Written by Dr Selina Gray, Private GP with a specialist interest in Women’s Health and Lifestyle Medicine at Dr Helen Medical in Ringwood.
One of the things I hear surprisingly often in my consulting room is:
“I just don’t feel like myself.”
Sometimes a woman has booked to see me because her periods have changed. But just as often, periods are barely mentioned at first.
Instead, she might tell me that she is waking at 3am every night. That she suddenly feels anxious when she has never thought of herself as an anxious person. That she cannot remember words or names as quickly as she used to. Or that her joints ache, her heart occasionally seems to race and she is completely exhausted by the end of the day.
And, understandably, many women have spent months putting it down to life.
Perhaps work is particularly busy. The children need you. Your parents need you. You’re not sleeping enough. You’ve fallen out of your usual exercise routine. Maybe you keep thinking you simply need a holiday.
For many of the women I see at our Ringwood clinic, there is a lot going on in life by the time perimenopause arrives. That is why the symptoms can be so easy to overlook.
Perimenopause does not always look how you expect it to
When we talk about perimenopause, we tend to think of two things: periods becoming irregular and hot flushes.
They are certainly common, but they are only part of the picture.
Women can experience changes in mood, concentration, sleep, skin, joints, bladder and vaginal health. Some notice heart palpitations. Others experience headaches, changes in libido or a level of fatigue that does not feel like their normal tiredness.
Brain fog can be particularly frustrating.
You might walk into a room and forget why you are there, struggle to find a word halfway through a conversation or feel that tasks which used to be straightforward suddenly require much more concentration.
When you are still trying to work, run a household, care for your family and get on with everyday life, that can be unsettling.
And then there are women who tell me:
“I don’t really have symptoms. I just don’t feel right.”
That is worth listening to as well.
Why can perimenopause affect so much of the body?
Perimenopause is the period leading up to menopause, when hormone levels begin to change and fluctuate.
Oestrogen does far more than regulate your menstrual cycle.
Oestrogen receptors are found in many tissues throughout the body, including the brain, bones, skin and genitourinary system.
It helps explain why hormonal changes can be felt in so many different ways.
Symptoms can include:
- changes to your periods
- hot flushes or night sweats
- difficulty sleeping
- anxiety or changes in mood
- brain fog or difficulty concentrating
- palpitations
- headaches
- joint and muscle aches
- dry or itchy skin
- vaginal dryness or discomfort
- urinary symptoms
- changes in libido
You certainly do not need to have all of these symptoms to be perimenopausal.
Every woman’s experience is different.
But not everything is perimenopause
This is an important part of the conversation I have with women in clinic.
Once perimenopause becomes a possibility, there can be a temptation to attribute every new symptom to hormones.
Sometimes hormones are the explanation. Sometimes they are only part of it. And sometimes something else is going on.
If you are having palpitations, significant fatigue, changes in bleeding or persistent changes to your physical or mental health, it is worth discussing them properly rather than assuming they are simply something you have to accept in your forties or fifties.
That is one of the benefits of seeing a GP rather than simply working through an online menopause symptom checklist.
We can look at your symptoms in the context of you
Do I need a blood test to find out if I’m perimenopausal?
This is another question women ask me regularly.
For most women aged 45 and over who have typical symptoms, perimenopause or menopause can usually be identified from your symptoms and menstrual history. A hormone blood test is not routinely needed to prove that you are perimenopausal.
Hormone levels fluctuate considerably during this stage of life, so a result taken on one particular day does not necessarily give us the answer women expect it to.
There are circumstances where further investigation may be appropriate, particularly if symptoms begin at a younger age or if we need to consider another possible cause for the way you are feeling.
Again, this is why an individual assessment matters. We would much rather understand what has changed for you, when it started and how it is affecting your life than simply order a long list of tests without a clear reason.
“Should I go on HRT?”
This is probably one of the most common questions I am asked. My answer is usually that we need to talk a little more first.
Hormone replacement therapy, or HRT, can be extremely helpful for many women and can improve a wide range of menopausal symptoms.
But menopause care should not start with a prescription pad.
When I see someone for a menopause consultation in Ringwood, I want to know what is actually bothering her.
Is it the hot flushes? Is she barely sleeping? Is anxiety making work difficult? Has sex become uncomfortable because of vaginal dryness? Are aching joints preventing her from exercising in the way she used to?
