The Invisible Symptoms: The Perimenopausal Princess Papers (Part 14)

Look at a perimenopausal woman.  Go on.  Take a good look. 

You can see if she’s having a hot flush.  Her huffing and puffing along with hand-fanning will give away that she’s feeling a tad warm.  If you are talking to her and she mixes up her words or gets flustered, you will know the meno-fog has descended.  But you’ll have no idea about her other symptoms: the ones that are embarrassing, rarely discussed and have a huge impact on her life and emotions.  And not all of them are ‘downstairs’.

Perimenopause and menopause bring with them a whole host of problems. Rather than feeling isolated and alone, we need to realise that many of them are actually quite common – apparently, up to half of all women face them. It doesn’t make experiencing them any easier, but by knowing that what we are going through is normal, it can really help us manage the transition to menopause and beyond.

Needing to Pee

Hormonal changes can have an impact on the strength in our muscles in the pelvic area, which is why women who are are going through the menopause can have issues. Estrogen helps regulate our periods and keeps our bladder healthy. As the levels of estrogen drop and our muscles weaken, we lose our control. The need to pee can be sudden, urgent and more frequent. Embarrassment can lead to accidents if we are unable to keep it in until we reach the loo, but there is help available.

Cut back on drinks that contain alcohol or caffeine, as these fill your bladder more quickly. There could be other underlying issues that aren’t helping the situation. You could be on medication, be constipated or are overweight – these all have an impact on how often you pee. And of course get checked out to see if you just have an infection.

Urgent Number Twos

We aren’t too good when it comes to talking about this function, are we? But we do need to be aware that menopause can have an effect on how we poo. Our hormones play another trick on us here that very few people will talk about at all! Symptoms here will vary from being constipated to needing to poo very urgently, uncontrollable wind (yes, you’ll fart a lot), haemorrhoids or fissures. What a delightful list! Even better, you can suffer from more than one at any time, making visiting the loo a very exciting experience, as you won’t know if you’ll make it in time or if you’ll go at all.

You may find that some foods become triggers, or that eating means you’ll need the loo in a certain amount of time. This can then have an impact on when and how you enjoy food, especially if you are at work or out and about. Making healthier choices can help, such as eating a balanced diet, eating pro-biotic rich foods and of course losing weight and being active. But please never be too embarrassed to talk about this with your doctor. Your issues could be explained by the HRT you are taking, or caused by an underlying issue such as IBS or bowel disease.

Vaginal Problems & Low Sex Drive

Half of us will suffer from vaginal dryness, pain during sex or just prefer a cuddle and a cup of tea. Stop cringing. You’ve seen the advert for Vagisil pop up during your favourite TV show, so no need to be alarmed or embarrassed. Our delicate areas suffer too with the lack of estrogen, (notice a pattern here?) so you might experience anything from the odd itch or twinge, being unable to wear your jeans or sex being a miserable experience because it’s too painful.

As with talk about anything ‘downstairs’, we often find it too awkward and uncomfortable to seek help or talk to anyone. Help yourself by following a healthy diet and doing some exercise. Thanks to the power of TV advertising, you now know you can buy a product such as Vagisil or lube from a shelf and breeze through a self-checkout so nobody needs to know about your ‘vag issues’. But do speak to your GP, just to be sure as smoking, depression, stress or immune issues can all contribute.


Being told that perimenopause and menopause is a natural transition does not make it any easier to deal with the crushing feelings of anxiety we get as our estrogen drops. Menopausal anxiety symptoms include panic attacks, shortness of breath, fatigue, dizziness, chills, heart palpitations, sweating, nausea or muscle tension. Anxiety can wash over you with no warning. The symptoms are invisible, squeezing the life out of you. While you are in it’s grasp, it’s also difficult to cope with your feelings, your mood and sometimes your temper, making it very difficult to tell people that you need space. It’s a horrible place to be.

There are a range of treatments available through your doctor if you ask for help, such as HRT, medication and supplements. Cognitive Behaviour Therapy (CBT) is also effective as it helps us examine the connections between our feelings, thoughts, and behaviours and how to modify our behaviour to ease the symptoms. Again, a healthy diet and getting some exercise will also help. Getting a good night’s sleep (if you have not been visited by another symptom – insomnia) can help, along with trying relaxation techniques. Focusing on negative thoughts only makes anxiety worse, so try focusing on the positive to keep anxiety at bay.


Depression feels different to anxiety. When you are depressed you feel sad, hopeless and generally lose interest in the things you enjoy. It can be like a fog that you just can’t shake off as you suffer with low esteem, guilt and lack of motivation. You’ll even begin to neglect your hobbies and avoid friends and family. You could also be off your food, have a low sex drive and struggle to fall asleep at night or wake up in the morning.

Perimenopause is such a roller-coaster of symptoms and emotions, it’s no surprise that women are twice as likely as men to develop depression. Falling levels of estrogen make us feel like we can’t cope. When combined with insomnia and the life changes outside of the menopause cycle that we need to deal with such as aging parents, kids growing up, our careers and our own health issues, it’s no wonder that mood swings and symptoms of depression can take over our lives.

Untreated, depression can lead to suicidal thoughts and sadly, the rates of suicide in women aged 45-54 are increasing. More and more reports are appearing in the media of women taking their own lives while they are struggling to cope with life and menopause. Please don’t suffer alone and seek help. Your doctor will be able to help you with some kind of hormonal relief, antidepressants or CBT. Speak to someone because your mood fluctuations are treatable. Emotional ups and downs happen to us all, but take action if they are having a bigger impact on your life than they should.

These invisible symptoms are the ones that can take us by surprise, so keep a symptom diary.  Track all of the issues you have, no matter how insignificant they may seem.  While you are in perimenopause, you’ll be able to see a pattern forming around your menstrual cycle. 

Use the patterns you discover to help you cope with planning your day-to-day life and work. You’ll be able to spot days in your cycle when you know you will be more prone to emotional outbursts, migraines or fatigue. And when you do talk to a medical professional if you decide you need help, the information you need to answer their questions is all there. Not only will it be great for talking through with your doctor, but it might just convince you that you’re not losing your marbles just yet.


Published by So Just Be

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