Am I going through the menopause?
The transition to the menopause — perimenopause — and its first signs: changes in the cycle, sleep and mood, hot flushes, brain fog and joint pain, explained from current evidence.
From the middle of the forties onwards, one of the first questions to arise is: am I going through the menopause? Changes you cannot quite account for, broken sleep, a cycle that no longer behaves — any of these can be unsettling. The first thing worth knowing is that the menopause is not an illness. Like puberty or pregnancy, it is an entirely natural stage of a woman's life.
What perimenopause is
People often speak of "reaching the menopause" as though it happened on a single day. In fact there is a long transition that begins, on average, 4 to 8 years before periods stop for good. This is perimenopause. As the ovarian reserve slowly declines, oestrogen and progesterone fluctuate and the body works to settle into a new balance.
The first signs
Every woman's experience is as individual as a fingerprint. Even so, some early signals are near-universal.
Changes in the cycle
Clinically this is the clearest and most objective first sign. If a cycle that was regular becomes 7 days or more shorter or longer on consecutive occasions — for example moving from every 28 days to 21, or out to 40 — that is the strongest indicator of early perimenopause. Later in the transition, gaps of more than 60 days between periods are common.
Sleep and mood
Sleep breaks more easily and is less refreshing. Irritability, tearfulness and anxiety may appear without an obvious cause. The fall in progesterone, which has a calming effect, is part of the reason.
Hot flushes and night sweats
A large proportion of women begin having flushes well before periods stop altogether. As fluctuating oestrogen affects the body's internal thermostat, a wave of heat spreads suddenly across the face and neck.
Brain fog and trouble concentrating
Oestrogen helps regulate energy metabolism in brain cells. Difficulty recalling words, trouble focusing and short lapses of memory make up what is commonly called brain fog — in perimenopause this is hormonal in origin and temporary.
Vaginal dryness and joint pain
Falling oestrogen affects more than temperature: it acts on connective tissue, skin and the thin linings of the body. Vaginal dryness, which can make sex uncomfortable or painful, and widespread joint and muscle aching felt in the mornings are both characteristic of this period.
When it is worth seeing a specialist
The transition is natural, but that does not mean the symptoms have to be tolerated when they affect your quality of life, your work or your state of mind. Current medical thinking does not recommend simply waiting it out — because early perimenopause is also the period in which bone loss accelerates and in which acting to protect cardiovascular health makes the greatest difference.
Assessment is individual: medical history, the severity of the complaints and personal risk factors are weighed together, and the plan can range from lifestyle measures to bioidentical hormone therapy.
If you recognise one or more of the signs above, it is worth speaking to a gynaecologist about managing this new stage safely. For the fuller picture see what the menopause is and the long-term risks.