December 6, 2022

Menopause is having a moment. From Davina McCall’s groundbreaking documentary series to how-to books from celebrities including Mariella Frostrup and Andrea MacLean, there are more places than ever to find out what to expect from the change in life.
But that doesn’t mean we’re all prepared for what lies ahead. Conversations about the most common symptoms – including hot flushes, irregular periods, insomnia and anxiety – are happening everywhere, yet not every woman experiences these classic signs.
In fact, the first indications that you’re entering perimenopause – the stage before the menopause when oestrogen levels begin to fall – might be far more subtle. This can begin in some women in their 30s, but most often it starts in women ages 40 to 44, with the NHS saying menopause happens normally between 45 and 55.
We asked top doctors and health experts to tell us about the body changes you might miss that are telling you you’re in perimenopause – and when to reach out for help.
When oestrogen levels start to drop, it can lead to inflammation of tissues and muscles throughout the body – including in the mouth. Just like in pregnancy, changes to hormone levels can lead to problems with gums and teeth as the body overreacts to plaque buildup. This can cause gum disease, which presents as red, swollen or bleeding gums. Thinning of the tissues in the mouth can also lead to pain or soreness, a sensation of burning or changes in taste.
Another problem a dentist might spot is inflammation of the periodontal ligament, which holds the teeth into the jawbone. “If that muscle becomes inflamed as a result of generalised inflammation, that will lead to sensitivity that won’t resolve with a change of toothpaste or adjustments to the bite,” says dentist Dr Sam Jethwa.
The most important thing is not to ignore it. “As we age, healing takes longer. Really good oral hygiene at home is important, and see the hygienist more frequently,” Dr Jethwa advises.
Often, long-term sensitivity resolves once a woman starts on hormone replacement therapy (HRT). Most dentists have very little training in the effects of female hormones on the mouth, so if you’re over 40 with long-term tooth sensitivity that your dentist can’t explain, discuss perimenopause with your GP.
Oestrogen levels affect the hypothalamus gland, responsible for body temperature, which explains the classic menopausal hot flush. But changes to the hormone’s action on the hypothalamus can show up in other ways too. Women may simply sweat more easily, or in more unusual places such as around the hairline or the nape of the neck.
Excess sweating might mean their body odour changes, becoming more intense and harder to manage. This can be compounded by changes to the natural bacteria that live on the skin. “Skin flora can change [in perimenopause], naturally being a bit out of harmony, just like our vaginal health might change,” says Dr Radhika Vohra, an expert in menopausal medicine and a trustee of The Menopause Charity.
If you notice a change in your smell, it’s time to start paying attention. “It’s definitely a reason to start tracking your cycle, downloading an app or keeping a diary to see what your cycle is doing, and start joining the dots,” Dr Vohra says.
Another surprising complaint in perimenopause is the onset of tinnitus – a sensation of hearing sounds that aren’t present, such as ringing or whooshing noises – which is reported by up to 20 per cent of women.
“It can be mild or it can be really annoying, and it can be exacerbated by other menopause symptoms such as anxiety,” says Dr Vohra. Act early because there are behavioural strategies, such as relaxation and distraction techniques, that can stop it getting worse and affecting your quality of life.”
Blepharitis, an inflammatory condition of the eyelids which leads to an overgrowth of bacteria on the eyelashes and lids, is common in perimenopausal women. Symptoms include red, burning and sticky eyes, excessive eye watering, light sensitivity and that annoying feeling that you’ve got something in your eye. It can also lead to constant twitching.
Unfortunately there is no cure, but there are treatments to keep it under control. “The mainstay of treatment at all stages is lid hygiene to control the bacterial build-up,” says consultant ophthalmic and oculoplastic surgeon Dr Elizabeth Hawkes. “Other treatments such as antibiotics, steroids and ocular lubrication may also be necessary.” Most of all, it could be an early indication that your hormones are in flux.
Hair transplant specialist Dr Furqan Raja is seeing growing numbers of midlife women with concerns about hair thinning and loss. Hair loss can be a sign of more serious illness, so it’s always worth seeking medical help – but hormone shifts in perimenopause can also cause hair to change rapidly, with hair becoming thinner, wispier or frizzier, or even falling out in patches. There is a genetic component, so women with female relatives who have experienced age-related thinning should look out for the same.
“In the very early stages, it depends on the sensitivity of the follicles. It’s similar to male pattern baldness, where some become bald at a very early age but with others it takes a long time to progress,” Dr Raja says.
“It’s very early on [in perimenopause] and it may be very subtle, but the female population tend to pick up on this very quickly and tend to come in and want a solution. A lot of women want to have a hair transplant straight away but we have to take a step back and carry out the right investigation.”
Dr Raja first asks patients to get checked for thyroid conditions, nutritional deficiencies, fluctuations in iron levels and anaemia, all of which can compound the problem. Crash dieting or extreme vegan diets can also lead to hair loss, so ensuring a balanced diet is a good preventative for women entering perimenopause. HRT may also help to restore the hair’s lustre.
Women know that menopause can lead to vaginal dryness, but the earliest signs of intimate changes be something slightly different. Pain in the vulva and itching can be annoying complications of the loss of volume of the labia majora, which leaves the vulva less protected, according to Dr Shirin Lakhani.
“It can happen at any time, and some women experience it early,” she says. “Get help whenever you first start being bothered by the symptoms. Hot flushes can get better over time, but genitourinary symptoms of menopause don’t and it’s likely to continue to get worse.” HRT is the “gold standard” treatment and can resolve symptoms entirely.
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