Everyone knows about menopause, that ‘special’ time in a woman’s life when she has reached a certain age. But as in most things in life, when you think you have something figured out, life throws you a curveball. This particular curveball is called ‘perimenopause’ or premenopause.  What is it exactly? If you’ve been feeling depressed, lost interest in sex and experiencing extreme mood swings, for no apparent reason, you could be experiencing its symptoms!

We spoke to Consultant Gynaecologist at Kings College Hospital and spokesperson for the British Menopause Society, Michael Savvas, who gave us the lowdown on what perimenopause is all about!

So, what is menopause?

Menopause is when a woman’s ovaries stop working and they no longer produce hormones, her periods have stopped, she no longer produces eggs and she becomes infertile. That’s menopause. Perimenopause is apparent usually two-three years running up to menopause, where the ovaries are still working, though the periods might be a little bit irregular because the ovaries are not functioning completely normally. During this phase the periods might be irregular, but they are still making an appearance. Because she is having periods sometimes it’s not recognized that symptoms are related to the menopause or hormonal. Often, the most troublesome symptoms for a woman is not after the menopause but in the few years prior, during the perimenopause.

How long does peri-menopause typically last for?

It’s very variable, usually it lasts for one or two years, sometimes it could last for longer, maybe five years or longer. It’s not unknown for some women to start perimenopause in their thirties!


What’s actually happening to the body during perimenopause, internally?

The woman’s ovaries are functioning but not as efficiently as before so she’s not getting as much estrogen as before, so she may start to develop symptoms such as hot flushes, tiredness, bone density loss. She might lose interest in sex, experience vaginal discomfort and discharge during sex, so the sex drive is affected, her general wellbeing is also affected, and her periods could become quite irregular and also heavy.

What’s the process for confirming that it’s perimenopause?

Sometimes a blood test but not always, because sometimes the blood test can appear to be normal. So, the best way is by proper assessment by an experienced doctor in the field of menopause and often the diagnose is made on the woman’s age, what her periods are behaving like.

How best can women treat the more extreme symptoms?

The best way to correct these symptoms is with estrogen replacement therapy, because that is crucially what is missing, that is what the ovaries are no longer producing very efficiently and its estrogen that would help to alleviate these symptoms.


Are there natural forms of estrogen?

There are some herbal remedies which are from plants, which have some natural source of estrogen, but they are very weak and usually they aren’t adequate. I would also like to add that the symptoms are usually the most troublesome at this stage and sometimes the symptoms are not immediately recognized as being related to menopause for example a very common symptom is depression and irritability and anxiety panic attacks and sometimes women might think that these are just part of life or work and sadly sometimes women go on antidepressants because that’s what first comes to mind when a woman has anxiety and depression. To compound the problem, side effects of some antidepressants increase the feeling of tiredness or reduced libido or sex drive.

Can lifestyle changes be helpful?

Lifestyle changes are helpful because increasing exercise and good diet would reduce the risk of some problems like heart diseases and osteoporosis. Both of these conditions become more likely in women after the menopause. Black women are less likely than white women to get osteoporosis but nonetheless exercise is still very important because it helps the blood pressure and heart disease which tends to be more common in the black community.

Are there any specific considerations or symptoms related to being a black woman?

The symptoms are the same, I think sometimes what is different in different communities is the knowledge and access to treatment but actually the symptoms are very similar. We do see a difference in the amount of knowledge and access out there. Generally speaking, we also find that certain sections of our society struggle to access health care. For example, women of color.

Why do you think so few women have heard about perimenopause?

I think many in the medical profession haven’t recognized it themselves. It’s confusing for doctors as well as patients that a woman is apparently having regular periods and yet she’s got all these symptoms and logic would suggest that if she’s having periods she’s not menopausal. So, I think doctors as well as patients can get confused by that.

What’s your view on Hormone Replacement Therapy (HRT)?

Women with symptoms of perimenopause should seek help and try HRT, particularly if the symptoms include hot flushes and tiredness, mood swings, loss of sex drive etc, rather than trying anti-depressants or something else. HRT is very safe, basically in the perimenopause when the ovary is young, the risks are minimal, and the benefits far outweigh any risk. They improve a woman’s wellbeing, they improve her sex life, they improve her life expectancy because less chance of developing heart disease and conditions like that.

For more information, help and advice on this topic, visit: www.womens-health-concern.org


Please seek the advice of your doctor for any health concerns.



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