How 3 Gynaecologists Are Getting Through Perimenopause

The language around menopause needs to change. Menopause is actually the term given to our final period. But it’s done in retrospect, so you don’t know it’s your last period until you’ve gone 12 months without one. Perimenopause, on the other hand, is a term that describes the years leading up to your final period. The symptoms women experience during this time vary significantly, and then once your periods have finished, symptoms can last for up to four years, on average.

I experienced an early menopause in my mid-30s. My husband and I started trying for a baby when I was 29 but we struggled, so I made the decision to start IVF. My ovaries responded poorly to the drugs given to stimulate them – this was the first sign my ovaries were acting more like a woman much further along in her reproductive life than expected. At the same time, I started experiencing terrible hot flushes, which were particularly bad if I drank coffee, and my once good sleep became terrible. I also experienced joint aches and struggled running around the hospital at work. I put my low mood down to not getting pregnant, but in hindsight the terrible anxiety and lack of motivation may well have been at least partially hormonal. 

I was diagnosed with premature ovarian insufficiency. Also known as POI, this is the official term for menopause below the age of 40. It wasn’t until I fractured my wrist on holiday that I began to take things seriously. Developing osteoporosis is a risk factor for premature menopause (and menopause), so I went to my GP to start HRT. I felt better within days. I was far less achy, my hot flushes and night sweats vanished – it felt like a veil had been lifted when it came to my ability to concentrate and multitask. I only wish I’d started HRT sooner. I’m now 39 and still take HRT and plan to do so for the rest of my life. I also take calcium and vitamin D supplements daily. 

Not all women need HRT. However, if your symptoms are affecting your quality of life, then replacing lost hormones will make the world of difference. Be patient though, as it can take a bit of trial and error to find your correct dose. Start with a gel or spray so you can gently increase the amount you use. You may also experience irregular bleeding on starting treatment, but this usually settles, either by itself or by tweaking your dose.

You can start HRT if you still have periods. My experience is proof that you are never too young to start HRT, but women are sometimes told they can’t start HRT until their late 40s – for no good reason. Similarly, there is no maximum age to start HRT, nor any age at which you should stop. 

Don’t be afraid to look beyond your GP. I often marvel at how GPs manage to fit HRT and menopause discussions into ten-minute appointments. Read up before any appointment you do have and know what you might want to explore. Balance Menopause is a fantastic app that helps you track and understand symptoms, and if you do look for a private clinic, look for a specialist recognised by the British Menopause Society. 

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In hindsight, I ignored my menopausal symptoms for years. I started properly noticing them at the beginning of 2021, although looking back, I think my hormones had been affecting my wellbeing for years. I had resigned from my long-term job a couple of years previously and was struggling with anxiety and insomnia. But I worked in the NHS during the Covid crisis so had put a lot of my symptoms down to that. In hindsight, this is a very common theme with women I speak with. The turning point came when I was having some routine blood tests done – they confirmed I was going through menopause. I started HRT and felt better within a few weeks – HRT is fantastic when it works.

Yoga keeps me strong and sane. I do Yoga with Adriene most days and love it – it supports my physical and mental strength, and is a fantastic way to start the day. I have also reduced my alcohol consumption and started to pay more attention to eating nutritious foods that support my gut health – the gut plays an important role in how we produce and metabolise certain hormones. I also ditched my dog walker and prioritised walking the dog, and started taking vitamins B and D and magnesium. 

Arm yourself with knowledge. Thanks to an increasing awareness of menopause, there’s never been more information available. I love Dr Louise Newson’s podcast, which I listen to on dog walks, as well as Menopause by Kate Muir on Audible and anything by Brené Brown. I also recommend The Perimenopause Solution by Dr Shahzadi Harper and Emma Bardwell to all my patients and love Dr Rangan Chatterjee’s The 4 Pillar Plan. The more you know, the better. There are still so many myths surrounding HRT: some of the most common are that HRT causes blood clots; that you can’t take it if you still have periods, or if you have a family history of breast cancer, or if you’re overweight, have blood pressure issues or regular migraines. None of this is true. 

Make time for self-care. Put time in your week before work, family and other commitments. This may include exercise – the most evidence-based and effective thing we can all do for our long-term health – but also meeting up with friends, spending time on hobbies and rest. 

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I recently made the decision to start HRT. I’m 46 and struggle with sleepless nights and night sweats, and have recently put on weight around my stomach, despite being slim everywhere else. A friend told me that since taking HRT she feels like she’s in her 20s again, with boundless energy and feeling full of vitality. I will be starting with oestrogen and progesterone – starting by getting stable on the oestrogen then potentially taking testosterone. If you are oestrogen deficient, testosterone gets converted into oestrogen anyway, so it’s not always essential to take it. I will be taking HRT as a gel and tablet.

Don’t be a martyr. The consequences of the menopause can be devastating – one in four women will experience symptoms that can last up to 15 years. Women regularly come to me saying they have given up work or turned down a promotion because of their symptoms – they struggle with their relationships and mental health. It’s unbelievable that menopause isn’t given the same consideration as other hormone deficiencies – such as diabetes or hypothyroidism – despite the lack of hormones leading to considerable morbidity in women. If you are living with symptoms, chat to your GP or a doctor who specialises in the menopause. HRT can change your life. 

Take an active role in your prescription. Under the NHS, there are two main types of HRT – oestrogen and progestogen – for women who still have their womb and oestrogen-only HRT for those who have undergone a hysterectomy. However, testosterone should factor into the mix, too. Unfortunately, the NHS doesn’t recognise this and as a result there isn’t a licensed testosterone formulation for women in the UK. Testosterone is essential for sex drive, metabolism, muscle strength and bone density. As a result, women are having to use formulations designed for men. It’s essential that women have access to a licensed female testosterone product and that access is standardised across the UK so it is not a postcode lottery. 

Women are still afraid of HRT. The media still portray the risks of HRT but science has debunked the myths. In my experience, HRT is still feared by many health professionals, who sometimes actively discourage their patients from taking it, rather than having a balanced discussion, considering up-to-date evidence instead of older, flawed studies. There hasn’t been enough education surrounding the benefits of HRT.

If you’re struggling to get support, find a local menopause clinic. If your GP isn’t being responsive, look elsewhere. Menopause clinics are mainly private, but there are some NHS ones – you can find your nearest one here.

Supplements have also helped me. At any given time, 4.7 million women in the UK are suffering from hair loss and research has shown there’s a clear link between hair and self-esteem. I’ve been taking Viviscal for several months now – it’s a fantastic supplement that really works. Skinade is also great – it helps rebuild and strengthen the collagen matrix below the skin’s surface to boost hydration and reduce the appearance of fine lines.

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DISCLAIMER: Features published by SheerLuxe are not intended to treat, diagnose, cure or prevent any disease. Always seek the advice of your GP or another qualified healthcare provider for any questions you have regarding a medical condition, and before undertaking any diet, exercise or other health-related programme.