Perimenopause: An Expert’s Guide on Turning Your Hot Flashes into Cool Confidence

Perimenopause is the transitional phase during which a woman’s body moves from its reproductive years toward menopause. In this article, we invite Dr Vikram Sonawane, Senior Consultant Endocrinologist and Founder of Harmony Thyroid, Endocrinology and Diabetes Centre (a member of Beyond Medical Group), to help women decode perimenopause and take charge of perimenopausal symptoms.

What goes on inside a woman’s body during perimenopause?

This is the transitional phase between the ages of 45 and 55 when women cease menstruation completely and enter menopause. During perimenopause, women experience marked hormonal fluctuations, particularly a significant reduction in oestrogen and progesterone levels. This hormonal disharmony potentially leads to symptoms such as irregular menstrual cycles, hot flashes, mood swings and sleep disturbances.

How can women recognise the signs and symptoms of perimenopause?

Common symptoms of perimenopause are:

• Irregular periods: One of the earliest signs of perimenopause is a change in the usual pattern of menstrual cycles. Periods may become irregular, shorter, or longer and the flow may vary in intensity. Some women might experience skipped periods.
• Hot flashes and night sweats (Vasomotor Symptoms): Sudden sensations of heat, often accompanied by sweating, especially at night.
• Sleep disturbances: Changes in sleep patterns, such as insomnia.
• Mood changes: Mood swings, heightened irritability, or increased sadness.
• Vaginal dryness: Lowered vaginal lubrication leads to dryness, irritation, discomfort and pain during intercourse (dyspareunia).
• Decreased libido: Less interest in sexual activity.
• Urinary issues: Increased urinary frequency or urgency.

These symptoms may differ in intensity and duration among individuals.

Furthermore, perimenopause is defined by hormonal fluctuations that can lead to a gradual fall in bone density, elevating the risk of developing osteoporosis. While bone loss can occur during perimenopause, the risk of osteoporosis increases significantly after menopause.

Therefore, it is crucial for women to monitor their bone health during perimenopause and continue to do so after menopause to prevent osteoporosis. The risk of osteoporosis is greater if menopause sets in the early 40s and family history of osteoporosis.

How can women tell if their symptoms are just due to stress or perimenopause?

Both stress and perimenopause have overlapping symptoms, such as mood swings, sleep problems, and fatigue. In order to distinguish between them, patients are advised to do the following things:

• Symptom tracking: Monitor the frequency and pattern of symptoms. Hormonal fluctuations often cause cyclical symptoms, whereas stress-related symptoms may be more constant.
• Consider context: Evaluate recent life changes or stressors that might contribute to symptoms.
• Medical consultation: Book an appointment with an Endocrinologist (a medical doctor specialising in hormonal conditions). Endocrinologists can perform a thorough evaluation to help you determine if your symptoms are due to perimenopause, stress or other conditions.

How long do perimenopausal symptoms typically last, and will they subside without treatment?

Symptoms of perimenopause often persist for about 2 to 4 years. Rarely, the menopausal transition can last between 7 and 14 years and symptoms may continue into postmenopause.

Many symptoms may subside after menopause without treatment; however, some, like vaginal dryness and bone density loss, may persist or worsen. Fortunately, there are ways to manage and treat perimenopause, which can mitigate symptoms of perimenopause.

How can lifestyle changes like diet, exercise, or vitamins help to alleviate perimenopausal symptoms and reduce the risk of osteoporosis?

Adopting healthy habits can reduce symptoms of perimenopause, lower the risk of osteoporosis and enhance overall well-being:

• Diet:
  • Eat a diet loaded with fruits, vegetables, whole grains, lean proteins and healthy fats. This balanced diet provides essential nutrients that support overall health and may help manage perimenopausal symptoms.
  • Ensure sufficient calcium and vitamin D intake to support bone health.
• Exercise:
  • Partake in brisk walking or jogging to improve cardiovascular health and help manage weight, which may lower the frequency and severity of hot flashes.
    Engage in weight-bearing activities like walking or resistance training to strengthen bones.
• Vitamins and supplements:
  Studies have shown that calcium, or calcium in combination with vitamin D supplementation, is effective in the prevention of osteoporosis in people aged 50 years or older.

It is important to note that while calcium and vitamin D are essential for bone health, they do not alleviate perimenopausal symptoms. Therefore, women should consider other strategies, such as hormone replacement therapy or lifestyle modifications, to manage perimenopausal symptoms effectively.

How can women manage perimenopause symptoms and maintain productivity at work or in their daily lives?

Reducing stress through relaxation techniques or meditation can help and ensuring you are getting enough sleep is key to managing irritability and fatigue. Regular physical activity is also beneficial for boosting energy levels.

If symptoms like hot flashes or sleep disturbances are disrupting your daily routine, it is important to speak to a doctor, as there are many treatment options available.

What treatments are available to manage perimenopause symptoms?

Several treatment options can alleviate symptoms of perimenopause :

• Hormone therapy (HT): Systemic oestrogen therapy is an effective treatment for relieving perimenopausal symptoms.
• Non-hormonal medications:
  • Antidepressants for the alleviation of mood swings and hot flashes.
  • Antihypertensive agents can help reduce the frequency and severity of hot flashes.
  • Anticonvulsants may be effective in reducing hot flashes.
• Lifestyle modifications: Diet, exercise and stress reduction techniques.

There are multiple treatment options for perimenopause, but what is most important is tailoring the approach to each woman’s individual symptoms and medical history. For some women, hormone replacement therapy, or HRT, works really well to balance fluctuating oestrogen levels. However, it is not suitable for everyone. For example, women who are diagnosed with breast cancer during the perimenopausal period would not be candidates for HRT.

Visit Harmony Thyroid, Endocrinology and Diabetes Centre

At Harmony Thyroid, Endocrinology and Diabetes Centre, an endocrine clinic conveniently located in Singapore’s Mt Elizabeth Hospital (Orchard), Senior Consultant Endocrinologist Dr Vikram Sonawane can come up with a tailored treatment plan for you. Rest assured, as Dr Vikram is well-experienced in treating perimenopause, he can help you to alleviate perimenopausal symptoms.

About Dr Vikram Sonawane

Medical Director at Harmony Thyroid Endocrinology and Diabetes Centre
MBBS, MD (Med), FAMS (Endocrinology), MRCP (UK), FRCP (UK)

Dr Vikram is a skilled Endocrinologist with more than 12 years of experience in endocrinology. He was awarded the Ministry of Health’s Health Manpower Development Plan (HMDP) sponsorship in 2015 for a fellowship to get trained in Clinical Thyroidology, Nodular Thyroid Disease, and Fine Needle Aspiration Biopsy of the thyroid at the esteemed Mayo Clinic, Rochester, Minnesota, USA. After his HMDP fellowship, he was appointed Lead of the Thyroid Service at Singapore’s Khoo Teck Puat Hospital and subsequently set up his own private clinic.

Images: Shutterstock and Harmony Thyroid Endocrinology and Diabetes Centre