I also want to understand her medical history, family history, current medication and any concerns she has about treatment.
Only then can we have a sensible conversation about the options.
HRT is not one single treatment
I think this is worth emphasising because women sometimes arrive believing HRT is simply something you either “take” or “don’t take”.
There are different hormones, doses and ways of taking HRT, including patches, gels, sprays and tablets.
Which option is appropriate depends on your symptoms, medical history, whether you still have a uterus, your own preferences and individual risk factors.
For many women, the benefits of HRT will outweigh the risks. For others, the discussion may be more complex.
If you have a particular medical history, including some previous cancers or other conditions that may be affected by hormones, your options need to be considered carefully and specialist advice may sometimes be appropriate.
What matters is having an informed conversation about your benefits and risks rather than relying on something a friend takes, something you have read on social media or a frightening headline you remember seeing years ago.
And what if I don’t want HRT?
That is completely reasonable too.
HRT is not the only way we can support women through perimenopause.
Depending on your symptoms, we may discuss non-hormonal treatments, menopause-specific cognitive behavioural therapy, vaginal treatments, lifestyle changes or a combination of approaches.
My lifestyle medicine background is particularly useful here. Sleep, alcohol, movement, strength, food, stress and social connection can all influence how we feel during this stage of life.
But I am also very wary of giving women another enormous wellness to-do list.
If you are exhausted, working full time and struggling to sleep, telling you to cook everything from scratch, exercise every day, meditate for an hour and somehow eliminate stress from your life is neither realistic nor particularly helpful.
Sometimes the starting point might simply be getting your sleep under better control.
For someone else, it might be returning to exercise they enjoy, whether that is strength training, swimming, yoga or getting outside for a regular walk around the New Forest.
Lifestyle measures can support your health enormously, but they should work alongside appropriate medical care rather than becoming another thing you feel you are failing at.
Vaginal and bladder symptoms deserve a conversation too
This is an area women sometimes find harder to bring up. Changes in oestrogen levels can cause vaginal dryness, irritation, discomfort during sex and urinary symptoms. Some women experience recurrent symptoms that feel like urinary tract infections.
These symptoms are common, but that does not mean you simply have to tolerate them.
There are treatments available, including vaginal oestrogen and non-hormonal moisturisers or lubricants depending on your circumstances.
We already have a more detailed article on genitourinary symptoms of menopause on the Dr Helen Medical website, which is worth reading if this is something you are experiencing.
Please do not feel embarrassed about raising it during an appointment. I promise, it is a very normal conversation for us to have.
Perimenopause care should feel personal
There really is no standard perimenopause patient. One woman might be experiencing debilitating hot flushes but sleeping well. Another may never have had a single hot flush but feels anxious, forgetful and exhausted. Someone else may mainly be struggling with vaginal dryness or recurrent urinary symptoms.
That is why I don’t believe menopause care should be reduced to ticking symptoms on a checklist and deciding whether somebody qualifies for HRT.
At Dr Helen Medical in Ringwood, our longer appointments (45 minutes) give us time to talk through what has changed, what matters most to you and what you would ideally like to improve.
Sometimes that means discussing HRT. Sometimes it means looking at non-hormonal treatments. Sometimes it means considering whether another medical issue needs investigating. And often it means doing a combination of things and reviewing how you feel over time.
You don’t have to wait until things become unbearable
Perimenopause is a normal stage of life, but struggling through it is not a requirement.
If your sleep, mood, concentration, relationships, work, physical health or general sense of wellbeing has changed, it is reasonable to ask for help.
You also don’t need to wait until your periods have stopped before having that conversation.
If you’re reading this thinking, “Actually, I haven’t felt like myself for a while,” that in itself may be a good reason to talk things through.
At our private GP clinic in Ringwood, I offer menopause and perimenopause consultations with time to properly explore your symptoms, medical history, lifestyle and treatment options.
The aim is not to tell you what you should do.
It is to help you understand what may be happening, explain the choices available and find an approach that feels right for you.
To book a Perimenopause/Menopause appointment at Dr Helen Medical in Ringwood, book online or call 01202 022956.
This article provides general health information and should not replace individual medical advice. Please speak to a healthcare professional if you are concerned about new or changing symptoms.