How to manage your perimenopause symptoms

HFG founding editor Niki Bezzant — author of  ‘This changes everything: the honest guide to menopause and perimenopause’ — shares ways to ease the most common symptoms along your path through menopause.

Depending on which list you refer to, there are over 40 symptoms of perimenopause and menopause. They range from things we’re familiar with to rarer or downright weird symptoms such as formication (the feeling of insects crawling on the skin), rage, migraines and heart palpitations.

What’s important to know is that every woman’s experience of menopause is different — and it would be very, very unlikely that you’d experience anywhere near 40-plus symptoms. One in five women has none at all. Most of us, though, will have something. And most likely, it will be one of the five main symptoms. Along with changes in menstrual cycle — shorter cycle, longer cycle, heavier or lighter bleeding, all of which are normal parts of perimenopause — these are the ‘top five’ symptoms, as reported in my survey of New Zealand women, conducted as part of the research for my book. These track closely with symptoms reported elsewhere in the world. Read on for the basics on what causes these and what you can do about them.

Hot flushes/night sweats

Hot flushes and night sweats are the ‘classic’ menopause symptom experienced by close to two thirds of women in perimenopause. Flushes — called night sweats when they happen during the night — can be extremely distressing.

➜ What causes them?

Astonishingly, science still doesn’t know exactly why we have flushes. We do know that, essentially, it’s the temperature-regulating centre of the brain, the hypothalamus, going on the fritz and overheating us. It’s thought to be related to the oestrogen receptors in the brain and the fluctuating levels of oestrogen that happen in perimenopause throughout the day and night. While these levels rollercoast, the receptors get confused and trigger a flush.

➜ What can you do?

Solutions for hot flushes and night sweats depend on how badly they’re bothering you. One way is management — wearing layers and natural fibres, avoiding your triggers (which might include hot drinks, alcohol and hot showers) and regulating the temperature in your home and workplace. At the other end of the range is the gold standard treatment: menopausal hormonal therapy (MHT, formerly known as HRT or hormone replacement therapy). This, according to the evidence, is the most effective treatment for hot flushes in women who are struggling. It’s also a low-risk treatment for most women. The old tale that hormone treatment is dangerous or causes breast cancer has been debunked.

➜ What to watch out for

There’s limited evidence for any herbal remedies for hot flushes – though there is a strong placebo effect for any treatment, so it’s possible these may give some relief. If it’s not helping after a few weeks, move on.

Brain fog/concentration & memory issues

Brain fog can affect women’s confidence and mood — losing words, names and concentration — and is also related to changes that occur in the brain during perimenopause.

➜ What causes it?

Again, it’s connected to fluctuating oestrogen. There are measurable changes in brain energy and function that take place in midlife for women, but this brain fog is a temporary symptom during menopause with no long-term cognitive loss.

➜ What can you do?

Menopausal hormonal therapy can help with brain fog, but it’s not a guaranteed fix. Other things that can help are regular exercise, getting enough quality sleep (see right: this is another issue in perimenopause), practising stress-reducing techniques, and ditching alcohol and limiting caffeine. Adopting a brain-friendly diet is a great idea, too — for now and future protection against dementia. Rule of thumb: if it’s good for your heart, it’s good for your brain. Think a Med-style plant-rich diet with whole grains, healthy fats, moderate dairy and fish, and only occasional red meat.

Sleep problems

Difficulty getting to sleep or staying asleep is an extremely common symptom in perimenopause which can happen because of — or independently from — other symptoms such as hot flushes.

➜ What causes it?

Sleep struggles can be down to a combination of things. If you’re having night sweats, these can be extremely disruptive to sleep, and hormone fluctuations can affect our sleep patterns with or without sweats. Stress, alcohol, caffeine and diet can also play a part.

➜ What can you do?

Keep the bedroom cool — around 18–19°C is ideal. Use natural-fibre bedding and sleepwear. Ditch the screens at least an hour before bed. Don’t eat too close to bedtime, and knock caffeine on the head after lunchtime. Cut back or cut out alcohol if you’re struggling with sleep, especially just before bed. Exercise can boost sleep, especially if you exercise in the morning light. And MHT can be a game changer here, too: the progesterone component of MHT is particularly useful for sleep, taken at night.

➜ What to watch out for

Sleep aids in the form of pills, whether natural or pharmaceutical, encourage dependence, so we find it difficult to sleep without them. Experts recommend getting up out of bed rather than lying awake in the wee small hours: do something relaxing and non-screen-related for a short time instead.

Weight gain and weight redistribution

Many women begin to notice body changes during perimenopause. Often this can be a redistribution of body fat — more around the middle of the body — with or without weight gain.

➜ What causes it?

Some weight or fat gain is hormone related. Oestrogen declining and interacting with insulin can cause more weight to go on around the waist area. There’s also a decline in muscle mass that happens as we age and is accelerated by declining oestrogen, which can add to weight and fat gain.

➜ What can you do?

Some body changes are inevitable as we age, so to a degree we need to accept this. If the changes are bothering you, understanding why your body is changing, and accepting that, can go a long way. Be kind to yourself, this is a turbulent time. On top of that, taking care with your eating is useful. Concentrate on nourishment: think of giving your body the goodness it needs. Keeping portion sizes moderate — we tend to need to eat less as we get older — while making sure we get good amounts of protein and fibre in every meal will help, along with eating lots of plant and minimally-processed foods. ‘Changing up’ exercises to include strength training — ideally challenging yourself with heavier weights — can be a game-changer too.

➜ What to look out for

Despite what we may see on social media, there’s no one diet that’s been shown to be useful for women in perimenopause and menopause. Sticking to a Med-style pattern
of eating is generally healthful, though, and will also look after your heart and brain.

Mood issues

Many women struggle during perimenopause with low mood, mood swings and other more serious mental health issues such as anxiety, depression and panic disorders. If that’s you, you’re far from alone.

➜ What causes it?

Once again, this mood disruption is thought to be related to oestrogen fluctuations interacting with oestrogen receptors in the brain. It can also be down to external factors — midlife for women usually has a lot going on! Things can get stressful and difficult, and when you throw in hormonal turbulence, it’s a perfect storm for mood changes.

➜ What can you do?

There are lots of mood-boosting practices that can help with mild issues. Exercise is a baseline activity. If you’re not getting out and doing something to move your body, even if it’s just a walk around the block, then that’s a great habit to get into. Evidence is constantly emerging about the real benefits of regular exercise for mood and mental health. Eating well is also super helpful: again, if it’s heart healthy, it’s brain healthy. For more serious mood issues, it’s important to seek help early. A range of therapies and medications, including antidepressants, exists (some of which also help with hot flushes). And MHT can be very helpful for low menopause mood. Many women say it’s helped them feel like themselves again.

➜ What to watch out for

If you are really struggling, or having thoughts of suicide or self-harm, seek help immediately:

● Australia emergency services: call 000
● Australia Lifeline: call 13 11 14 or text 0477 13 11 14
● NZ emergency services: 111
● NZ Need to talk?: Call or text 1737

In a nutshell

Some lifestyle basics can help with all of these ‘top five’ symptoms, boosting our health not only in perimenopause but for the rest of our lives.

Those things are: Regular exercise (including both cardio and strength training); a healthy, plant-packed diet; cutting back (or cutting out) alcohol; and finding ways that work for you to handle stress.

And don’t forget: There are very useful treatments available to women in perimenopause, both hormonal and non-hormonal. So if you are struggling, don’t suffer in silence. See your doctor as a starting point and seek some help.