I felt like a zombie for years. Like I was living in a fog all day.”

For Eva, HRT was the only solution. “For three or four years I tried all sorts of natural things – I even self medicated with herbs – but in the end the HRT dealt to my hot flushes.”

care + advice from a Pharmacist

Monterrey Wigglesworth, Pharmacist at Unichem Torbay Pharmacy, says ground linseed and good bowel health can all make a difference to symptoms, as can reducing coffee and alcohol. Magnesium and B vitamins help too. And if a woman is experiencing hot flushes either right before her period or mid-cycle, then a progesterone prescription either from her doctor or through pharmacies can be really effective.

Monterrey suggests using supplements, diet and herbs to encourage ovulation (which then produces progesterone) and also help the body process and excrete excess oestrogen. She says progesterone balances out the other hormones. It also helps deep sleep and can reduce hot flushes. “We used to think women in their forties were experiencing a drop in oestrogen, but this hormone is in fact going haywire (on average 30% higher).”

Black cohosh may assist in balancing out oestrogen and Monterrey adds, “When we’ve pushed ourselves hard, run families and careers, we can burn up our adrenal energy reserves, which can mean our adrenal glands are less able to continue their oestrogen production role post-menopause, when the body most needs them to. Adrenal-feeding herbs such as Rehmannia, Rhodiola and Withania will support women right through into their 50s.”