Calls for improved support of menstruation changes during perimenopause

Perimenopausal women need better education and support about how their periods might change towards the end of their reproductive life, finds a new study led by UCL researchers.

The research, published in Post Reproductive Health, highlighted how, as women approach menopause, their periods may become unpredictable and heavy and cause worse premenstrual symptoms—including mood swings, breast tenderness, and headaches.

The team of researchers from the UCL EGA Institute of Women's Health and Centre for Reproductive Health, University of Edinburgh, interviewed 31 perimenopausal women aged between 40 and 55 who lived in the UK.

Almost all of the women spoke of having unpredictable periods that accompanied the perimenopause—including changes in cycle length, period duration, and the amount of blood flow. This was the case even if their periods had been regular throughout the rest of their lives.

Most women stated that due to these constant and unpredictable changes, it was challenging to commit to plans in case they coincided with a period that would leave them unable to cope (either emotionally or physically) outside of their home.

Additionally, many women talked about the increased heaviness of their periods during the perimenopause. This could result in them being caught off-guard and left in embarrassing situations or having lower iron levels, which left them exhausted in ways they had not previously experienced.

Premenstrual symptoms were also described as being more intense and lasting much longer than before. This ranged from new feelings of anxiety to uncontrollable mood swings and generally longer periods of Premenstrual Syndrome (PMS).

Senior author Professor Joyce Harper (UCL EGA Institute for Women's Health) said, "We need to be sure that perimenopausal women understand how their periods might change at this time in their lives and that we need to be supporting perimenopausal women as their periods become unpredictable, heavy, or have worse premenstrual symptoms. All of these factors can affect the working life and mental well-being of women going through the perimenopause."

All of the women interviewed described numerous ways they needed support in managing their periods.

Suggestions included extra support in the workplace, such as working from home to reduce anxiety around unpredictable periods, greater sympathy from managers and colleagues, as well as mandatory managerial training, and more consistent and earlier education in schools.

Many of the women also desired emotional support as they navigated mood swings and other bodily changes—particularly from their husbands, children, and friends.

While the women said that having friends or mothers that they could confide in about their experiences was comforting, many also desired additional help from support groups where they could meet people with similar experiences and be reassured that they are not alone.

Experts at UCL, including Professor Harper, have recently announced plans for the UK's first menopause education and support program.

The new program, which is in partnership with two charities, Well-being of Women and Sophia Forum, and with support from the Royal College of Obstetricians and Gynaecologists and the British Menopause Society, aims to provide education and support for women across the UK experiencing menopause, to help them gain a greater understanding of what is happening to their bodies.

Professor Harper said, "This study offers valuable insight into the impact of periods on the well-being of perimenopausal women."

"Most negative menstrual experiences stem from a lack of education about what is and isn't normal and when to seek medical care. Early, inclusive, and comprehensive menstrual education is vital for everyone, alongside specialized women's health training for health care professionals. Empowering women with knowledge aids self-advocacy and informed treatment choices. We have conducted a similar study in schools with 49 15-year-old girls, and they felt they needed more education and support around menstruation."

"Finally, accessible support is essential for each woman's perimenopause journey. We hope to make this possible for more women through our plans for the UK's first menopause education program."