WTF is Perimenopause? We Break it Down with Dr. Linsey Leach

Let’s begin by saying perimenopause is nothing short of being damn confusing. Often women enter into this phase with no clue whatsoever. We were never briefed on this! So, how on earth are you expected to wade through this impenetrable ocean of information when you’re already neck-deep in symptoms like fatigue, rage, and sweats? We hear you. That’s why we are tackling perimenopause in bite-sized chunks, so you don’t have to. Even better, we have an army of experts here to give you a professional opinion when you need it most. 

Wizz Selvey:

Can you tell us a bit about yourself and your experience in female health?

Dr. Linsey Leach:

I am a General Practitioner (GP), and I've been practising as a GP for 14 years. I specialise in women's health, which I genuinely love. Being a woman myself, I find that women of a certain age tend to prefer coming to see me. By default, I see a lot of female patients and have developed a deep understanding of women's health issues. This experience has always fueled my passion for learning more.

Wizz Selvey:

That's really inspiring. So many women don't even know how early perimenopause can start, or what the symptoms are. To top it all off, it can be incredibly confusing to find a reliable source of information.

Dr. Linsey Leach:

Yes, there is a lot of information out there, but it isn’t always helpful.

Wizz Selvey:

Now that we have you here to answer our burning questions, first off  — how can we spot the signs of perimenopause? More specifically, how does early perimenopause typically present?

Dr. Linsey Leach:

Exactly, it's a tricky one indeed. Perimenopause can be difficult to identify because the symptoms are varied and can start quite subtly. Basically, it all comes down to understanding these symptoms and piecing them together to see if they indicate perimenopause. 

Menopause nearly always occurs at the busiest time in a woman's life, factors like extended work and family responsibilities —  it can all further complicate the diagnosis. By carefully examining what's happening in a patient's life and by excluding other medical issues, we can arrive at a diagnosis, through a process of exclusion. I believe it is so important for women to recognise the symptoms and consider that they might be experiencing perimenopause. We simply must raise awareness. And it’s discussions like this that can really help women to have those light bulb moments where they realise, ‘That’s it, I’m in perimenopause now!

Wizz Selvey:

You say perimenopause could start quite early. In your experience, what is the age that women should start considering whether they are in perimenopause?

Dr. Linsey Leach:

The average age of menopause is around 51, but symptoms can start as early as 10 years prior to that. We often see women in their early forties presenting with subtle symptoms. Starting to recognise these early signs can empower women to make lifestyle changes and prepare for the journey ahead.

Wizz Selvey:

What would you say constitutes a ‘subtle symptom’, as you mentioned?

Dr. Linsey Leach:

The main early symptoms include mood changes, which often coincide with changes in menstrual periods. Women may notice their cycles becoming irregular or experiencing changes in bleeding patterns, such as heavier or lighter periods. Mood changes, including low mood and increased anxiety, are common early indicators. These symptoms are often cyclical, aligning with the menstrual cycle.

Wizz Selvey:

Why does anxiety increase for many women during this time?

Dr. Linsey Leach:

All these symptoms are related to the gradual decline of oestrogen. Oestrogen affects almost every organ in the body, including the brain. As oestrogen levels drop, it impacts neurotransmitter function, which can increase anxiety. Although research is still exploring the exact mechanisms, it's clear that the reduction in oestrogen affects the brain's neurotransmitters, contributing to mood changes.

Wizz Selvey:

As these early stages progress over the 10-year period, how do the symptoms typically evolve from the early to the middle and later stages?

Dr. Linsey Leach:

Yes, firstly I would say mood changes can persist throughout, potentially becoming more intense or changing significantly over time. In particular, early anxiety might develop into a more pronounced low mood. And as oestrogen levels continue to decline, other symptoms like hot flushes and insomnia often worsen. Many women also experience a noticeable decrease in libido. There are also more subtle symptoms, such as changes in skin, hair, and nails, which women often manage on their own and may not bring up with their doctors. The range and intensity of symptoms tend to increase rather than just remain subtle, as time goes on.

Wizz Selvey:

And when would you encourage someone to seek help from a doctor or medical professional regarding perimenopause?

Dr. Linsey Leach:

Honestly, as soon as possible. We often see women in their late thirties to early forties who don't realise they might be experiencing perimenopause. They might come in with symptoms like anxiety or low mood, wondering if it’s related to their diet, or thyroid, or they might be thinking they have diabetes. And, while it is important to rule out these other possibilities first, we can also consider perimenopause as a likely cause.

Wizz Selvey:

It’s so true. I’ve also heard many women are misdiagnosed with depression instead of perimenopause. Is this common, and why do you think that is?

Dr. Linsey Leach:

Yes, it's quite common. Mood changes, such as anxiety and low mood, are among the earliest symptoms of perimenopause. As doctors, our goal is to alleviate symptoms in the short term, so we might start by treating the mood symptoms. Stabilising mood can significantly help with other aspects of a woman's well-being. However, we also have got to recognise that these mood changes might be part of a broader hormonal shift.

Wizz Selvey:

I’d love to know more about the physical, emotional, and mental changes that happen over the years leading to menopause. Let's begin with the physical changes.

Dr. Linsey Leach:

Physically, periods change significantly. They may become irregular, with longer or shorter cycles, and often get heavier before tapering off. The absence of periods for a certain time is the true sign of menopause. Other physical changes include dry skin, hair thinning and dryness, and nail changes. Anxiety can cause heart palpitations, night sweats, day sweats, and hot flushes, which are challenging to manage daily. These symptoms also affect sleep, leading to further fatigue. Another thing is, women often experience achy joints, which can really take a hit on their exercise routines and overall activity levels. This, if untreated, further impacts their health in a negative way, and it’s a big problem.

