Menopause how do I love thee – let me count the ways

You may have been led to believe that the menopause arrives one day, along with your last ever period, transforming you into a wizened, sweaty version of your former self.  However, you do get a bit of a run up – anywhere between a few months to 10 years. Every experience is different. The perimenopause […]

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You may have been led to believe that the menopause arrives one day, along with your last ever period, transforming you into a wizened, sweaty version of your former self.  However, you do get a bit of a run up – anywhere between a few months to 10 years. Every experience is different.

The perimenopause refers to those symptoms which may occur as your hormones level drops, before your periods stop for good.  The list of symptoms is long and varied, and you may be surprised by some of them. They can be mild or severe, and cumulatively can make you feel miserable.

However, there’s no need to simply put up with them and struggle on, we want you to aim higher.

We’ve broken them down into vague categories, although they all overlap to some degree.  Remember, you probably won’t experience all of them, or severely, but the are the things to look out for.

Physical Symptoms

First, the common physical symptoms we most associate with the menopause start to show themselves.

Irregular periods

Periods don’t stop overnight, and can become unpredictable for a while. Your cycle may get longer or shorter, your periods heavier or lighter. PMT may still be an issue (sore breasts, mood swings) but may miss the accompanying period.


Yes perimenopausal women can legitimately claim to have a headache, especially if its been a common premenstrual symptom for you too. Your hormones affect the chemicals in your brain, which can result in pain.

Bloating or tender breasts

In the same way, if you experience premenstrual bloating or tenderness, you may find it hangs around a little longer than usual during this transition phase.

Hot flushes

This is probably the most recognised symptom, with up to 79 percent of women experiencing them to seem degree.  It’s not merely ‘feeling a bit hot’, you feel a burning slowly rising up towards your face and neck.  You might turn red or sweat and they can be an embarrassing if they happen in awkward situations.

Night sweats

Oh and they can happen at night too.  Not only are they unpleasant, they disrupt your precious sleep. Sometimes they are so severe you may need to change the bedding in the middle of the night, which is not going to make you popular if you share a bed.

Sleep issues

Most women over 40 will frequently say they are exhausted – and with good reason.  Up to 60 percent of women in some stage of menopause experience sleep disturbances that affect their quality of life, whether that’s night sweats, needing the loo or a simple inability to sleep.  We have some further advice on that here.

It’s not entirely clear whether it’s a hormonal change or an natural sign of ageing that we sleep less soundly than when we were younger.


Even if you do get a good night’s sleep, you may not feel much better.  Fatigue is a common symptom of perimenopause.  Life is tiring! As with nearly everything, a healthy diet and regular exercise is going to help that – however it’s worth having a quick check-in with your GP if nothing seems to help.

The physical changes to our appearance during this time can be distressing, and it’s important to know how our bodies are  ageing, and what, if anything, we can do about it.

Weight gain

Your changing middle aged body can be difficult to some women to come to terms with, affecting their sexual confidence and body image. Hormonal changes can cause weight gain, particularly around your middle so it’s even more important to have a healthy diet and plenty of exercise.

Hair changes

While your middle may be getting fuller, you may see the opposite effect on your hair, which may not be quite so thick as it used to be.  Some women may experience some thinning too as oestrogen levels drop.  It will fall out more quickly and regrow more slowly.

Skin issues

Oestrogen affects the collagen levels in your body, which is a key component in our skin looking plump and youthful.  As we lose collagen, our skin may become dry and itchy.  We don’t need to notice or talk about the wrinkles.

Brittle nails

Oestrogen is also needed to keep our nails strong, so if they no longer withstand what they used to, the perimenopause may be to blame.   When hormone levels decline, nails become weaker and split or crack more easily.

Gum issues

Make friends with your dentist as, you’ve guessed it, our hormones also affect our teeth and gums.  Up to 60 percent of women have some kind of dental health issues during perimenopause.

Body odour

All those hot flushes can cause your body to sweat more, which is not always pleasant for the person nearby. Your hormones can also cause your body’s natural scent can change.  Just like the teenage years, regular washing and a good deodorant should do the trick.

Sexual Wellness

And if all that wasn’t enough to make you not exactly in the mood, there are other changes the perimenopause brings which can affect your sexual activity.

Changed interest in sex 

Sweaty sheets aren’t the only problem, and some women feel less interested in sex, while others feel decidedly friskier. Every woman’s experience is different.  Some of that change is due to fluctuating hormone levels, along with the additional long list of symptoms which may make you feel less than your sensuous self.

Vaginal dryness

Painful or uncomfortable sex is a common complaint during this time.  Your declining hormones mean your vaginal tissue begins to thin, producing less of your natural lubrication. Vaginal dryness can also feel like itching, burning or general discomfort.  These symptoms can be alleviated in a variety of ways, but if left untreated the effects could be permanent.

Bladder issues

It may be time to get rid of the trampoline.  That lowering of oestrogen and thinning of the vaginal tissue can also result in stress incontinence.  This is when you wee if you sneeze, laugh too much, life something heavy.  Or you may just not be able to hold on like you used to.  Going to the loo more often is also a problem.


So your body is a mess and your sex life has taken a nose dive, but there are a whole host of mental and psychological symptoms too.  You’re not going mad, it’s your hormones.

