Everything you need to know about perimenopause and its impact on your mental health and sex life

We concur, being a woman is hard. We live in a painfully patriarchal world and our lives are made a tad bit harder by the gamut of biological changes that our body must go through—our teenage years are coupled with hormone troubles, periodic bleeding, bloating, sore breasts, and more. And menstruation is a forever-kinda affair. Almost. The late twenties and thirties, for some of us, mark the onset of motherhood—cravings, morning sickness, swollen ankles, and a child in your belly. 

And just as it seems there could be nothing more, we’re welcomed by menopause and its unofficial partner, peri-menopause. We’ve all heard of menopause and the symptoms it brings with it for a decade or more. Yet, today’s medical buzzword is perimenopause and we’re here to give you the download—from an insight into the concept to its impact on mental health, your hormones, sex life, and navigating your way through it. 

Perimenopause and its symptoms 

According to an article in Healthline, perimenopause occurs before you officially hit menopause. “Hormonal changes are seen about a decade ahead of menopause.” While perimenopause is marked by a drop in the oestrogen level it is still possible to get pregnant, but with the onset of menopause, the ovaries produce such little oestrogen that it is not possible to get pregnant. “Perimenopause can last many years and is characterised by changes in the levels of oestrogen and progesterone, the two major female hormones. These hormonal changes might have an impact on women's physical and emotional health,” says Dr Shweta Wazir, consultant of obstetrics and gynaecology at the Motherhood Hospital, Gurugram.
 
The symptoms of perimenopause include irregular periods, lighter or heavier periods than usual, breast tenderness, weight gain, difficulty in concentrating, loss of sex drive, and urinary tract issues among others. “Symptoms of perimenopause can vary from person to person. However, the most common ones are sleep disturbances; hot flashes; dryness inside the vagina, especially during sex; mood swings; depression; irritability; cognitive changes such as memory loss or brain fog; and even reduced self-esteem,” says  Dr Manoj Kutteri, medical director and CEO of Atmantan Wellness Centre. 

The phase can be challenging for those going through it and, perhaps, for even those around them. “It's important to note that each person may experience perimenopause differently and it may have different effects on their mental health,” says Kutteri. “It is not a disease but a phase of life that marks the end of one’s reproductive years. And instead of fearing it or feeling ashamed about it, embrace it with dignity and pride. Many women associate menopause with ageing, loss of fertility or loss of femininity. Women frequently fear being stigmatised, and thus may regard menopause as a private or personal topic that cannot be discussed. Menopause is a natural and positive transition. It is a time to celebrate your wisdom, strength, and beauty. It’s the beginning of a new and exciting chapter in your life,” says Wazir.

Impact of perimenopause on mental health 

Besides the physical changes, perimenopause can also have an impact on your mental health and well-being. “The hormonal changes during perimenopause can lead to immense mood swings, depression, and anxiety. In many cases this can be extreme,” says psychologist Nisha Khanna. “Depression occurs in approximately 20 per cent women experiencing perimenopause; it is more likely in those with a previous history of depression or anxiety and results in a low mood, fatigue, the feeling of worthlessness, and, at times, suicidal thoughts. The manifestations of these hormonal changes can be hot flashes, panic attacks, difficulty in breathing, and whatnot,” adds Kutteri. 

Chances are that mental health issues will also have an impact on your relationship with your partner and others around you. “Consult with a healthcare provider for the right support if you feel your mental health is suffering or that you're in a lot of distress. Some women go through this phase without any issues, but some might have trouble in relationships due to irritability and mood swings,” says Kutteri. “Some women may feel out of sync with their peers who are not going through menopause, or who have different experiences of the phase. It is important to respect and appreciate the diversity of menopause experiences and to seek help if needed. There are effective treatments and coping strategies available for women who struggle with their social connections during menopause,” adds Wazir. 

Impact of perimenopause on sex life 

The drop in oestrogen levels can have a direct impact on your sex life. “Sometimes, the loss of sex drive can lead to the loss of intimacy in relationships; couples may feel distant from each other. In such situations, when physical intimacy is a problem and mood swings are frequent, emotional connection is a must—you should be able to be open and honest about your thoughts, emotions, and feelings. You should also take out some time for self-care, connect with yourself, and spend time with your loved ones,” says Khanna.
    
“Seek professional help to assist you navigate your experience. Besides this, the loss of sex drive at this age could be due to a lack of novelty in sexual routine. You can try new positions, locations, and other forms of sexual satisfaction like oral sex, massage, and so on. You should plan regular dates with your partner and keep the romance alive,” says Wazir. 

Combating perimenopause and when to seek professional help 

“Sometimes, if the symptoms you experience are more than the “normal” condition, it can affect your daily life. To manage these phases in life, it is better to adopt a healthier lifestyle—from sleeping well and adding physical exercise, to having a balanced diet and eating necessary vitamin supplements.” 

Sometimes, you may not be able to distinguish between normal and extreme levels of symptoms that you may be experiencing, and that’s when you should seek professional help. “If you have risk factors and complications such as osteoporosis, cardiovascular disease, diabetes, thyroid, or cancer you should see a healthcare professional,” says Wazir.

“Seeking professional help may also be a good idea if you have questions or concerns about their symptoms, diagnosis, treatment options, or prevention strategies and if you need emotional support or counselling to deal with the psychological and social changes and challenges of perimenopause,” says Wazir.