The Ultimate Guide to Perimenopause: Symptoms, Treatments, and Ways to Feel Your best.

In some cases, perimenopause can start as early as the late 30s, but most of the time it begins between the ages of 40 and 44. The average start date of perimenopause in the UK is 47.5 years, but it heavily depends on race and ethnicity and can also be affected by your lifestyle. Early onset perimenopause can often be due to genetics, so knowing when your mother started her journey might give you a rough estimate of when you can expect yours to begin. 

There are various signs of perimenopause. These can vary from individual to individual as it isn’t a “one size fits all” scenario. Perimenopausal symptoms can differ depending on your lifestyle, ethnicity, race, and genetics. It is also associated with fluctuating hormone levels leading to good days and bad days within no particular pattern or consistency, which can be frustrating. 

1. Irregular menstrual cycles: These can often be the  first signs of perimenopause.  This means that you might experience heavy or light bleeding and sometimes you might skip a cycle altogether. One important thing to note is that women with a Mirena coil or on the progesterne only pill may miss this clue.  
2. Hot flashes and night sweats: These are extremely common(affecting75% of women) Vasomotor symptoms like hot flashes and night sweats are often influenced by genetic factors too. 
3. Difficulty sleeping:  This might be a consequence of night sweats , joint pains, anxiety, palpitations and the need to get up to pee during the night. Or you might get the opposite, perimenopause fatigue: where you struggle to stay awake. 
4. Vaginal dryness: Oestrogen levels decrease during perimenopause, which leads to vaginal dryness. This symptom can also bring about a drop in libido, as having sex might cause discomfort.  
5.  Mood changes, depression, anxiety, irritability: Due to the continuous imbalance of your hormones during perimenopause, this can result in frequent mood swings and, in more serious cases, depression. Take a look at our article on mental health and menopause if this is an area you might be struggling with.  
6. Brain fog and cognitive difficulties can also occur, leading  some women to fear they have early onset dementia. Difficulty concentrating, worsening headache and migraine, fatigue, dizziness and tinnitus are also possible symptoms.  

There are many more perimenopause symptoms, but the above are some of the most common. 

Bladder weakness is a consequence of perimenopause that can be taboo, so many people don’t report this as a symptom. However, it's important to address it. 

Not everyone experiences incontinence, but it is more common than you might think, and if you do find yourself experiencing it, you’re definitely not alone.  

Stress urinary incontinence occurs when you leak urine when you laugh, cough or sneeze and is common after childbirth.  

Urge urinary incontinence occurs when you feel the urge to pee and can’t make it to the toilet in time.  

Both are made worse by reducing levels of oestrogen in the pelvic floor which occurs in the perimenopause. 

As with most of the other symptoms of perimenopause, bladder problems happen when oestrogen levels start to decrease. In the years leading up to perimenopause, these hormones play an important role in keeping the pelvic floor and bladder strong. So, when they start decreasing, it’s suddenly harder to control your bladder. 

However, managing incontinence before and after menopause is definitely possible. One type of perimenopausal treatment to help with incontinence is pelvic floor strengthening exercises. They are highly recommended, and you can use our Kegel Trainer alongside the Emy app for best results.  A referral from your GP to a Women’s Health pelvic floor physio may also help with this symptom. 

There are also other steps that you can take to prevent bladder leakages like avoiding drinking caffeine and alcohol – check out our exhaustive list of drinks and foods to avoid for more information. Finally, TENA is here to help you with bladder weakness by supplying a wide range of safe, absorbent and discreet incontinence pads and underwear. 

First line treatment for perimenopause is a healthy diet (the British Heart Foundation has good guidance) and lifestyle including exercise, reducing smoking and alcohol. Following this, hormone replacement therapy, also known as HRT, may also be a potential treatment. HRT replaces the hormones that are at low levels. We’d recommend consulting your GP for the right types and dosage, and to see if this is right for you as not everyone can, or wishes, to take HRT.  

The primary indication for use of HRT is relief of perimenopausal and menopausal symptoms, and usually symptoms will have improved within 3 months. You can also expect reduced risk of osteoporosis and heart disease¹.  

Alternatives to HRT include oxybutynin which is a bladder medication useful for flushes, clonidine, venlafaxine and escitalopram are antidepressants that used in low doses help with some perimenopausal symptoms, and also some anti-epileptic medications such as gabapentin².Cognitive Behavioural Therapy (CBT) for menopausal symptoms has also been proven to reduce the perception of flushes³.  

Perimenopause supplements can be a natural alternative, however natural supplements and alternative medicines may not necessarily be safe, as some herbal medications can interfere with prescribed medications. If you are considering using herbal medicines please consult with a health care professional specialising in this field. There are different kinds depending on your symptoms, including: 

• Phytoestrogens including Red Clover. 
• Sage, Black Cohosh and St John’s wort are other alternatives that may be helpful 
• Calcium and Vitamin D are important for bone health. 
• Omega 3 is beneficial for brain and heart health. 

In case of loss of libido and if HRT doesn’t seem to work, your doctor might prescribe you testosterone, but this can have possible side effects. Please note in a lot of health boards across the UK, GP’s may not be allowed to prescribe testosterone and you may need a referral to an NHS menopause clinic to obtain testosterone.  

These are some of the most common perimenopausal treatments, however we’d recommend always consulting your GP or gynaecologist before starting to take any medication as they will be able to advise on the best option for you. 

The end of perimenopause coincides with the start of menopause. Menopause is when you have had no period for 12 moths and in the UK the average age this occurs is 51. After 12 months of no periods, you will have officially entered the menopause, and the perimenopause will have ended 

The perimenopausal symptoms start to change as well; for example, you might experience fewer headaches but more hot flashes and poorer quality of sleep. However, it’s not all doom and gloom as mood swings might also start to subside, leaving you feeling less emotional. This happens because after entering menopause, your hormones will have stopped fluctuating and now reached a consistent, low level. 

The average woman will spend over thirty years in menopause – if you experience bleeding while going through it then this could be a sign of a more serious condition and you should immediately consult your doctor. 

Perimenopause is a period in a woman’s life that often gets overlooked, so it is important to communicate with those around you and seek solidarity amongst friends and family. From understanding the signs of perimenopause to learning how to treat it and feel your best, we hope that you now feel more.

Take a look at our #LastLonelyMenopause campaign for more guidance, advice and stories from women navigating this life stage.