Wizz Selvey:

And what about the emotional changes?

Dr. Linsey Leach:

Emotionally, the most common changes include increased anxiety and low mood. The severity and type of mood changes vary from person to person and can be influenced by lifestyle factors. Increased worry, fear, lack of motivation, and concentration difficulties are particularly prevalent. Menopause-related "brain fog" is really quite common, it involves blurred thinking and cognitive challenges, primarily linked to mood changes.

Wizz Selvey:

Yes, brain fog is a big one that a lot of people talk about. What exactly happens to the brain during menopause that causes this really quite irritating symptom?

Dr. Linsey Leach:

To understand brain fog, we must firstly understand that oestrogen affects cognition, and its decline can slow down cognitive functions. Therefore, brain fog is often related to these fluctuating oestrogen levels. And while the exact mechanisms are not fully understood, the fluctuation in oestrogen levels leads to the "foggy" feeling. I would say, however, that this symptom tends to improve once oestrogen levels stabilise. In fact, the fluctuations in oestrogen during perimenopause cause most of the common symptoms, and once the body adjusts to lower oestrogen levels, those symptoms often become more manageable.

Wizz Selvey:

Please can you explain the significant change in oestrogen levels during perimenopause, as compared to our younger years?

Dr. Linsey Leach:

Yes. So, in our younger years, oestrogen levels cycle consistently, without the significant fluctuations seen in perimenopause. During perimenopause, oestrogen levels go up and down erratically, unlike the more stable cycles of earlier years. This change mirrors the initial years of menstruation in some teenage girls but is more pronounced during perimenopause.

Wizz Selvey:

What are your recommendations for women considering Hormone Replacement Therapy (HRT)? There’s a lot of talk around whether people should or shouldn’t use it.

Wizz Selvey:

And what if someone doesn’t want to take HRT? Is it still worth seeing a doctor?

Dr. Linsey Leach:

Oh absolutely. You must, in my opinion, talk to a medical professional, even if you decide against specific treatments. This is because a confidential conversation with someone who is separate from your personal life can provide clarity and support for many women. I would even go as far as to say, sometimes, just simply discussing your symptoms and understanding the journey you are on can make all the difference to how you feel. A problem shared, as the saying goes.

Wizz Selvey:

Agreed. We must keep the conversation going, at all costs. But back to HRT, what are the different ways to take this medication?

Dr. Linsey Leach:

There are so many methods available now, and women have the option to choose one that suits them personally. Traditionally, HRT was taken in tablet form, but that's not necessarily seen as the preferred method anymore due to some people experiencing absorption issues. So, alternatives nowadays include patches, sprays, and gels, which are often better absorbed. Sprays and gels typically provide oestrogen only, so you might need to take progesterone in another form, like a tablet or a progesterone hormonal coil, to balance the hormones.

Wizz Selvey:

Thank you. And what about testosterone? Am I correct in saying it’s also pretty important for women as well as men?

Dr. Linsey Leach:

Oh exactly, yes, it’s so important for women, and for many reasons. Women will typically experience low levels of testosterone, which is important for a healthy libido, among other things. That said, we use testosterone with caution and mainly for libido issues, we wouldn't use it for any other symptom — plus, if someone is taking it we must always measure and monitor levels carefully through testing. I should also stress that before considering testosterone for libido, we ensure women are on the maximum effective dose of oestrogen, as oestrogen is the primary hormone we need to manage.

Wizz Selvey:

In your opinion, how can supplements help with hormone levels?

Dr. Linsey Leach:

It’s really about enhancing your body’s ability to absorb and use the natural oestrogen you still have left. Different supplements can help support this process by balancing hormones and making the most of that oestrogen that remains in your system.

Wizz Selvey:

And how does exercise fit into a hormone-supporting lifestyle?

Dr. Linsey Leach:

Oh, for sure, yes. Exercise plays a massive role, by giving a boost to your natural oestrogen but also by increasing endorphins — making you feel good. I would recommend exercise in almost every consultation because staying fit, healthy, and active is the cornerstone for managing symptoms while maintaining a great quality of life in perimenopause.

Wizz Selvey:

Oh, sure thing, definitely. Lastly, many women fear being misunderstood or wasting time in the doctor's office. What would be your answer to this issue?

Dr. Linsey Leach:

To make the most of your doctor’s appointment, it helps to be prepared, as much as you can be. Start by keeping a symptom diary, in here you can note any changes in your menstrual cycle and other symptoms over time. You can also do a bit of research on perimenopause — this article is a good starting point to research anything else you are unsure about. And I’d also recommend looking on the NHS site for more information. Then jot down any questions you have remaining, so you can get the answers you need for yourself on a personal level.

It’s also super important to know your personal and family health history and be ready to discuss it. When you meet with your GP, don’t be embarrassed to bring anything up—you’re almost certainly not alone in these issues that might seem a bit taboo. Sharing everything openly will help ensure you’re understood and get the most out of your consultation. I hope this helps!

Wizz Selvey:

We’re sure it will help! Thank you so much Linsey, you have answered so many pressing perimenopause questions and provided some clarity for women in this confusing time. Until next time.

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We’d love to hear from you—how’s your perimenopause journey going? Did you find this article helpful? Let’s keep the conversation going.

*Please note that the information provided in this article, including any product recommendations, is for informational purposes only and is not intended to diagnose, treat, cure, or prevent any disease. Always consult with a healthcare professional before starting any treatment.