Tingling tongue, achy joints or itchy skin? When it comes to the signs of menopause, we've all heard of classic symptoms such as flushes, sweats and insomnia, but, at times, bizarre symptoms may also occur. The jury is still out as to whether these are caused by the hormonal roller coaster or whether it's just coincidental that they happen at the same time as hormones start to dwindle. Women report a lot of strange symptoms around this time and although there is no strong scientific evidence that they are caused by fluctuating hormones, there are oestrogen receptors (protein structures that let oestrogen into cells) throughout your body. Periods become irregular perimenopausally, which can mean premenstrual symptoms (swollen breasts, bladder problems, bloating and migraines) become unhinged from the normal cycle, making them difficult to interpret. Women often complain of feeling generally unwell. Doctors often suggest a three-month trial of low-dose HRT. If symptoms improve, they are probably hormone-related; if not, further investigation is warranted.
What is perimenopause?
It's the years running up to your final period. It usually begins in your late forties to early fifties, but can start any time from your early forties.
A 2009 review found irritable bowel syndrome (IBS) symptoms - such as abdominal pain, bloating, bowel discomfort and changes in bowel patterns, together with diarrhoea and/or constipation - become more common perimenopausally both in women with and without IBS. They are thought to be caused by the effects of fluctuating oestrogen and progesterone on pain "pathways" in the gut and the brain.
- Exercise, stress management, regular meals, and limiting caffeinated and fizzy drinks and alcohol, can help.
- Insoluble fibre (bran), found in wholemeal bread and cereals, can exacerbate symptoms, so steer clear.
- Soluble fibre, found in foods such as oats, pulses and linseeds can - by contrast - help, especially with bloating, so try to eat some of it every day.
- Probiotics can help to rebalance gut bacteria, which may be a factor in IBS. Try Activia yogurts from supermarkets or a probiotic supplement such as Bio-Kult, £8.99 for 30 capsules, from pharmacies.
Simple changes to how you eat can help to ease digestive problems - don't skip meals or eat late at night sit down to eat, take your time over your meal and chew the food well.
More than half of women experience joint and muscle pains perimenopausally; oestrogen is responsible for stimulating collagen, a fibrous protein that gives the skin strength and resilience and acts as a scaffold for it and other tissues.
- Although it may be uncomfortable, exercise can help. Walking, muscle-strengthening exercises - such as squats and lunges - and yoga are good choices.
- A hot-water bottle or heat pack can help to increase mobility, especially before exercise, while a cold pack can reduce inflammation.
- Eat more Brazil nuts - one of the best sources of selenium, low levels of which are linked to arthritis. Other sources include beef seafood and chicken. Or try a supplement such as Healthspan Selenium 200mcg, £6.45 for 180 tablets, healthspan.co.uk.
- In studies, GOPO Joint Health supplement eased pain, improved mobility and reduced the need for painkillers. It contains a rose-hip extract as well as vitamin C, which is needed for collagen formation.
DIZZINESS AND VERTIGO
Although they don't often appear In medical textbooks, dizziness, llght-headedness and vertigo frequently crop up on patient websites and forums and often occur with flushes. The cause Is unknown, but a 2010 US study suggests a type of headache, called vestibular migraine, which may or may not cause a headache, may be responsible. It's thought to be due to hyperexcitablilty of the brain, triggered by the effect of fluctuating oestrogen and progesterone on brain messenger chemicals.
- Try to identify and avoid triggers - stress, poor sleep, light, noise, coffee, chocolate, blue cheese and red wine are common ones.
- Stress management, exercise and limiting your intake of salt, especially around your period, may help.
- Prescribed medications, from antidepressants to certain blood pressure-lowering drugs, may help.
Around two-thirds of women experience memory lapses, poor concentration, fuzzy thinking, slowness and other cognitive changes, according to US research. They are thought to be due to the disrupted balance between oestrogen and progesterone on nerve cells, rather than simple loss of oestrogen. Symptoms appearing perimenopausally are usually worst in the first postmenopausal year, then seem to improve.
- Stress exacerbates cognitive problems so take regular breaks, give yourself wind-down time, and make time to see friends.
- Make notes, use Post-its and your smartphone to remind you of appointments and other things you need to remember.
- A supplement of Ginkgo biloba may help - studies suggest it improves blood flow to the brain. Try Pharma Nord Bio-Biloba Gingko Biloba lOOmg, £19.50 for 60 tablets, from pharmacies.
