Mythbusters: the perimenopause

Hot flushes, mood swings and brain fog… common symptoms you might have heard surrounding the menopause. But did you know this could actually be the perimenopause? Although some of the symptoms might be the same, this is the phase in a woman’s life before the menopause starts and is often mis-diagnosed.

Nikki Porges, registered nurse in AXA Health’s 24/7 health support line, for members, is taking a look at some myths surrounding the perimenopause and sorting out which are fact, and which are fiction.

1) I’m getting symptoms, so it must be the menopause

If you are experiencing menopause symptoms but still having periods, then it isn’t the menopause. Periods may change in frequency and can become heavier and/or longer lasting but until there’s a 12-month timeframe of no periods then you’re more than likely experiencing the perimenopause.

It’s a common misdiagnosis, as some women might be experiencing menopause symptoms such as hot flushes, mood swings, lack of energy or headaches but this time in a woman’s life is often referred to as the ‘transition period’ leading up to a woman ‘officially’ being classed as menopausal.

2) I can’t get pregnant during the perimenopause

Although it can be harder to become pregnant with hormone levels rapidly changing during this time, if a woman is still ovulating then pregnancy is still possible.

Perimenopause can sometimes start before the age of 40, or in the early 40s, but typically the average age for perimenopause to begin is anything from 45 years upwards.¹ It’s worth noting that a woman’s fertility chances decrease with age – ages 45 and beyond, your likelihood of becoming pregnant is no more than 3 or 4%,² so although pregnancy is still possible, chances are low.

Contraception, however, is recommended to be continued until two years after the last natural period in women aged under 50, and until one year after natural menopause in women aged over 50. If menopause cannot be confirmed, then contraception should be continued until age 55.

3) Every woman will go through perimenopause

This is another myth. If a woman has gone through:

• surgically-induced menopause, for example removal of the ovaries,
• sudden primary ovarian failure,
• or taking medications that can shut the ovaries down

then they can experience an immediate change in hormones that leads straight to the menopause.

It’s worth bearing in mind when medications are the cause, once the treatment has ended then normal ovarian function is usually restored reversing menopause symptoms.

For some women menopause symptoms are instant but for others they may experience a few of the symptoms with varying levels of severity.

So no, not every woman will experience symptoms of the perimenopause first which then leads into the menopause. Some women will skip this stage entirely.

4) I can’t have HRT until I’m going through the menopause

Many women mistakenly think that they cannot have Hormone Replacement Therapy (HRT) until they are in the actual menopause itself. Whereas it’s usually most needed during perimenopause to help stabilise and replace the hormone oestrogen, that’s being lost during this time.

HRT can help with symptoms related to oestrogen deficiency, such as:

• hot flushes,
• vaginal dryness,
• sleep disturbances,
• mood changes and concentration.

Some women may experience unwanted side effects when taking HRT for the first time. These can include breast tenderness, leg cramps, nausea, bloating, irritability and depression.

Always discuss HRT with a GP or menopause specialist, as every woman’s menopause journey is different. A GP can help find the right dosage and type of HRT, as well as outlining both the benefits and risks.

>Read more about HRT in our HRT guide

Discover more menopause myths in our mythbuster series that focuses on treatments, unexpected symptoms and why it's more than just hot flushes. 

Further reading

• Our ultimate guide to the menopause
• The menopause - Women's Health Concern

References

1. When does the perimenopause start? – Patient Info
2. What Are the Chances of Getting Pregnant at 45 or Older? – Medicine Net