Symptoms of perimenopause can occur in any number of combinations. Some women experience few symptoms, while others have specific problems for up to two years prior to their last period.

The most common, earliest sign that a woman is approaching the menopause is erratic periods.  They can be irregular in length or occurrence, or unusually heavy or light in flow.  Other signs that can signal the onset of perimenopause in any combination are mood swings, flooding, and hot flushes or 'flashes'.

Physical symptoms

The most usual physical symptoms are hot flushes, vaginal dryness and loss of bone density - which can lead to osteoporosis.  These result from the dramatic drop in oestrogen levels that is characteristic of the menopause, and can be effectively treated with Hormone Replacement Therapy (HRT).

Hot flushes are episodes of uncomfortable body heat coupled with increased heart rate.  They can be brought on by spicy foods, hot drinks, alcohol, stress, or simply by being too warm. 

These episodes can be embarrassing and debilitating, and can cause sleep disturbances and night sweats. 

Hot flushes are thought to be due to a change in circulatory dynamics, brought about by the lack of oestrogen, since oestrogen has a powerful effect on blood vessel activity.

The drop in oestrogen levels is also responsible for vaginal dryness, often experienced prior to, during, and following the menopause.  The walls of the vagina become thinner and more fragile, and therefore less moisture is produced. 

This can result in painful intercourse and vaginal infection, which is usually the cause of discharge experienced during menopause. 

A similar thing happens to the walls of the urethra, the duct through which urine is discharged from the bladder, and so infections of the bladder are also common. 

The bones of both men and women lose density and mass as part of the natural aging process.  Osteoporosis is a disease where this loss is exaggerated to the stage where bones break or crumble in response to little or no trauma.  Oestrogen protects against losing too much bone mass, so at menopause the risk can increase. 

Other symptoms

Skin, and sometimes hair, can be affected by changes in hormone production occurring throughout perimenopause.  Oestrogen stimulates the production of collagen, the supportive fibrous structure that gives skin its strength.  Collagen production falls after the age of 40, and so the additional decrease in production brought on by menopause can lead to sagging and wrinkling of the skin.  This can also lead to a drop in elastic fibres in the skin, which will exacerbate the situation. 

Lower levels of oestrogen and ageing in general can lead to a slower turnover rate of skin cells, so renewal of the upper layers of the skin, the epidermis and dermis, is not so efficient as prior to the menopause. 

Oestrogen also controls the sebaceous glands, which produce the skin's natural oils, so erratic hormone production experienced during perimenopause can cause an array of skin problems. 

Hair loss is another, less common, feature of the menopause.  Changing hormone levels can affect growth rate, and may affect hair follicles, sometimes leading to hair loss.

Flooding is a common symptom.  It should always be taken seriously as it can be a sign of benign tumours such as fibroids. 

Flooding is described as particularly heavy periods that cannot be controlled with sanitary pads.  Usually flooding occurs in an irregular pattern, signalling the erratic production of ovarian hormones. 

Headaches, as with flooding, are a symptom of menopause, but can signify an unrelated illness. 

Flatulence, bloating, digestive problems, and tingling sensations on the skin are other effects of the menopause on women's bodies.

Psychological symptoms

Memory loss, confusion, and lack of concentration are some of the most distressing symptoms of menopause and can cause much associated worry.  They contribute to the depressed mood that often accompanies this time of life.

Depression, anxiety, weepiness, and irritability can be major causes of disruption and debilitation during the menopause.  

When women feel physical and emotional effects of age creeping up on them this is also a major factor in the depression that accompanies menopause.

Complications

Although menopause itself is a natural process, not an illness, there are complications that can occur as a result of the processes involved. 

Since oestrogen has a number of protective effects, long term post-menopausal oestrogen deficiency can lead to increased health risks such as osteoporosis, cardiovascular disease and stroke due to increased fatty deposits in the arteries, and weight gain due to changes in body fat distribution and metabolism. 

Another complication can be a prolapsed womb, where the womb drops into the vagina.  This can be dealt with quite simply be a GP.

20/05/2009