A SKIPPING HEART BEAT
Palpitations - fast or irregular heart beats - are extremely common perimenopausally. Fluctuating levels of oestrogen, causing sudden widening of the blood vessels (the same mechanism that causes hot flushes), may be responsible. A recent study found that heart rate increased by, on average, four beats a minute during a hot flush. Palpitations often occur at night, or while you are relaxing.
- Rest and breathe quietly for five minutes.
- Regular meditation can keep them at bay.
- Avoid alcohol and caffeine: don't smoke.
- Learn how to take your pulse, so you can identify when it's fast; it should be 60 to 100 beats a minute.
- If dizziness, fainting, or tightness in the chest or neck accompanies palpitations, seek immediate medical help.
Itchy skin (medical name pruritus) is another common symptom, usually caused by drier skin due to loss of oestrogen and collagen. Acne, thinning skin, wrinkles and changes in pigmentation are other symptoms. Sensations such as tingling and numbness (known as paresthesia) and something called formication, which feels as if insects are crawling on or under your skin, can also occur. These are thought to be caused by the effects of fluctuating hormones on the central nervous system - see the doctor if you experience these.
- Increase intake of omega-3 fatty acids found in foods such as salmon and walnuts.
- Drink six to eight glasses of water a day to keep skin hydrated.
- Hot water can be drying, so use warm water and shower rather than bath.
- Moisturise! E45 Intense Recovery Moisture-Control Lotion is said to alleviate dryness in two weeks. £5.99, from Boots.
- Avoid smoky atmospheres, stress, and lack of sleep, which can exacerbate itchiness.
A BURNING TONGUE
This is one of the weirder symptoms of the perimenopause, affecting four out of ten women. It's thought to be a result of activation of pain-sensitive nerve cells surrounding the bitter taste buds at the back of the tongue, which can be damaged by dwindling oestrogen. Symptoms, which can also affect gums, lips and other areas of the mouth, typically start between three years before and 12 years after menopause.
- Drink plenty of fluids, but avoid fizzy drinks.
- Steer clear of alcohol and products containing it, such as mouthwashes, which can irritate the lining of your mouth.
- Avoid spicy and acidic foods and drinks, such as tomatoes, orange juice and coffee.
- Try mild or flavour-free toothpastes.
HOT FLUSHES What really works?
The commonest and most troublesome aspect of menopause is an out-of-control body thermostat. Hot flushes affect six to eight out of ten perimenopausal women. Signs often include an intense whoosh of heat that can cause you to break into a sweat, lasting for three to five minutes. When testing therapies, try one at a time for a minimum of six weeks, and note how often and how severe flushes are,so you can decide how effective it is.
**CHECK IT OUT**
The symptoms described can have many causes; get them checked by a doctor before attributing them to the perimenopause. Low levels of thyroid hormones (hypothyroidism) is a common cause that often occurs around the same time as menopause. Your GP or practice nurse could help, or ask for referral to a Well Woman Clinic.
Put soya back on the menu
THE EVIDENCE It has long been speculated that soya quells flushes, but results have been mixed. Now, however, a recent US analysis of 17 studies concluded that the equivalent of a couple of daily portions of soya-based foods and drinks lower frequency and severity by up to 26 per cent.
HOW? Plant chemicals in soya called isoflavones are thought to mimic the effect of oestrogen.
TRY IT You need 54mg of soya isoflavones daily for six weeks to a year. A serving of tofu (55g/2oz) or soya milk (600ml/1 pint) contains 35 to 40mg of isoflavones.
NOTE Try it for six weeks, but if there's no improvement, it could be because you don't produce equol, a substance produced by gut bacteria from soya foods. Non-equol producers don't benefit from soya.
Will herbs work for you?
THE EVIDENCE Many herbal remedies have been studied such as red clover ginseng, liquorice and black cohosh - on its own or with St John's Wort. Evidence suggest the latter is effective for mild to moderate flushes and sleep-disrupting sweats.
HOW? It's not known exactly but black cohosh may mimic oestrogen, and may also work on the parasympathetic nervous system. St John's wort helps to balance serotonin levels.
TRY IT Pharmacies or health food stores will be able to suggest a supplement combining both herbs.
NOTE Avoid if you've had breast cancer or liver disease. Stop taking if you develop jaundice, dark
urine or fatigue.
Book a course of acupuncture
THE EVIDENCE A study showed a course of acupuncture twice a week for ten weeks reduced severity though not frequency Previous research has shown mixed results.
HOW? It's thought to alter the brain's mood chemistry by increasing endorphins. This in turn stabilises the body's temperature control mechanism. Find a local practitioner on The British Acupuncture Council - visit acupuncture.org.uk. The cost for a first consultation ranges from £45 to £70, and £30 to £50 per session there after.
