When Canberra GP Dr Kelly Teagle became a new mum, her elation was soon clouded by irritability, anxiety and poor sleep.
Using a Mirena IUD contraceptive device meant she no longer had periods, so Kelly didn't notice one of the more obvious signs of perimenopause: an irregular cycle.
Still, she asks, "As a doctor who specialises in women's health, how did I not realise what was happening to me?"
For British writer Liz Earle, sleep disturbance sent her scrambling to her GP. The mother of five can handle what life throws at her – with a good night's sleep!
"I think it's fair to say the perimenopause takes most of us by surprise – we may feel in the peak of good health, only to become aware of niggling, troublesome changes," she says.
"There are literally dozens of symptoms associated with perimenopause, including itchy skin, weight gain, hot flushes, night sweats, sleep disruption, depression, anxiety, water retention, poor memory, brain fog, change of body shape, dry eyes and aching joints."
When someone mentions menopause, you probably picture flushing, forgetfulness and temper flares. Yet these usually begin in perimenopause – the beginning of the end of your periods (but not your life!).
Most women enter perimenopause between 45 and 55 years of age and it usually lasts four to six years, though can last up to 10.
"Think of perimenopause almost as a second puberty," says Dr Peta Wright, a gynaecologist in Brisbane, Australia.
"The ovaries are running out of eggs but the pituitary gland starts working overtime, pushing the ovaries to ovulate. This can result in hormone swings, shorter cycles, heavier or irregular periods, hot flushes, vaginal dryness, libido changes, muscle aches, sore breasts and brain fog."
Symptoms tend to dissipate as you approach menopause around age 52.
"Twenty per cent of women will move through perimenopause smoothly, but 50-80 per cent will experience symptoms ranging from mild to severe," adds Dr Wright.
There's no simple blood test to pinpoint perimenopause, so if something is bothering you, see your GP.
In 2002, menopausal hormone therapy was wrongly linked to breast cancer.
Experts now stress there is no increased risk from taking oestrogen and natural progesterone and that hormone therapy is safe and effective for the vast majority of women.
"Other benefits are a decrease in osteoporotic fractures and cardiovascular disease and possible positive effects on the menopausal weight shift from the hips to the abdomen," adds Dr Wright.
"Modern forms of hormone replacement therapy, such as gels, patches and micronised progesterone all come from the wild yam plant, are molecularly body identical and can be considered to be simply a natural topping-up of that the body had earlier in life," adds Liz, whose download The Truth About HRT is available from lizearlewellbeing.com.
"A conversation about perimenopause should always start with a holistic approach," says Dr Wright.
"Healthy habits can go a long way to improving or easing your symptoms before you even look at MHT." Her advice is to choose a Mediterranean diet, adding that some women find eating phytoestrogen-rich foods (such as tofu and soy) helpful, "although evidence is minimal".
Also try to...
Exercise to keep your bones and cardiovascular system healthy and promote positive moods.
Meditate or practise mindfulness to ease mood changes and anxiety.
Sleep 7-8 hours a night to keep you feeling your best.
Layer clothes and bedding in breathable fibres.
Connect with friends/family to help you cope and keep moods stable.
Take care of yourself. Don't be last on your list because stress can exacerbate symptoms.
Quit as smokers may go through menopause earlier and suffer more from hot flushes.
Detox as endocrine disruptors such as BPA, phthalates, parabens and pesticides may be linked to early menopause.
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