Recognising the signs of perimenopause

Perimenopause isn’t something I knew anything about until I was in the thick of it. I was almost 50 and had just walked away from my career of over 20 years as I didn’t think I knew how to do my job anymore.

I’d been off for a while following my mum having a stroke. When I went back to work, everything had changed. It was the start of 2021 and we were still in the midst of Covid-19. Unfortunately, I didn’t receive the support I needed to get me back up to speed and I felt like I had no idea how to do my job.

I worked as a legal adviser in a courtroom. It was a stressful job at the best of times. But due to adoption leave and sick leave, at the start of 2021, I’d been away from work for 18 of the previous 24 months. Things had changed so much because of Covid. Despite having over twenty years of courtroom experience, I was left feeling like I was completely incompetent.

Panic attacks

I felt like I was on the verge of a panic attack most of the time and would come out of court ringing with sweat. I’d start to give advice in court and my mind would go completely blank. I thought all of this was because I’d lost my confidence due to the amount of time I’d been off.

It was clear I wasn’t going to get the support I needed from management, and was actually told that the trainees (who were 20+ years younger than me) were being given priority for support over me. I felt completely useless and that I couldn’t do my job anymore.

So, with nothing other than the beginnings of a writing business, I handed my notice in and left my job. I felt like I had no choice. I was becoming ill because I felt that I wasn’t capable of doing my job. So I left.

I knew things wouldn’t be a bed of roses straight away, but I felt a huge sense of relief at not having to go back into that environment. I had some work and was confident I’d soon have more.

Noticing menopause symptoms

I was sitting at my desk writing one day a few weeks later when the penny dropped. I was feeling relaxed and enjoying my work when I felt a warm feeling start in the pit of my stomach. It gradually moved up my body, front and back until it got to my neck. I felt like I’d been hit by a bus. I cried my heart out for the next 30 minutes or so and had absolutely no idea why. Then, as quickly as it came on, it passed.

After a frantic search on Google, I realised I’d had a hot flush. And then I realised that is what I’d been experiencing at work. And that a lot of how I’d been feeling over the last few years were probably perimenopause symptoms.

What is perimenopause and menopause?

Perimenopause is the time leading up to your periods stopping. Not everyone will experience symptoms during this time, but a lot of people do. These range from being mild to affecting daily life and can start many years before your periods stop. I think I was 45 when I first started experiencing them. I was 49 when I connected the dots.

You reach menopause when you haven’t had a period for 12 months. Symptoms can start many years before you reach menopause and continue afterwards.

The main symptoms of perimenopause

• anxiety
• changes in mood – such as low mood or irritability
• changes in skin conditions, including dryness or increase in oiliness and onset of adult acne
• difficulty sleeping – this may make you feel tired and irritable during the day
• discomfort during sex
• feelings of loss of self
• hair loss or thinning
• headaches or migraines
• hot flushes – short, sudden feelings of heat, usually in the face, neck and chest, which can make your skin red and sweaty
• increase in facial hair
• joint stiffness, aches and pains
• loss of self-confidence
• night sweats – hot flushes that occur at night
• palpitations – heartbeats that suddenly become more noticeable
• problems with memory, concentration and ‘brain fog’
• recurrent urinary tract infections (UTIs), such as cystitis
• reduced sex drive (libido)
• tinnitus
• vaginal dryness and pain

For me, anxiety, hot flushes and brain fog were the worst. But because there was a lot going on in my life during that time (bereavement, becoming a parent again, a global pandemic) I just assumed that everything I was feeling was down to that. Some of it will have been. But I’m pretty sure that the vast majority of the symptoms were due to perimenopause.

I didn’t go to my GP straight away because I wanted to monitor things. Over the next few months, I experienced crippling anxiety for about five days before my period, for a few days after it started until a few days after it stopped. I was getting about a week of feeling ok before the cycle started again.

Talking about menopause

Menopause is still a subject that isn’t talked about enough. Things are getting better and many large companies and Government departments have menopause policies. But they’re only any good if staff and in particular, managers, are aware of them.

The Government department I worked for has one. But I didn’t know that at the time. It’s something that all women should have been made aware of, regardless of their age.

It’s something I’m going to talk to my girls about when they’re older. I didn’t have any conversations with my mum about it either as a teen or adult. Make sure you educate yourself about the symptoms, whatever your age. A lot are common to everyday life. But if you start to experience one or two of them, it’s worth going to speak to your GP.

There isn’t a single test you can take so your GP will take into account things like your menstrual cycle, your age, your symptoms and their severity and regularity. Blood tests won’t conclusively say whether you’re perimenopausal as your hormone rates fluctuate throughout the month.

My GP was lovely. I was convinced she’d say everything I was experiencing was just life and that I should just get on with it. She didn’t. She listened and said that everything pointed to perimenopause.

Treatment for perimenopause and menopause

A lot will depend on your symptoms and the impact they are having on your daily life. Some people find natural remedies, exercise and a change in their diet keep their symptoms at bay.

The most common medication is Hormone Replacement Therapy (HRT). This involves taking oestrogen because your body stops making as much when you experience peri and menopause. If you have a womb, this must be taken with progesterone to protect the womb lining from the effects of taking oestrogen.

The form it takes varies. I have patches which I replace twice a week. I have two weeks of oestrogen and then two weeks of progesterone patches. They are worn below your waste, stuck to your skin. I find mine work best on my bum cheek or the side of my hip. Depending on your history, you may be prescribed HRT in tablet form or in a coil. Sometimes, people have a combination.

It takes about a month for HRT to start to work, but it can be very effective in controlling symptoms such as hot flushes, brain fog, joint pains, mood swings and vaginal dryness. I honestly felt like a new women once my patches started to work. It wasn’t until they did that I realised how bad my symptoms had been.

HRT pre-payment certificate

As with all medication, there is a risk. But generally HRT is an extremely safe treatment for menopause. The cost of receiving it has recently reduced thanks to the introduction of the HRT pre-payment certificate. It costs £19.30 and covers most HRT for a year. That’s a big saving as each of my prescriptions count as two because they contain two different hormones.

Other treatments include anti-depressants, blood pressure or epilepsy medicines, oestrogen tablets or gel (with HRT), cognitive behavioural therapy and testosterone gel. Eating calcium-rich foods such as kale and yoghurts helps to keep your bones healthy.

So, if you think you might be experiencing perimenopause symptoms, make an appointment with your GP. They’ll take through all of your treatment options including the risks and benefits of each one.

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