Take a deep breath
THE EVIDENCE A technique called "paced breathing" may shorten and cut down the number of flushes, according to a 2012 study from the Mayo clinic.
HOW? Slow, deep breathing is the fastest way to trigger your parasympathetic nervous system, which is involved in relaxing the muscles, slowing the heart rate and lowering the blood pressure, into action.
TRY IT Yoga or Pilates breathing is ideal, or follow this exercise twice a day: find a quiet spot and breathe in deeply for 5 seconds. Now breathe out for another 5 seconds. Continue like this for 15 minutes and feel the warmth ebb away.
**3 QUICK FIXES**
PICK A FLOWER THERAPY
Mulla Mulla flower essence is said to help put out the fire of flushes. Try taking a few drops, morning and evening. Australian Bush Flower Essence Mulla Mulla, £10.75 for 15ml, nealsyardremedies.com.
AIR CONDITION YOUR SKIN
Chillicious is a cult buy for ladies who flush. Smooth on and the lightweight gel will instantly chill your skin - this is just fantastic! Temple Spa Chillicious, £18 for 100ml, victoriahealth.com
SIP A COOLING CUPPA
A proper herbal tea will help to calm your personal summer. Add 1 to 2tsp sage, motherwort or raspberry leaf to a cup of boiling water for five to ten minutes, strain and drink. Buy herbs from baldwins.co.uk
WHAT'S THE ALTERNATIVE?
So, if you've discussed it with your doctor, and decided not to go the HRT route, but are still suffering regular perimenopausal symptoms, it's time to look at the natural remedies available. Here are just a few of what's on offer to make this time of your life less of a trial:
Feel like you've suddenly stepped into a sauna? Some studies have shown that spicy foods, caffeine, smoking and alcohol can contribute to frequent hot flushes.
Because flushes come on unexpectedly, the obvious tip is to layer clothing, and you can also reduce their frequency by taking regular and gentle exercise. Research suggests that high impact exercise can increase the chance of a hot flush, while gentle exercise may reduce them, so stick to yoga, swimming or long walks in nature. Ginseng, red clover, soya beans, evening primrose oil and black cohosh have all been shown to help curb hot flushes.
Eating a healthy diet is important to our whole well-being, even more so if you are suffering from aching joints as part of the perimenopause.
A diet rich in calcium and vitamin D has been shown to help keep our joints and bones in tip top condition. Around 10OOmg of calcium (the equivalent of drinking one pint of milk) could help reduce the pain, as can eating 55g of cheese or a single-serving pot of natural yoghurt once a day.
The National Sleep Foundation recommends that we have seven to nine hours sleep a night, but that's not easy when you just can't get settled.
30-120mg of lettuce eaten just before bed has been shown to promote a restful nights' sleep due to its sedative properties. Spritzing your pillow with essential lavender oil will also help, as will l-theanine, an amino acid that comes from green tea, which boosts your REM cycles. Sage, taken daily, has also been shown to help combat memory loss and insomnia.
Ride the emotional rollercoaster! Mood swings and mild depression are often the first sign that you're heading towards perimenopause...
Ginkgo Biloba, from the ginkgos tree native to China, boosts blood circulation and may help.
You can buy it as a tea, powder or as a skin cream. Recommendation: Nature's Way DIM-Plus (£23.99 amazon.co.uk) to lessen the symptoms.
Breast tenderness, often associated with pre-menstrual symptoms due to hormonal changes in the body, is also a problem for many perimenopausai women.
To reduce swelling, gently massage your breasts when in the shower. Studies have found women who eat soya, and those who have a high fibre diet, are less likely to suffer this pain, so it's also worth looking at your diet. Cut back on anything that contains hydrogenated oils, such as margarine, because this prevents your body from converting fatty acids, also linked to tender boobs. Dandelion, a natural diuretic, can be taken in tablet form or as a tea.
These supplements all claim to help lessen those uncomfortable symptoms...
Promensll Double Strength £25.99, Boots
The naturally-occurring red cloverisoflavone in this supplement has a similar effect to oestrogen on the body, helping boost mood and minimise other symptoms.
Phyto Soya £21.95, healthy2u.co.uk
This contains an isoflavone-rich extract only from the hypocotyl (the embryo) of the soya bean, which is especially rich in natural phytoestrogens, plant oestrogens which support balance for menopausal women.
Cleanmarine Krill Oil for Women £22.99 cleanmarinekrilloil.com
Combining powerful omega 3 (more bioavailable/sustainable than that sourced from fish oil) with soy isoflavones and vitamins 8 1 , B2 and B6, this helps regulate hormonal activity and reduce fatigue.