Perimenopause is not the end of the world

Problems with sleep

“Night sweats are the nighttime version of hot flushes and can disrupt sleep. Some women say that they can cope with hot flushes during the day but not at night,” says Hickey. “Sleep is complicated, and whether menopause contributes to poor sleep beyond night sweats isn’t clear. But again, cognitive behaviour therapy can help.”

Other factors that can disturb midlife sleep include stress (your teenager’s still out and it’s 2am), and alcohol, which can send you to sleep but then cause you to wake up during the night, according to Jean Hailes for Women’s Health.

Weight gain

Menopause itself doesn’t add kilos, although symptoms like lack of sleep can make it harder to stick to a healthy weight. But hormone changes can mean you store weight differently, with extra fat settling around the middle instead of hips and thighs. In post-menopausal women, belly fat can account for 15 to 20 per cent of total body fat, compared with 5 to 8 per cent before menopause.

Age-related muscle loss can also increase weight. Losing muscle slows your metabolism, meaning your body burns fewer kilojoules, making it harder to keep weight off, explains Professor Robin Daly, chair of exercise and ageing at Deakin University’s Institute for Physical Activity and Nutrition.

But there’s an antidote. “Our research with post-menopausal women found that four months of twice-weekly strength training was enough to rebuild most of the muscle they’d lost in the previous seven to eight years,” he says.

Memory loss

Brain fog – being easily distracted and having difficulty concentrating, for example – is common. But whether it’s because of hormone changes is uncertain, Hickey says. “The few studies conducted show small changes in memory during perimenopause that recover after menopause. There’s no evidence to suggest cognitive decline or any association with later cognitive issues like dementia. It’s likely that pressures in midlife and sleep difficulties are contributing.”

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Mood changes and mental health

Low mood affects some women at menopause, but it can be hard to untangle the cause. Lack of sleep and stress related to juggling family and work can have an effect. Suggested coping strategies range from practicing mindfulness and getting more exercise to seeking therapy.

As for a higher risk of problems like anxiety and depression, a review of studies of menopause and mental health last year found no universal increased risk, Hickey says.

“Although it’s possible that women with a history of depression might have a recurrence during menopause, and that women with severe menopause symptoms might have a higher risk,” she says.

Changes to the vagina…

It’s one thing to be upfront about hot flushes, but if there’s one post menopausal topic we don’t broadcast, it’s that cause of sandpaper sex – less lubrication in the vagina and vulva that affects some women after menopause. Low levels of oestrogen mean these tissues get thinner and lubrication scantier, sometimes making sex painful.

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“But it doesn’t happen overnight,” says Dr Judith Hammond, a GP working with Jean Hailes for Women’s Health in Melbourne. “It’s a gradual process over time, although during perimenopause when oestrogen levels can go up and down, levels of lubrication can fluctuate, so there may be times when you’re more lubricated than others. But menopause may not be the only culprit. If you’re feeling stressed during sex for some reason, you won’t lubricate as well.

There are also other ways to stay lubricated, she adds, including over-the-counter vaginal moisturisers, silicone-based personal lubricants, and prescription vaginal oestrogen. Very little oestrogen from vaginal oestrogen products is absorbed and it’s considered safe for most women – check with your doctor.

…and the bladder.

The same hormone changes can affect the bladder, making you need to pee more often, or more urgently, says Hammond. Again, vaginal oestrogen may help (and reduce the risk of recurrent UTIs). Strengthening pelvic floor muscles helps too – a specialist physiotherapist can show you how.

The ups and downs of libido

Menopause isn’t the death knell to good sex. A 2015 study found that around 73 per cent of 57 to 64-year-old women reported an active sex life. You’ll hear that shifting hormone levels at menopause can cause a drop in libido, but there’s not much evidence for this, says Hickey. Besides, as Judith Hammond says, issues like stress, fatigue, painful sex and the quality of your relationship can have an effect.

“How women experience menopause is very individual, and for some women, it’s business as usual.”

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