Perimenopause and Menopause Care

Menopause is confirmed after you have gone 12 consecutive months without a menstrual period.

Perimenopause is the transitional phase leading up to menopause, which can last for several years. During this time, hormonal changes cause menstrual cycles to become irregular. Symptoms of perimenopause can include changes in the pattern of periods, hot flashes, night sweats, vaginal dryness, reduced libido, joint pain, sleep disturbances, and mood changes. To determine if you are perimenopausal or menopausal, we consider your age, symptoms, and the frequency of your periods.

To confirm a diagnosis, we evaluate your symptoms, discuss your medical history, and may conduct tests or hormone level assessments if needed. This helps us understand your hormonal status and guide you towards appropriate management options.

Differences between perimenopause and menopause symptoms:

Perimenopause and menopause have distinct symptoms. Perimenopause is the phase leading up to menopause with hormonal fluctuations, resulting in irregular menstrual cycles and symptoms such as hot flashes, night sweats, mood swings, vaginal dryness, and sleep disturbances. Menopause is defined as the time when you haven’t had a menstrual period for at least one year. During menopause, menstrual periods cease, and while symptoms like hot flashes and night sweats may persist, they usually become less frequent over time. Though part of the same natural process, perimenopause and menopause represent different stages, each with its own set of symptoms.

Premenopausal vs. Perimenopausal:

Premenopausal and perimenopausal are different stages. Premenopausal refers to the period before menopause when menstrual cycles are still regular and ovulation occurs normally. Perimenopause, however, is the transition leading up to menopause, characterized by hormonal changes and irregular menstrual cycles. Symptoms during perimenopause include hot flashes, mood swings, and changes in menstrual flow. This phase can last for several years before reaching menopause.

Menopause can affect women in various ways. Some might experience no symptoms, while others may have brief or severe and distressing symptoms. Hormonal changes during perimenopause, the period leading up to menopause, can impact every cell in the body, causing a range of symptoms that you might not initially associate with hormones. The LGP Menopause Symptom Checker is a helpful tool for tracking and understanding these symptoms.

Symptoms of menopause can be categorized into:

• Vasomotor: hot flashes and night sweats
• Psychological: mood changes, sleep disturbances, reduced interest in sex
• Physical: joint and muscle pain
• Vaginal/Bladder: vaginal dryness and frequent urinary infections

Even if you have had a hysterectomy (removal of the womb), you can still experience menopause symptoms. Additionally, other natural aging changes may be intensified by menopause. For instance, muscle strength may decrease, and the risk of osteoporosis and heart disease may increase, though these conditions often develop without noticeable symptoms. We can evaluate your risks and create a personalized plan to help manage your health during and after menopause.

During perimenopause, hormone tests are generally not very useful because hormone levels fluctuate throughout the menstrual cycle. Therefore, you are unlikely to need these tests. Additionally, if you are taking hormonal treatments, such as those for heavy periods or contraception, it can be more challenging to determine when you have reached menopause.

For women over 45, blood tests are not typically needed to diagnose menopause, as the diagnosis is usually based on symptoms alone.

Blood tests may be offered if:

• You are between 40 and 45 and have menopausal symptoms, including changes in your menstrual cycle.
• You are under 40 and it is suspected that you are experiencing menopause (see also premature menopause).

The blood test measures the level of FSH (follicle-stimulating hormone), which is typically higher during menopause.

Some contraceptives can affect your natural FSH levels. If we deem it necessary to measure your FSH levels, the following steps may be taken:

• If you are using a contraceptive containing estrogen and progestogen (such as the combined pill, ring, or patch), you may be asked to stop the contraceptive for 6 weeks before the test.
• If you are using a high-dose progestogen contraceptive (such as the Depo injection), the test may be scheduled just before your next injection when hormone levels are at their lowest.

