Dr. Olga Sambolska. Photo courtesy of Family Medical Practice

Dr Olga Sambolska*

Many women say they're "in menopause", while they're actually going through the menopausal transition, also called perimenopause. This is the period before the full menstrual cycle cessation, and comes with specific physical changes.

The first sign of perimenopause is an irregular menstrual cycle. Menstrual cycles become longer or shorter, with heavy bleeding or spotting between periods from declining ovarian function. Heavy bleeding in turn can cause fatigue and increase risk of anaemia.

Then there are the hot flashes – a common name for vasomotor symptoms. They come on rapidly and can last from one up to 5 minutes. They range in severity from a fleeting sense of warmth to a feeling of being consumed by fire from inside out. A major hot flash can induce facial and upper-body flushing, sweating or chills. Hot flash frequency varies widely. Some women have one per week, others may experience 10 or more in the daytime and even at night.

Another symptom is slowed metabolism and weight gain caused by hormonal changes, causing fat storage around the belly. This excessive body weight increases the risk of diabetes type 2, hypertension, heart disease and respiratory problems.

Some women experience ''foggy brain": attention problems and increased forgetfulness. This memory decline is not a sign of dementia, as these cognitive changes are typically small and well within normal range. Also sleep problems may occur, from full insomnia to interrupted sleep or waking up too early.

Other symptoms are depression, anxiety and mood swings. These are caused by estrogen fluctuation, leading to decreasing serotonin, our "happy hormone". There can be irritability or sudden feelings of anger called "perimenopause range". Another symptom can be vaginal atrophy, which feels like "dry" vagina and causes painful intercourse.

Some lesser-known perimenopausal symptoms are altered depth perception, “dry, watery or tired” eyes, body odour, wild hair (chin, nipple), joint pain and stiffness, muscle and bone ache, voice changes, skin sensations like tingling or itching with dryness.

The signs and symptoms described above are usually enough to tell that a woman started the menopausal transition. In some circumstances, blood tests can be necessary to check the level of Estradiol and FSH hormones or the thyroid function.

Many perimenopausal symptoms are of little concern and can be easily remedied — Photo shutterstock.com

How to reduce perimenopausal symptoms before starting hormone replacement therapy (HRT):

1. Healthy diet plays a crucial role to minimise menopausal symptoms:

- High fibre food with cruciferous vegetables such as broccoli, cabbage and kale helps to balance estrogen levels. Fibre is important for the cardiovascular system, maintaining cholesterol levels, keeping a healthy weight and reducing constipation. Some of the best sources include nuts, seeds, legumes/beans, and avocado.

- Omega-3 fats from fish and flaxseed can protect the heart, and promote smooth skin. The best resources are salmon, sardines, mackerel and anchovies.

- Healthy fats and cold-pressed oil: it's true that fats have more calories than proteins or carbohydrates, but they are essential for metabolism and many processes in our body. Moreover, unrefined oil provides vitamin E that helps regulate estradiol levels. Good sources of healthy fats: extra-virgin olive or flaxseed oil, coconut milk and wild seafood.

- Probiotic foods: as probiotics help to regulate levels of key hormones like insulin and leptin, capable of raising the immune system and cognitive function. The best sources include yogurt, kefir and other fermented food.

2 Water: aim for 8 glasses daily to help replace fluid loss from hot flashes and decrease bloating

3 Avoid certain foods like packaged food, as it contains added sugar, chemical preservatives, and high amounts of sodium and synthetic additives. Avoid sugary and carbonated drinks, and reduce alcohol and caffeine intake as both aggravate hot flashes and contribute to weight gain

4 Regular exercise like yoga, aerobic or strength-training, 10-30 minute activity most days of the week help to reduce depression, improve sleep quality and body weight.

5 Reduce stress: stress causes higher cortisol hormone levels which leads to weight gain, fatigue, poor sleep and low libido. Different stress-reducing techniques to relieve stress: meditation, acupuncture, aromatherapy, and spending time in nature.

6 Sleep: our body and brain need time to recover from daily stress and restore energy, the aim is 7-9 hours of sleep per night. Excessive stress and poor sleep lead to higher cortisol in the morning and as a result higher susceptibility to anxiety and trouble with work performance.

Not every woman in menopause experiences unpleasant symptoms. Some women have all of them, some just a few, others experience none at all. Many perimenopausal symptoms are of little concern and often correct themselves given time. Others can be easily remedied by diet, exercise, hormone therapy or other medications.

If symptoms of perimenopause become severe and affect quality of life: it's time to check in with a healthcare provider. — Family Medical Practice

*Dr Olga Sambolska graduated from Lviv National Medical University in 1996 and commenced her medical career at the Volyn Regional Maternity Hospital in Ukraine. Since 1998 she has been a registered obstetrics and gynecology doctor, providing healthcare to women in relation to pregnancy, birth control, menopausal issues, contraception, menstrual cycle diseases and sexually transmitted diseases. She is fluent in Ukrainian, Russian, Polish and English.

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