From clever period tracking (opens in new tab) apps, to HRT treatment now being available over the counter (opens in new tab), to working to better understand things like PMDD symptoms, we’ve come a long way when it comes to a frank discussion about women’s hormonal health. But there are some areas that are still little discussed, despite affecting almost all women – and perimenopause is one of them.
By 2025, over 1 billion women around the world will have experienced perimenopause, yet too often, the menopause is still a place of shame and woefully misunderstood. According to the Menopause and the Workplace report by the Fawcett Society and Channel 4 (opens in new tab), which was published in April this year – and polled 4,000 women aged 45-55 – almost half of the women haven’t approached their GPs about the menopause and three in ten of those who have experienced delays in diagnosis. While data from Health and Her (opens in new tab) has revealed that one in 10 women have suicidal thoughts (opens in new tab) and 86 per cent suffer mental health issues (opens in new tab) as a direct result of perimenopause.
So, what exactly is perimenopause, and how do you know if you’re experiencing symptoms?
Davina McCall’s menopause
Thanks to Davina McCall (opens in new tab) and her ground-breaking 2021 documentary, Sex, Myths and the Menopause, menopause is beginning to move out of the shadows of stigma.
In the 60-minute Channel 4 documentary, the presenter candidly explained how she was told not to talk about the menopause at work, as it was somehow “a bit unsavoury”. She honestly discussed her symptoms – from brain fog to hot flushes (that made her question whether her make-up chair was heated) – she opened up about her hormone replacement therapy (HRT) and spoke to doctors and professionals about how, for many, menopause (opens in new tab), early menopause (opens in new tab), perimenopause – and the various treatments for all three – are still seen as taboo.
The programme was watched by more than 2 million people and resulted in 22,000 GPs and nurses volunteering to complete a six-hour menopause course. But most importantly, it inspired a wave of women to go to their GPs. Private healthcare company Bupa, which offers a personalised plan for women suffering symptoms related to the menopause, saw a threefold increase for its service. And requests for HRT skyrocketed – so much so, one pharmaceutical company reported a 30% rise (opens in new tab) in demand for HRT products the month after broadcast. They called it the “Davina effect”.
Davina McCall’s perimenopause
McCall went through perimenopause at 44. To manage her symptoms, she started taking hormone replacement therapy, but shares that, at the time, she found it so embarrassing she told no one.
This is the whole point of the documentary – to start breaking down the many menopausal myths and smash the stigma that still surrounds the very natural occurrence.
Most people who identify as women will go through the menopause at some point in their lives, and so how we talk about it – and treat those experiencing it – has to change. Things are moving in the right direction, and the lack of both education and awareness slowly shifting, but more needs to be done.
Keep reading for everything you need to know about perimenopause, hormone replacement therapy – and guidance on when to see your GP.
Perimenopause: what is it?
According to best-selling author of Mindful Menopause (opens in new tab), Sophie Fletcher, perimenopause simply refers to the symptoms you’ll experience in the months or years leading up to the menopause.
As per the NHS website, the “duration and severity of symptoms varies from woman to woman”, and symptoms can affect you both before and after you actually go through the menopause. “On average, most symptoms last around four years from your last period. However, around 1 in every 10 women experience them for up to twelve years,” the site reads.
“During perimenopause, your hormones (opens in new tab) start to shift,” Fletcher explains. “We are usually familiar with the decline of progesterone and oestrogen, but other hormones such as testosterone also dip and can have an impact on your mood, sex drive and general wellbeing.”
At what age does the average woman go through perimenopause?
Good question – although, do note here, it does vary from person to person. “Everyone’s experience is different,” explains Fletcher.
“1 in 100 women experience it before the age of forty, and some girls go through it as early as their teens, though this is rare,” she shares.
Although Fletcher explains that it’s not that actually easy to define when your perimenopause starts. “Although hormones may start to decline earlier, most women don’t start to notice physical or emotional changes until their early to mid 40’s,” she explains. “Some people define it as when your periods (opens in new tab) start to change, but many women can experience effects of lower progesterone, such a low mood or depression (opens in new tab), before this happens,” she goes on.
As per the NHS website, the menopause normally occurs between the ages of 45 and 55, and the average age the woman reaches menopause is 51.