For women of any age, it might be necessary to test for other conditions that can cause symptoms similar to perimenopause, such as thyroid disease. It’s important to discuss your symptoms and menstrual cycle with us so we can determine what tests may be needed.

Hormone Replacement Therapy (HRT) can have both beneficial effects and potential side effects. Some common side effects of HRT include:

• Breast tenderness or swelling: Some women may experience increased breast sensitivity or swelling while on HRT.
• Spotting or breakthrough bleeding: Irregular bleeding or spotting can occur, especially during the early stages of treatment, but this usually resolves over time.
• Nausea: Mild nausea may occur when starting HRT, although this side effect typically subsides.
• Headaches: HRT can occasionally trigger headaches or migraines in some women.
• Fluid retention: Some women may experience fluid retention, leading to bloating or swelling in the hands, feet, or ankles.
• Mood changes: HRT may influence mood in some individuals, causing irritability, mood swings, or mild depression. However, for many women, HRT can improve mood and overall well-being.
• Digestive issues: HRT can occasionally cause gastrointestinal symptoms like indigestion, bloating, or stomach discomfort.

It’s important to note that not all women will experience these side effects, and their severity and duration can vary. We will discuss potential side effects with you before starting HRT and provide personalized advice and guidance based on your individual circumstances. Regular monitoring and follow-up can help address any concerns and ensure optimal treatment outcomes.

When considering hormone replacement therapy (HRT), it’s essential to weigh the benefits against the risks. Studies from the early 2000s raised concerns about potential risks associated with HRT, leading to hesitancy among some women and doctors. However, more recent research suggests that while not entirely risk-free, HRT remains the most effective treatment for relieving menopausal symptoms and can also help prevent osteoporosis. In certain age groups, it may even provide protection against heart disease and possibly dementia (though further research is needed). Recent evidence indicates that the benefits of HRT generally outweigh the risks.

The risks associated with HRT are typically small and depend on factors such as the type of HRT used, duration of use, and individual health risks.

Breast cancer risk: There is generally little to no change in breast cancer risk with estrogen-only HRT. Combined HRT (estrogen and progestogen) may be associated with a slight increased risk of breast cancer, which is influenced by the duration of HRT use and decreases after discontinuation. Young women (under 51 years) taking HRT do not have a greater risk of breast cancer.

Blood clots: Evidence suggests that oral HRT (tablets) may slightly increase the risk of blood clots, while transdermal HRT (patches or gels) does not pose an increased risk.

Heart disease and strokes: Starting HRT before the age of 60 does not significantly increase the risk of cardiovascular disease, and may even reduce the risk. While HRT tablets are associated with a small increase in stroke risk, the overall risk for women under 60 is generally low.

We will discuss your individual risk factors to provide personalized advice based on your circumstances.

The term ‘bio-identical’ literally means the product has the same molecular structure as the hormones produced in the body;

Regulated bioidentical hormones (rBHRT) – these are what might be referred to as Body Identical HRT – they are hormones derived from plants and produced by pharmaceutical companies and undergo strictest testing and regulations. These regulated HRT products are the only products that are available on the NHS and mainstream scientific, clinical and regulatory bodies in women’s health advise. We will prescribe for you.

Compounded bioidentical hormones (cBHRT) are produced by a compounding pharmacy for private clinics and here the term ‘bio-identical hormone therapy’ is often misused and is widely marketed as a ‘natural’ alternative to conventional HRT. This type of HRT is not regulated with the rigorous licensing standards which apply to normal pharmaceutical products. There is no evidence to support this way of testing the compounds and no regulations to support their safety in the UK. A further limitation is that quite worryingly the transdermal (cream) micronised progesterone may not protect your uterine lining. Mainstream scientific, clinical and regulatory bodies in women’s health advise against the use of these products. Additionally, this costly practice of complex blood and saliva tests and the compounded products are significantly more expensive than the cost of private or NHS prescriptions. Paying more does not mean better. We do not prescribe these.