Navigating perimenopause

Most women start experiencing perimenopause symptoms for several years before going through the final transition of menopause.

A 48-year-old woman presented at the clinic with a range of symptoms that were impacting adversely on her life. She was suffering from lack of energy and after being a good sleeper previously, for the last few months she was experiencing increasing problems getting to sleep as well as waking during the night and not being able to get back to sleep. She was also stressed and anxious and constantly irritable, which was affecting her family life. She felt she had always been healthy and had a good life and no real cause for complaint, so this was concerning her.

She had started experiencing mild incontinence — urinary leaks several times a week with urinary urgency. Having to urinate during the night was one reason she was waking up. She was concerned as she felt her memory and concentration were deteriorating as she was forgetting names and where she had put things, and had difficulty focusing at work. She was also starting to experience the occasional hot flushing.

Overall, her health was good. She had few digestive symptoms and a reasonably good diet — high in vegetables with a wide variety of foods. Her alcohol consumption was minimal and she was not a smoker. She had no aches and pains and she exercised about three times a week, mainly going for long walks with friends. She also went to Pilates classes once a week. Her DEXA scan showed good bone density, blood pressure was on the low side and other medical blood tests were essentially normal including good vitamin D levels.

She had a good job that she liked, her children were healthy, in their late teens and were thinking of leaving home (which was one source of stress). She was still menstruating regularly, but her periods were becoming lighter. However, she was experiencing premenstrual symptoms of bloating, cravings for chocolate, fluid retention and swollen breasts for three to four days beforehand, which she had not had for years.

Speaking to this woman, she had the classic symptoms of perimenopause. Most women start experiencing symptoms for several years before going through the final transition of menopause. Women can experience symptoms for seven to 10 years. Menopause is considered finished when the last menstrual period was 12 to 18 months ago, although women can still experience some symptoms after this time.

Overall, most women experience symptoms of menopause — some severely — but many have mild problems and generally these can be managed relatively easily with herbal and nutritional help. Medicine has the tendency to over-medicalise what is a normal transitional state for 45–55-year-old women and while some women may need pharmaceutical help, most can benefit greatly from herbal and nutritional support. Understanding the process is essential and managing the symptoms makes life much more bearable during this time.

Sleep is critically important — insomnia exacerbates all symptoms — and she had been to her doctor who recommended sleeping pills that she was reluctant to take as she was concerned about the addictive potential.

As she was essentially a healthy woman, we focused mainly on symptom relief and general health support. Several suggestions were made. Melatonin was recommended to help with sleep. Melatonin drops significantly during menopause and research indicates it can improve sleep, anxiety and a variety of perimenopausal symptoms. The trick is getting the dose right for the individual. There are no problems with addiction. We started her on a 2.5mg dose, which was not very effective but doubling this to 5mg improved her sleeping patterns significantly. It was also suggested she exercise in the early morning or late afternoon, in the sun without sunglasses or skin creams — sunlight on the skin (and eyes) and vitamin D are important components of melatonin metabolism.

To reduce the premenstrual symptoms, Chaste tree tablets were recommended to be taken daily for the two weeks prior to menstruation. After a couple of months, she was almost symptom free at this time.

Urinary leakage is very common in older women. She had no prolapse issues, so Kegel exercises were recommended along with an Ayurvedic herb called Crataeva, which strengthens the bladder. A herbal formula of ginkgo, bacopa, lemon balm and rosemary was recommended to improve her memory and concentration.

Added to this there were several supplements recommended for overall support and hormone balancing including the nutrients zinc, magnesium and B vitamins. Ubiquinol was recommended to improve energy and support for the cardiovascular system. Krill oil was suggested to improve her dry skin and support brain function. As her children were soon to leave home, adrenal support was also suggested to manage this stress, and included Withania and vitamin C.

Sage tea was recommended in the evening as this can help reduce urinary urgency during the night and reduce hot flushes, and organic green tea was suggested as a drink throughout the day for overall antioxidant support. She found these measures relatively easy to introduce and was very happy with the result. Once she started sleeping better, many of her symptoms improved and she was feeling more like her old self again and was happy to maintain this program.