Anna Clayton is a Senior Physiotherapist and Director of Bury Physiotherapy Clinic, working closely with people experiencing the menopause. Alongside musculoskeletal physiotherapy, Anna provides a women’s health service at Bury Physio Clinic. Anna talks about the early symptoms of the menopause and the effects of contraception on hormonal health from a professional perspective.

Perimenopause can begin from the age of 35, however it doesn’t necessarily mean that from the morning of your 35th birthday and thereafter, you will be bombarded with night sweats, brain fog or unexplainable rage until you hit your 50s.

Some women will start to experience symptoms much earlier, and others into their late 40’s, or not at all. The menopause is the 12 months since your last period, then you can celebrate (or commiserate) that you have then entered post-menopause.

There can be differences in the experiences of symptoms for women who are not on contraception versus those who are in this perimenopause time span (aged 35 -50 approx).

To understand how your body is evolving as you enter this life stage, it is essential to understand how it functions ‘normally’ in the lead up, and for that we’ll back track to the menstrual cycle.

There are 2 phases to the menstrual cycle: the follicular phase and luteal phase, with ovulation in the middle. Oestrogen and progesterone fluctuate throughout, with oestrogen, peaking at ovulation and again, but not to such a high level, in the luteal phase.

If you are not on contraception and you track your cycles, temperature, and possibly vaginal mucus at ovulation, you may be aware of how the body and your energy levels also fluctuate with the hormones.

This is because oestrogen has an influence on approximately 400 different functions in our bodies, and it is when the systemic levels start to decline as we age that we can notice changes in the body via ‘menopausal symptoms’.

If you are on a form of contraception in your 40s then the fluctuating levels of oestrogen and progesterone are maintained on an even keel using synthetic forms of oestrogen and progesterone, with the main intention of preventing ovulation and pregnancy.

Contraception can improve symptoms of heavy periods associated with endometriosis and other pelvic pain/hormone issues, and whilst current evidence indicates they are safe to use, they do remove the ability to track any changes that might otherwise occur to a natural cycle when we progress through our 40s.

Having said that, women on contraception can still experience peri/menopausal symptoms.

If you are wondering how it is you might identify if you are near the menopause year and you are on contraception, in short - you can’t, however, the closer you are to age 50, health professionals use age as the determining factor that you will likely be closing in on the age at which oestrogen levels reach peak decline.

Patients that come into clinic often present with varying combinations of the symptoms, and these can gradually build up, or seemingly all pile in at the same time. Use a diary to note significant changes to behaviour, mood or physical differences as this helps to monitor patterns – and reassure you that you have not lost your marbles!

Often the main questions about peri and menopause management are ‘how can I help myself?’, particularly if women aren’t at the stage where HRT is an option. Below are five key elements to hormone health and this can apply even if you are on contraception:

• Good levels of hydration – helps body functions, and gut health/motility/digestion (plus alcohol slows the breakdown of oestrogen in your liver, so moderation/reduced intake is key).

• Good nutrition - protein, veg, fruit, and high fibre ensures good gut health. Nutritional therapy advice can be helpful to look at foods that might irritate gut, or aggravate symptoms of perimenopause (eg spicy food).

• Adequate quality sleep - this is when our repair systems kick in as 39-47% women have sleep disturbance.

• Exercise - particularly for the benefits on heart health and bone health. Both of these elements are affected by a drop in oestrogen which is cardio and bone protective, so working the heart at both high and moderate intensities and strengthening the bones with weight bearing/resistance band/hand weights exercise is essential.

• Reduced stress - mindfulness, relaxation, talking therapy, outdoor nature etc.

Whilst many women are juggling work, children, older parents, and their own health concerns, perimenopause is not a life phase to be apprehensive about. Being well informed about how to track and manage changes in our bodies (physical/mental and emotional) sets the tone for the post menopause phase and ‘aging well’.

There can be a lot of other factors to consider in the management of symptoms, however using the support through GP, workplaces, the Menopause & Me project, peer support and HRT if you choose will enable continued quality of life as you navigate this stage.