Mood swings

You may have learnt to cope with PMT mood swings, but the perimenopause can turn it up a notch.  It’s not just the rage or irritability that we associate with the menopause, anxiety and depression are common, often misunderstood, side effects.  Roughly 23 percent of women will experience mental health symptoms to some degree.


The main emotion people associate with perimenopause is irritability or rage. Women in their 40s often have a lot to be angry about, but if you’re finding yourself suddenly or inexplicably irritable, you can blame your hormones. Yoga, meditation and exercise can all help, or maybe just shouting.


As well as erratic changes, women often experience more lasting changes to their mental health.  Women are twice as likely as men to develop depression, and the menopause can be a trigger for this.  GPs often prescribe anti-depressants at this time but it’s worth considering whether there might be hormonal reasons behind any issues you’re facing.


You many also find that anxiety becomes and issue, or gets worse. As your hormone levels rise and fall, they affect your emotions and many women feel nervous or on edge but can’t explain why.

Panic attacks

At the severe end of this spectrum, while not a common symptom, some women may experience panic attack.  Your hormone levels are creating a storm of emotional and physical distress that your body can react to.

Cognitive Function

Brain fog, is also a common complaint.  You may have difficulty focusing during activities at home or work (I’ve made three cups of tea writing this article).  This is, once again, caused by a drop in oestrogen which affects how the brain uses energy.  You may become forgetful, or struggle to process things that you used to find straightforward.  Forgetting what you went upstairs for has an actual medical explanation.

You can try to alleviate this by keeping your brain as active as possible.  Crosswords, maths problems, sudoku or learning a new skill are all worthwhile.

Me too! I wondered what that was!

The list feels fairly long and depressing already, but there are a few other symptoms which fall into the ‘I wondered what that was’ category

Joint pain

Everyone expects to get a little achy as they age, but you don’t expect it to happen so young! Oestrogen works to strengthen your bones and reduce inflammation in your joints.  As your levels drop, inflammation can make your joints feel painful.

Electric shocks

No, you have not turned into Captain Marvel, but fluctuating hormone levels can make you suddenly feel like you’ve received an electric shock. Often this can occur just before you get a hot flush.  Bonus.

Burning tongue

Remember when we talked about your dry vagina?  Well the same thing can happen to your mouth.  Mucous membranes in your mouth can also be affected by lower oestrogen, which dries out your mouth and can make your tongue feel like it’s burning.

Muscle strain

Not only do your joints feel painful, you may find muscle strain more of an issue.  Much of this is caused by the psychological issues we’ve discussed already.  Anxiety and stress tighten your muscles which make them easier to strain – even turning over in bed can be hazardous.  Once again, yoga, meditation and exercise can provide the solution.


Like a Victorian lady, you may become susceptible to sudden unexplained bouts of dizziness.  It can often have many causes, but if your swooning is accompanied by other perimenopause symptoms, it’s most likely that.

Digestive problems

Oestrogen isn’t the only hormone at play here, although it does affect the others.  Normally oestrogen helps to keep your cortisol (stress hormone) at a healthy level.  As your oestrogen drops, your cortisol levels soar, making you feel stressed and upsetting your digestion. Nausea, cramp, heartburn and flatulence can all become an issue.


You may have gone through life allergy free, but the perimenopause is the perfect time to add some new ones.  Oestrogen also links to your immune system, so it’s easier to suddenly be irritated by something which never bothered you before.

Tingling in extremities

Tingling and pins and needles can all worsen during perimenopause, and you can also feel numbness or burning sensations. Oestrogen also affects your central nervous system, which can then send confusing messages to the far corners of your body.

Heart palpitations

These confusing signals from your central nervous system can also reach your heart, causing it to skip a beat or have palpitations.

All of the symptoms listed above can have major or minor impacts on our lives.  Some last only a short time or some can last for years.


However our last symptom, osteoporosis, is almost certainly the most important.  Osteoporosis leads to weak bones which easily fracture. Oestrogen is vital in maintaining healthy, strong bones and is one of the major benefits of Hormone Replacement Therapy.

What can you do?

We don’t want this list to depress you (although it might).  There’s a good chance you won’t experience all of these symptoms, or only mildly.  Millions of women go through this stage of life every year and cope in a million different ways.

Take some time to look at this list and see what seems familiar to you. If you’ve ticked off a fair few, and they are affecting your day to day life, it’s time at talk to book a consultation with us. You can discover the right treatment to ease your symptoms. It doesn’t always involve HRT, sometimes some natural remedies or lifestyle changes are all that’s needed, but sometimes you might benefit from a prescription. Understand what’s happening to your body and what you can do.

Final thought

However many of these symptoms you are experiencing, there is no obligation to grit your teeth and struggle on.  There are no badges or certificates for martyrdom, and there is a wealth of treatments available to you. Aim higher for your health and your happiness.

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Online consultations available to help you with:
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A note on our language

Throughout this website, we use the term women when describing people who experience hormonal symptoms. However, we acknowledge not only those who identify as women require access to menopause and hormone health information. For example, some trans men, non-binary people, intersex people or people with variations in sex characteristics may also experience menopausal symptoms and PMS/PME or PMDD, and we warmly welcome everyone who needs this support in our clinic.

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