Is it perimenopause? The lesser known menopause symptoms

Menopause is something that we all like to think that we know about, characterised—or caricatured—by night sweats and hot flushes.

Young women don’t talk about it, in the knowledge that it awaits. Older women distance themselves from it, having been through it and knowing that they won’t need to go through it again. 

It is not a health concern that gets much air time and there is much misinformation, where menopause and perimenopause are misunderstood by the majority of people—including the women who are experiencing it. 

One of the greatest difficulties with perimenopause is that there are just so many potential symptoms related to declining oestrogen levels.

So, while there are plenty of well-known symptoms—including the much-derided hot flushes and emotionality—it’s possible for a woman to move into perimenopause without knowing it because they don’t have the classic presentation. 

In fact, according to the 2023 Forth Women’s Health survey, the best-known perimenopause symptoms aren’t even the most commonly experienced.

Of the 6,806 women questioned by Forth, 87 per cent experienced mood changes during the perimenopause, while 79 per cent experienced poor sleep and 78 per cent had digestive issues, the latter of which is rarely ever mentioned when the topic of menopause arises.

This compares with just 43 per cent who experienced hot flushes and 54 per cent who experienced night sweats, underscoring the fact that for a lot of women, menopause isn’t what many people believe it to be. 

And there are a range of other symptoms experienced much more commonly than the few that are broadly acknowledged.

These include brain fog, joint and muscle pain, changes to sex drive, headaches, vertigo, dizzy spells, and dry or itchy skin, meaning that the lived experience of the menopausal woman may be very different to that so commonly portrayed in the media. 

Although perimenopause is most commonly associated with women aged 40-44, there are several linked physiological symptoms known to be experienced by both younger and older age groups. 

88 per cent of the Forth survey respondents in the 30-39 age bracket, for example, reported vaginal dryness and pain during sex, something that is experienced far less commonly amongst those over 40. More of the women in this age group also reported bloating and digestive issues, lower sex drive, and drier skin. 

While for women aged 50-59, poor sleep and memory changes were far more common, along with increased frequency/need to urinate, irregular periods, headaches, dizzy spells, and vertigo. 

Although strongly associated with perimenopause, it’s important to note that all of these symptoms can also be associated with a wide range of other conditions, or even be a result of external factors.

So, unless a woman has tested for menopause or perimenopause—and even if she has – it’s essential not to ignore them.

Bladder weakness, for example, can be caused by something eminently treatable, such as pelvic floor dysfunction, or conditions that can be highly detrimental to health if left untreated, like type 2 diabetes or a bladder tumour.

With all of these issues, awareness is key to ensuring that women feel understood, supported, and physically well. 

While research is helping to provide a greater understanding of perimenopause and the lived experience of women at this stage of life, the variety of symptoms does make diagnosis difficult.

Without a blood test to check the hormones that are directly involved in perimenopause—not currently offered as standard on the NHS—women can be left feeling confused and uncertain.

Many will suffer in silence, dismissing treatable conditions as something that they simply have to accept at this time of life. 

Perimenopause can be a difficult subject. It is rarely spoken about, with women often feeling upset or diminished at their loss of fertility, and keeping their symptoms and experiences to themselves.

This opens up an enormous possibility for misconceptions and misinformation. This needs to change if women are to be empowered to take control of their perimenopause and menopause experience.

Until women start realising what help is available, menopause will continue to be shrouded in secrecy, and women will continue to suffer in silence.