Perimenopause is the transitional phase leading up to menopause, marking the end of a woman’s reproductive years. Symptoms can start up to 10 years before menopause, which is the point when a woman has not had a menstrual period for 12 consecutive months. Perimenopause is characterized by hormonal fluctuations as the production of sex hormones such as oestrogen and progesterone, declines.

Symptoms of Perimenopause

Symptoms of perimenopause can vary widely among women but may include:

1. Irregular menstrual cycles: Menstrual periods may become irregular in timing, duration, and flow.
2. Hot flushes and night sweats: Sudden sensations of heat, often accompanied by sweating and flushing of the skin.
3. Sleep disturbances: Difficulty falling asleep or staying asleep, often due to night sweats or other hormonal changes.
4. Mood swings: fluctuations in mood, including irritability, anxiety or depression.
5. Vaginal dryness: Decreased lubrication in the vaginal area, which can lead to discomfort during intercourse.
6. Changes in libido: Some women may experience a decrease in sexual desire.
7. Changes in skin and hair: Hormonal fluctuations can lead to changes in skin elasticity, texture, and hair growth patterns.

Individuals may notice one or all of these symptoms. It can be difficult to put all the pieces together and hence discussions with your GP are vital to look at strategies to manage and treat perimenopause if suspected.

Treatment for Perimenopausal Symptoms

The treatment options for perimenopausal symptoms depends on their severity and the individual’s preferences and include:

1. Hormone therapy: Estrogen therapy or combined estrogen-progesterone therapy can help alleviate symptoms. 
2. Non- hormonal medications: certain antidepressants may help alleviate symptoms like hot flushes and mood swings.
3. Lifestyle changes: healthy lifestyle habits, including regular exercise, a balanced diet, stress management techniques and adequate sleep, can help manage perimenopausal symptoms.
4. Vaginal moisturisers and lubricants: for vaginal dryness and discomfort during intercourse, these may provide relief. 

Perimenopause should be taken seriously as it can significantly impact a woman’s quality of life and may increase the risk of certain health conditions, such as:

1. Osteoporosis: decreased estrogen levels during perimenopause and menopause can lead to bone density loss and increase the risk of osteoporosis, a condition characterized by brittle and fragile bones.
2. Cardiovascular disease: Estrogen plays a protective role in heart health, and the decline in estrogen levels during perimenopause and menopause may increase the risk of heart disease and stroke.
3. Cognitive changes: some women may experience cognitive changes, including difficulty with memory and concentration, during perimenopause and menopause.
4. Emotional well-being: Hormonal fluctuations during perimenopause can contribute to mood swings, anxiety, and depression, impacting emotional well-being.

Perimenopause and Exercise

In perimenopause, incorporating a variety of exercises that focus on cardiovascular health, strength training, flexibility, and balance is recommended. Consideration needs to be given to how you feel on the day and as such you may need to be flexible with your expectations. Have a variety of activity to chose from as some days you may feel like you have boundless energy and can smash the weights or a run; other days it will be a struggle to engage in any activity so a more gentle approach on those days may work better for you. Below is a brief list of why it is important to include activity in your weekly routine during perimenopause.

1. Aerobic Exercise: Aerobic exercise, also known as cardiovascular exercise, is crucial for heart health, weight management, and mood regulation during perimenopause. Activities such as brisk walking, jogging, swimming, cycling, dancing, and aerobics classes are beneficial.
2. Strength Training: Strength training exercises help maintain muscle mass, bone density, and metabolic rate, which tend to decline during perimenopause. It can include weightlifting, resistance band exercises, bodyweight exercises, or using weight machines.
3. Yoga and Pilates: Yoga and Pilates focus on improving flexibility, balance, and core strength, which can be beneficial for managing symptoms such as mood swings, stress, and sleep disturbances during perimenopause.
4. Tai Chi: Tai Chi is a mind-body exercise that incorporates slow, flowing movements and deep breathing. It can improve balance, coordination, and mental well-being, which may be particularly beneficial for women experiencing mood swings or anxiety during perimenopause.
5. High-Intensity Interval Training (HIIT): HIIT involves alternating between short bursts of intense exercise and brief recovery periods. It can improve cardiovascular fitness, metabolic rate, and insulin sensitivity, which are important considerations during perimenopause.
   Incorporating a combination of these exercises into a regular fitness routine can help women manage symptoms, maintain overall health, and improve their quality of life during the perimenopausal transition. Just remember to have a schedule of activity where you can be flexible in your participate and always have an alternative option. Remembering that some days, it is better to do something than nothing at all.

Albeit perimenopause is a normal part of life for people with ovaries, its effects and symptoms are often overlooked or accepted as the norm even when they disturb normal day-to-day activities and quality of life.   

No treatment is without risk. Hormone replacement therapy (HRT) has had a bad rap and has previously been associated with a higher risk of breast cancer. Nowadays HRT has far less risk associated with its use than ever before. The long-term health benefits of HRT as mentioned above can, for many, far outweigh the risk of the medication. It is important to assess your level of risk with your GP and work out what you are comfortable with in regard to treatment.

There are other natural therapies that some people report success with. These natural remedies or treatments can be a great starting point for addressing your symptoms. It is always suggested that you speak with your GP about any recommendations that you receive to be sure that there are no contraindications with any other health conditions or medications that you may be on. 

Perimenopause is not just someone ‘being emotional’ or having problems with their periods. Perimenopause is real and can have potentially devasting and lifechanging symptoms. There is no need to be ashamed or embarrassed about asking for assistance if you think it is having an impact on your life. There is also no need to suffer in silence. If you think you are experiencing symptoms of perimenopause or would like to know more, further information can be found at https://www.jeanhailes.org.au/news/lets-talk-about-perimenopause or https://www.balance-menopause.com/ 

Exercise Physiologists can assist in setting up exercise programs that will work with your level of symptoms, such as accommodating lethargy, or brain fog. Perimenopause is often a time that women find it challenging to exercise. It is recommended to meet with a practitioner who understands these challenges and can accommodate for them in your training, whether you are currently active or not, so you can achieve the most benefit from exercise.