Perimenopause is the time of a woman’s life, usually in her 40s to early 50s, when her hormones are adapting as she transitions to menopause (the cessation of periods). During this stage, many women experience a myriad of bothersome symptoms with around 90% of women seeking out their healthcare provider at some point on how best to cope.
There are many symptoms, such as irregular periods, hot flushes, sleep problems, depression and anxiety, that are commonly associated but some symptoms cause more concern than others. Within my clinic, weight gain and tiredness are probably the most common reasons why women in their 40s book an appointment with me.
So let’s take a deeper look at some of the common symptoms associated with perimenopause so that you can be prepared and know what might be contributing.
75% women will experience hot flushes, sometimes called hot flashes or vasomotor symptoms. It’s a feeling of intense heat lasting around 4 minutes but could be much shorter or longer. You might experience this once a week or several times per hour.
So what’s going on, why does this happen?
In truth, it’s still relatively unknown but it’s possible that it’s due to a ’touchy thermostat’. In our brain, the hypothalamus regulates our reaction to temperature changes. During perimenopause, it’s thought that the hypothalamus becomes more sensitive, narrowing the range of temperature that it considers normal. Previously, your hypothalamus accepted and coped well with small temperature changes like drinking hot tea, stepping indoors but in perimenopause, the tiniest shift in temperature results in the hypothalamus trying to adjust overall body temperatures. Why? It seems that rise and fall of the fluctuating oestrogen levels directly affects the thermostat in the hypothalamus. We also know that the more stressed you are, the more likely you are to flush as oestrogen alters the levels of serotonin and adrenaline, which also affect the hypothalamus and body temperature.
A common complaint from women as they near menopause is increasing difficulty falling asleep, or waking during the night. The lack of sleep will lead to general tiredness, and even elevating other symptoms like brain fog, stress and food cravings.
So what’s going on?
Progesterone helps facilitate sleep as it is a calming hormone and helps to lower anxiety. During perimenopause, progesterone is one of the first hormones to decline and so your body needs time to adjust. With the occurrence of hot flushes or night sweats you may also be woken throughout the night. During the hot flush, your adrenaline levels will rise which is a similar response as to that which happens when you are stressed ‘a flight or fight’ scenario, providing you with a sudden burst of energy. It’s pretty difficult to get back to sleep after this happens.
Other factors like stress, medications, drinking alcohol and other stimulants can also disrupt your sleep cycle and quality.
Brain fog and other memory problems is often quoted as being in the top three most common symptoms of perimenopause that affects the ability to work and function properly. It’s that feeling of a cloudy brain, forgetfulness, difficulty with words or concentration. It can be challenging for any woman working in high-powered jobs but it can also affect simple tasks like reading and listening.
So what’s going on to cause memory problems?
Oestrogen plays a role in the normal function of the parts of the brain used for memory and executive function as well as in the provision of energy needed for brain activity. Oestrogen is known to be neuroprotective, especially in women. With falling levels of oestrogen, there can be a temporary 25% reduction in brain energy, leading to memory loss and brain fog, and acting as a tipping point to dementia risk.
As well as the effects of fluctuating oestrogen, perimenopause is a time of declining progesterone levels. Progesterone protects the brain from damage and promotes repair. When progesterone is balanced, the brain is calmer and so the changing levels may contribute to memory loss too.
Other factors like stress, cortisol levels, sleep quality and thyroid and liver problems may also be contributing to the brain fog.
Many women find that they steadily gain weight during their 40s and into their 50s without really changing the way they eat or exercise. They often find that strategies that they’ve used before to lose weight no longer work. Many of my clients have tried various diets in the past without seeing the results they want.
So what’s happening during perimenopause to lead to weight gain?
Once again, oestrogen plays a part! One of the roles of oestrogen in your body is to regulate metabolism and muscle mass, and so as oestrogen levels drop as you head towards menopause, your metabolism naturally slows. That’s why you might experience weight gain when you haven’t changed your food or exercise. We also know that there are oestrogen receptors in our fat stores that are affected, making it more difficult to release excess fat. Combine this with other contributing factors, like increasing insulin sensitivity and stress, it’s understandable why your body struggles with weight gain during perimenopause.
To learn more about other contributing factors to perimenopausal weight gain, check out my free ebook ‘Why Losing Weight is Even More of a Struggle in your 40s’
Body aches and pains
A study found that women going through the menopause transition were nearly twice as likely to have chronic pain, like fibromyalgia, migraine and back pain. Common areas of pain include back pain, joint pain , headaches and breast tenderness.
Whilst it’s not fully understood, it’s likely that oestrogen and other hormones affect pain sensitivity so with changing levels it seems that women may be more susceptible to new pain or flare ups of old pain. Oestrogen protects joints and reduces inflammation. Increased weight, sleep disturbance and depression may also contribute through lack of movement and a reduction in pain tolerance.
Perimenopause is a natural stage in a woman’s life that is commonly marked by a variety of bothersome symptoms. Whilst the fluctuating and declining levels of reproductive hormones are likely contributing, especially oestrogen, it seems that the severity of the symptoms are also affected by factors that may well be modified. Managing stress, through mindfulness, relaxation or meditation practices, getting regular gentle exercise, like walking or yoga, quitting alcohol and eating plenty of cruciferous vegetables to help eliminate high oestrogen levels may help manage a number of these symptoms.
Is weight gain your main concern?
Find out more about why you might be struggling to lose weight, including the link between stress, poor sleep and weight gain, by downloading my FREE ebook here
Santoro N. Perimenopause: From Research to Practice. J Womens Health (Larchmt). 2016 Apr;25(4):332-9. doi: 10.1089/jwh.2015.5556. Epub 2015 Dec 10. PMID: 26653408; PMCID: PMC4834516.
Briden L, Health Master’s Live: Hormone Health for over 35