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Perimenopause: How do I know I have it, and how does it differ from regular Menopause?  

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Hot flashes? Mood swings? We speak to a women’s health expert to get the lowdown on menopause, perimenopause, and how to recognise symptoms

While the phrase “of a certain age” can sometimes feel low-key offensive, it does apply to one unavoidable feature of middle-aged motherhood: menopause. At what age can you expect to start experiencing “The Change”? And what are the key symptoms to look out for? We spoke with leading gynaecologist and former Head of KK Women’s and Children’s Hospital’s Peripartum Unit, Department of Maternal Fetal Medicine, Dr. Chee Jing Jye, to find out more. Perhaps you’ve heard terms like Perimenopause and Premenopause – Dr. Chee breaks down the differences and lets you know what you can expect, mama.

Premenopause, Perimenopause and Menopause: How do they differ?

Menopause, by medical definition, is when a woman has no menses for at least 12 months due to cessation of hormone production by the ovaries. Menopause typically happens around 50 years of age. Menopause sometimes can happen earlier due to reasons like family history of early menopause, smoking, chemotherapy or surgical removal of the ovaries for various medical reasons.

“Pre” means “before”, so “premenopause” simply means before menopause. Premenopause refers to the time when a woman has regular menses with normal levels of hormones from the ovaries.

“Peri” means “around”, so “Perimenopause” means the period of time before and after menopause. This is also the time when most women will have symptoms related to menopause.

What are the symptoms?

Perimenopausal symptoms can start a couple of years before menopause occurs. In other words, for a typical woman who will menopause at 50, she may start to feel perimenopausal symptoms from the age of about 47 or so. The symptoms will usually abate within 1 year after menopause.

Classical perimenopausal symptoms would be hot flashes and night sweats. These are essentially the same things, except the latter occur at night. A woman experiencing hot flashes or night sweats would suddenly have a warm feeling arising from her chest going up to her head, and she will break out in a profuse sweat. This can happen anytime regardless of the surrounding ambient temperature, meaning a woman can still experience this in sub-zero temperatures.

The other classical tell-tale sign of this symptom is that it will be all over within a couple of minutes. So if a woman feels warm for “most of the day”, she is unlikely to be having hot flashes.

Other symptoms attributed to perimenopause include insomnia, mood swings and irritability. However, these are not specific to perimenopause. Other contributing factors or causes need to be excluded before one can safely say the symptoms are due to perimenopause.

What remedies or treatments can I take to alleviate the symptoms of perimenopause?

Perimenopausal symptoms will resolve spontaneously. As mentioned, the symptoms will usually abate within one year after a woman has menopause, even without any form of treatment.

Of all the symptoms, hot flashes are probably the most obvious and disturbing. Some things a woman experiencing such symptom can do to cope would be

  • Dress in layers. As and when the hot flush hits, outer layers of clothing may be peeled off easily to allow one to cool down quickly.
  • Have a handheld fan handy in your purse. Fanning oneself during the hot flashes will also help a lot in cooling down and will also allow the perspiration on the face and neck to evaporate quickly.

Some women find their symptoms to be very debilitating, especially if they have multiple hot flashes and / or night sweats every day, causing disturbance to their quality of life. In such cases, a short-term hormone replacement therapy (HRT) will work. As mentioned earlier, the symptoms will resolve spontaneously with time. So the aim of the HRT here is to tide the woman over the perimenopausal period when they are very symptomatic.

After one year or so, the HRT can be stopped to see if the symptoms are still bothersome. If the symptoms are gone, then there is no need to continue the HRT. On the other hand, if the symptoms are still very disturbing, the HRT can be continued for another 6 mths to 1 year. The HRT should be stopped once the symptoms are not deemed to be bothersome anymore.

Plant-based hormones like phytoestrogens have not been proven to be useful in treating the perimenopausal symptoms.

Can you get pregnant when you are perimenopausal?

During the perimenopausal period, the hormones produced by the ovaries are lesser, so the woman ovulates less frequently. However, ovulation may still occur, so pregnancy is still a possibility.

Thank you so much, Dr. Chee! For more information, you can contact Dr. Chee’s office at (+65) 6732 9882, or visit her website at www.drjjcheegynae.com.

Lead image and image #2 sourced via Getty; fan image by Siniz Kim

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