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Perimenopause: Symptoms, Diagnosis and Treatment Q&A with Dr Shahzadi Harper

Perimenopause: Symptoms, Diagnosis and Treatment Q&A with Dr Shahzadi Harper

Perimenopause pondering really takes hold once women reach their 40s. With every symptom experienced there’s a voice in your head “Is it starting? Is this perimenopause?” How do you know what you’re experiencing is actually perimenopause, what is the best way to get diagnosed and how can symptoms be treated most effectively?

We spoke with a top perimenopause expert and unleashed the questions we hear ourselves and our friends wondering regularly. Dr Shahzadi Harper is here to help!

Dr Harper founded The Harper Clinic in London to prioritise the health and lifestyle needs of women in perimenopause and menopause. The clinic’s ethos is to have a 360 degree approach to optimising women’s wellbeing and hormones in midlife. She is co-author of a new book ‘The Perimenopause Solution: Take control of your hormones before they take control of you’.


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I’ve heard many women in London say that GPs will only diagnose/treat perimenopause if the most well-known symptoms are happening regularly – night sweats, dramatic changes in your period, vaginal dryness. And they are told hormone blood tests aren’t helpful as your hormone levels are constantly changing.

What would you recommend a woman in her 40s say to their GP when they are experiencing a myriad of unexplained symptoms so that perimenopause isn’t quickly dismissed? Many women start this journey sat in front of a GP.

Yes it can be hard being heard by your GP, so what I often say is to go in prepared.

First when booking your appointment ask the receptionist if there’s a GP within the practice who potentially might have an interest in perimenopause and menopause. Also ask if it’s possible to have a double appointment because 10 minutes is definitely not enough time to unravel and go through symptoms that many women are experiencing at this time.

Make a list of what you’d like to discuss during your appointment, write down your symptoms and and if possible go online and download and complete the menopause symptom questionnaire from my website which lists many of the symptoms you may be experiencing and some that maybe your GPs may not even be aware of.

Take a friend in with you if possible because often you may forget things or you may not remember what was said in the consultation. And potentially print off the NICE guidelines on menopause to wave under your GP’s nose to show them that you can potentially be in perimenopause – early 40s is not too young!

From bleeding gums to heart palpitations to numb limbs to memory loss and increased anxiety, there seem to be an endless number of perimenopause symptoms! How do you know when these are being caused by perimenopause versus something else that’s going on?

Good question, because so many things can coincide or mimic the symptoms of perimenopause. So that’s why I say that midlife is a good time to take stock of your general health. Look at those what we call modifiable lifestyle factors which doctors have been banging on about such as eating a balanced healthy diet (less red meat, more plant based) are you potentially drinking too much, (many women can often be drinking too much, using it as a soother and calmer around this time and need to cut back) and stop smoking! Do you need to move your body more? We know from clinical studies that women in their 40s are more sedentary than men. Take up an activity or set a target which is realistic and sustainable.

However, there are other conditions that can also mimic symptoms of perimenopause such as having an underactive thyroid, which can make you feel tired, gain weight, dry hair and skin, constipation and an overactive thyroid which can make you feel more anxious and give rise to palpitations. Iron deficiency anaemia can occur if you are breast feeding and especially if you are having heavy periods, or not eating much red meat. This can also give rise to palpitations, feeling of anxiousness, headache, hair loss and fatigue. You may be vitamin B12 deficient if you are vegan/vegetarian and again that can cause fatigue nerve tingling, low mood also surprisingly many women are vitamin D deficient. Depression, stress, Long Covid, chronic fatigue and fibromyalgia can also give rise to some of the symptoms of perimenopause such as fatigue, muscle aches and pains, and flat mood.

So it’s not surprising that it’s confusing to know if what you are feeling is perimenopause or is it something else. And all these conditions can co-exist with perimenopause and can exacerbate the symptoms of peri. That’s why it’s important to go and speak to a doctor who understands and can go through your symptoms, unravel what is what, and potentially have some blood test to check for these nutritional deficiencies and assess your mental health and wellbeing.


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What tests and examinations do you do to determine that a woman has started perimenopause?

First, it’s important to take a thorough history. Ascertain what is going on, what are the stresses in the woman’s life. Often this time of life coincides with career peaks and changes, some women have young children others have teenagers leaving for university and elderly parents to look after. There may be issues within their relationship and even if there isn’t hormonal change can often put pressure on a relationship. So it’s important to look at all strands of a woman’s life – her home, her work, her relationships, and her health before jumping to any conclusions that this is all perimenopause.

Based on this I may do a number of blood tests, to look at her general health. I think it’s a time to be proactive and priorities your health so this is a good time to do a health MOT.

The NICE guidelines state that if you are over 45 and have symptoms then blood tests are not necessary, however for those women who potentially might be on a progesterone only pill or have a coil fitted so may well not be experiencing any periods then checking hormonal levels, and FSH, which stands for follicle stimulating hormone and is raised in menopause can be useful. I may also hormonal blood test, if I am considering starting a woman on HRT and especially if I’m considering pressing testosterone as part of it

How do you decide when to start HRT and determine which type and dosage is best?

Starting HRT should always be a joint decision and personalised to each woman. Starting very much depends on her symptoms and how debilitating and impactful they are.

There are many types of HRT preparations and the decision to choose which preparation is very much dependent on personal choice and lifestyle. There are patches, sprays gels and oral tablets as well as a vagina oestrogens. Many women worry about weight gain because of their experience on the pill, so it’s important to explain the benefits and any potential risks so she can make an informed choice.

I do usually like to commence my patients on body identical hormones which are chemically similar to our own natural hormones. So I usually prescribe an oestrogen gel and one of the beauties of this is that it’s an invisible clear gel so I often call it sexy HRT and it can be titrated according to each woman and her symptoms (for example, 2 pumps for some 3-4 for others).

If a woman has a womb then she will also need progesterone and I like to prescribe natural micronised progesterone. However for some women their lifestyle is busy and applying gels and remembering to take a capsule at night might not fit in with them. So I might consider patches or even an oral tablet and many women in perimenopause do like the thought of a tablet as it’s very much in line with them in the past having taken the contraceptive pill

When you follow-up with a patient, how do you determine if they are on the right type or dosage of HRT? What determines if you change it?

I usually follow up with my patients after about 8 to 10 weeks. At this point we discuss what’s gone well, how things have improved and life in general and also what if anything still needs to be assessed such as libido, weight and insomnia. Does the dose need to be increased or adjusted, did this preparation suit her, would she prefer something different. She may also have remembered other things she now wants to talk about, her skin , her hair, so this is all individually dependent.

A blood test may be required to check for adequate absorption of the HRT and also I usually would request a blood test if I’m going to now prescribe testosterone, I usually prescribe testosterone at this or the third review appointment

Please tell us something hopeful about perimenopause, to end on a positive note!

All women will go through perimenopause and menopause and we make up 51% of the population, so understand you’re not alone. Being aware, having an understanding and educating yourself can help you navigate this time.

I think this is a time of life for many women that they come into their own, they find a voice and a new found confidence. This is often a crossroads for money and decisions are made with priority given to self. I think this can be a really liberating time of life for a woman she finds her strength, her inner calm and confidence to enter into the next phase of her life.

So whilst there may be a few bumps on the road all women go through this and understand that this can be a renewing time to rediscovering a pathway to a sexy confident you.

Follow Dr Harper online:

Website / Instagram: @drshahzadiharper and @theharperclinic


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