Perimenopause symptoms: 15 to watch out for
Fletcher stresses that your symptoms – and perimenopause experiences generally – will depend on where in the perimenopause cycle you are.
However, during perimenopause, as progesterone and then oestrogen drops, she shares that you may experience:
- heightened anxiety (opens in new tab)
- mood swings
- depression
- low mood
- difficulty sleeping
- heavy periods (opens in new tab)
- headaches (opens in new tab)
- PMS (opens in new tab)
- dry itchy skin
- hair thinning
- joint pain
- weight gain
- sleep disturbances
- hot flushes
- vaginal dryness
And as perimenopause moves on? “Your oestrogen starts to drop more and other physical symptoms may begin to show,” she explains. She does emphasise that treatment is simple and life-changing, so do visit your GP if you are experiencing any of the above symptoms.
What is hormone replacement therapy – and is it safe?
So you know what perimenopause is and how to identify the symptoms. But do you know how to treat your symptoms, should it come to it?
Again, as per the NHS website, hormone replacement therapy – the same HRT that Davina chats about being on – is often prescribed to ‘relieve’ menopause symptoms. They explain that it works by replacing hormones ‘that are at a lower level as you approach the menopause’.
According to the UK’s healthcare watchdog (NICE) (opens in new tab), about a million UK women use HRT treatment for their menopausal symptoms, and the numbers taking it are rising (opens in new tab). It’s thought to help with hot flushes, night sweats, mood swings, loss of libido and more.
As with any medication, the choice to use HRT is an individual one and it doesn’t come without risks, but the official stance on HRT, despite the 2002 study’s findings, is that HRT ‘does not significantly increase the risk of cardiovascular disease (including heart disease and strokes) when started before 60 years of age’.
Current research finds that cancer risks are low in medical terms, while there are benefits, particularly from newer forms of HRT, in terms of lower Alzheimer’s and osteoporosis risks.
In fact, according to the previously mentioned Menopause and the Workplace report (opens in new tab), 54% of women using HRT say it has given them their life back. Among women who have not tried it, low impact of menopause symptoms was the biggest reason (28% say this), while 24% said that they don’t know enough about HRT.
As Davina shares on her page, ‘it’s a really important conversation about the bigger picture and lack of awareness about the benefits of HRT even today.’
5 tips for managing your perimenopause symptoms
1. Educate yourself
You don’t have choices unless you learn about your options, shares Fletcher. “Menopause care can be patchy – being informed means that you can be proactive in asking for the right the support,” she goes on.
Some experts, like Fletcher, prefer more integrative treatment methods, like meditation and self-care. Others, like Davina and the experts in Sex, Myths and the Menopause, will encourage you to opt for HRT.
Ultimately, it’s up to you what you decide to go for.
2. Get moving
Fletcher shares that your body should respond well to weight-bearing exercise during perimenopause.
“Think strength training (opens in new tab), yoga and walking – these are all exercises that can improve both your emotional and physical well-being,” she explains.
3. Practice self-care
Sounds simple, but can be really effective for dealing with the more annoying symptoms the menopause springs on you.
“Anything that helps with sleep, reducing anxiety or just generally makes you feel good is a plus,” shares Fletcher. Our guide to the best self-care ideas (opens in new tab) might help.
4. Get appy
Period tracking (opens in new tab) apps can be a great way to stay in sync with your hormones, and many of them, like Clue (opens in new tab) and My Moontime (opens in new tab), allow you to predict everything from productivity to mood swings based on your cycle. Tracking symptoms on a free, medically accurate app, like Balance (opens in new tab), can really help to give you a full picture of your overall health. Scroll through the Balance app and you can see a whole host of symptoms, plus handy hints and tips on how to ease them.
5. Get support
Ultimately, the experts will know how best to help you and your symptoms, so do see your GP or a qualified expert if you need help.
“Even talking to friends can help – we just don’t talk about it enough,” shares Fletcher. “The more we share, the more we can support each other.”
In partnership with Vichy. Fashion’s DIgest created this content as part of a paid partnership with Vichy. The contents of this article are entirely independent and solely reflect the editorial opinion of Fashion’s DIgest.