EXPLAINER: What is perimenopause and how do you get through it?

Claire, 50, suddenly felt warm on a cold afternoon. At first, she didn't really make a big deal out of it. And then she began to say more frequently, "It's really hot today!" Weeks later, she realized it was unusual because sometimes, even when the air conditioner was on, she would feel a sudden onslaught of warmth. “It's like my body would heat up internally,” she said.

She started to feel more and more tired, most times listless doing activities she once enjoyed. "Things are suddenly harder to do because I'm able to focus less," Claire shared, adding that she also found it difficult to sleep all of a sudden. It all happened gradually.

“What was going on?” she wondered.

Claire found out she was experiencing perimenopause when she sought the help of a doctor for a yeast infection that wouldn’t go away. "I was somehow relieved when I knew what it was. Something really didn’t feel right in my life, especially when I began to dread going to the gym. I’m usually like an Energizer bunny so I was really confused,” she shared.

"I thought you'd only get hot flashes when you were actually menopausing," she continued. It turns out, there's an entire time frame—about a decade—where you experience perimenopausal symptoms, all of which can affect your life in more ways than one.

What is perimenopause and what are its symptoms?

Perimenopause happens during a woman's transitional years before menopause. "Before you have that last menstruation, you already have symptoms," obstetrician-gynecologist Agnes L. Soriano-Estrella told PhilSTAR L!fe. "When we talk about natural menopause, it means that there is permanent cessation of the menstrual period for twelve consecutive months without any pathological cause. Menopause means that your menstruation is not occurring anymore. That's natural menopause."

According to obstetrician-gynecologist Maria Jesusa Banal-Silao, it can begin five to seven years before menopause and its symptoms may vary from person to person—with hot flashes being one of the most common. Among Filipinos, about three out of five women, or about 63%, will mention to their doctors that they experience it. "Exactly what you feel is a sudden, transient sensation of warmth. And then it's an intense heat over your face, chest, neck, and head. Sometimes, it is concluded by profuse perspiration," Dr. Soriano-Estrella explained, adding that there are a few lucky women who don't experience it at all, too.

Others who are transitioning to menopause, meanwhile, deal with night sweats. "It's just like you're having hot flashes, but at night. Sometimes, it can lead to sleep disturbances if they wake up often, and some may become anxious about it. Their sleep is not right, and it's not so efficient. They don't have a good night's sleep so they won't have a perfect day the next day," said Dr. Soriano-Estrella.

Dr. Banal-Silao also told L!fe that one can have mood swings, irritability, and depressive mood with perimenopause. "Sometimes, there's also what we call brain fog; you're more forgetful. There are feelings of low energy. Some women will complain that they wake up feeling like they have no energy. The hot flashes and night sweats can aggravate the psychological part," she continued.

Joint pain and itchy skin are also symptoms of perimenopause. One could likewise experience vaginal dryness, which could worsen as the years pass. "As your ovaries age, the amount of estrogen being released gets smaller. As you go through perimenopause, menopause, and later on, when there's absolutely no estrogen anymore, the incidence of the dryness goes straight up," Dr. Soriano-Estrella said.

How to handle perimenopause

Going through perimenopause–and aging–isn’t easy. "When we approach people with perimenopause, we have to consider the whole health landscape that they're in. It's not just the perimenopausal symptoms," obstetrician-gynecologist Issa Matibag said in an interview with L!fe. "At this stage of life, a lot of women also develop comorbidities, like hypertension, diabetes, autoimmune diseases, and even malignancies. It's really a whole bunch of things that you have to screen them for and not just perimenopause. It would be best to treat them holistically."

One of the most effective ways to deal with perimenopause is by having hormone replacement therapy (HRT) that improves one's hormone levels. "We can give it as a preventive strategy. It will correct the hot flashes and improve sleep patterns disrupted by night sweats. And, of course, when it comes to sexual problems from dryness and not wanting to have intercourse, you're giving back the estrogen that the patient has lost. It will improve the sexual life of the woman as well," Dr. Soriano-Estrella added.

Per Dr. Matibag, HRT costs around P30 or P900 a month.

The medical experts stressed the importance of seeing their OB-GYNs regularly once they reach their 40s. But suppose they can't manage the psychological symptoms of perimenopause, Dr. Matibag said it's best to consult a psychologist, therapist, or psychiatrist as well.