Her periods had been irregular since the birth of her daughter Chloe, now aged 7.

"There had been so many changes in my life I didn't take much notice at first," she says.

But back at work full-time, she was finding day-to-day living exhausting. Her periods remained irregular -- she often missed two in a row and when they did come, they were heavy and lasted more than a week. She had repeated urinary tract infections (UTIs), which had her running to the bathroom frequently.

"My life felt out of control," she says. "I was moody and couldn't sleep properly, which was not me at all. I was terrified there was something seriously wrong." Sandra's doctor suggested antidepressants, suspecting she was suffering from a form of post-natal depression. "But I didn't feel that was the problem. I felt perfectly able to cope with motherhood," she says.

"The UTIs were so painful and I felt as if my energy was sapping away. Eventually, six months after my symptoms developed, I asked to be referred to a gynecologist." To investigate, she underwent a hysteroscopy, where a thin telescope is inserted through the cervix into the womb.

Her doctor called to say the tests showed nothing out of the ordinary, but added: "It may seem strange, but I'm beginning to suspect you are experiencing early menopausal symptoms." In fact, Sandra was going through perimenopause -- the time leading up to menopause where some women may experience changes such as irregular periods, trouble sleeping and irritable moods, but are not officially considered to be menopausal.

Women normally go through perimenopause between the ages of 45 and 55, but it can also affect women, like Sandra, in their 30s.

The symptoms of perimenopause are increasingly being seen as a condition in their own right, especially in the U.S. The exact number of women who go through perimenopause is difficult to gauge: blood tests are unable to measure changes accurately while hormone levels are fluctuating.

While a consistent decline in estrogen levels may indicate the onset of menopause, when these are up and down, results are inconclusive. The true menopause is defined as the end of menstruation, when the ovaries have ceased to function.

Technically, it occurs on the day that a woman has gone 12 consecutive months without a period.

Eight out of 10 women experience hot flashes or other mild to moderate symptoms during the months leading up to menopause, according to the British Menopause Society. And it's thought that hundreds of thousands of women in the U.K. alone experience some symptoms up to 15 years before menstruation ends completely.

During this perimenopausal stage, the ovaries start to shut down and a woman's fertility begins to decline.

Each time a woman fails to ovulate, the ovaries also fail to produce another hormone, progesterone.

This frequently causes disruption of menstruation and emotional well-being, leading to mood swings.

However, the symptoms of perimenopause are often ignored or missed because of a reluctance by women and their doctors to blame fluctuating hormones for a range of physical and mental health problems experienced by women in their late 30s and early 40s.

"There seems to be an assumption that women's ovaries work perfectly well until one day when they just suddenly turn off," says gynecologist Heather Currie of the British Menopause Society and spokesperson for the Royal College of Obstetricians and Gynaecologists.

"However, ovulation can become irregular more than a decade before the 'official' menopause begins.

"And the impact of fluctuating hormones in the years running up to menopause is often when symptoms such as irregular periods, irritability, bouts of rapid heartbeat and frequent UTIs are most severe."

Dr. Currie believes this is exactly the time when women should be receiving hormone replacement therapy (HRT) to counter the symptoms of perimenopause, despite fears by some that it increases the risk of breast cancer, heart disease and strokes.

The problem is that many doctors remain divided over the existence of perimenopause, with doctors unlikely to view a woman coming to them with problems such as urinary tract infections as "hormonal."

"Women who complain of perimenopausal symptoms are as likely to be suffering emotional and physical problems brought on by lifestyle changes, children leaving home, or their marriage going through a difficult stage," says Dr. Sarah Jarvis, a spokesperson on women's health for the Royal College of General Practitioners.

"So without proper medical conformation, it's difficult to establish if their problems are related to menopause. It's not like treating a clear-cut medical problem like high cholesterol, where there are tests that can be done."

Doctors are also divided about how to treat perimenopausal symptoms.

On the one hand, women are advised to take HRT for as short a time as possible because of safety fears over long-term use, so doctors remain opposed to offering HRT to women under 50. Concerns were raised in a 2002 study by the U.S. Women's Health Initiative involving more than 27,000 people. It claimed women using the therapy were at higher risk of heart disease and strokes.

However, earlier this year, re-analysis of the data found the extra risks may apply only to older patients in their 60s and 70s who do not normally use HRT. Indeed, HRT was shown to cut heart attacks among women in their 50s. Nevertheless, Dr. Jarvis says it's better to try to cope with symptoms for as long as possible before going on HRT.

"All we can offer to women who will not face menopause for several years is the same advice we offer anyone in a stressful situation: get plenty of sleep, eat healthily and exercise regularly," she says. "Unfortunately, some women will interpret this as not being taken seriously."

Specialists take the opposite view. They say many women who consult their doctors are being left to cope on their own unless they insist on a specialist consultation.

Once they've got past their doctor, however, women complaining of perimenopausal symptoms are routinely offered HRT by specialists.

Dr. Currie is not swayed by the recent health scares over HRT, describing the identified risk as "tiny." Far from posing a danger, she says, HRT before menopause is a "modifying" treatment, replacing hormones to a "normal" level.

"It's so safe to use before menopause that the simplest way to find out if a woman is going through perimenopause is to try HRT," she says. "If a woman feels better, then it is highly likely she is suffering perimenopausal symptoms."

The U.K.'s Medicines and Healthcare Products Regulatory Agency's safety advice on HRT, updated in September, supports that view. "For younger women who use HRT to relieve menopausal symptoms and their overall risk [of an adverse effect] from HRT is very low," it states. However, some practitioners stress the importance of a detailed consultation before any perimenopausal treatment goes ahead, to ensure it is tailored to each woman's needs.

"It's as individual as a thumbprint," says Harley Street endocrinologist Dr. John Moran.

He recommends proven natural treatments, such as the phytoestrogen red clover, which has been shown to reduce hot flashes. When trying HRT, he says it's best to stick to bio-identical hormones -- those with a chemical structure identical to a woman's natural hormones.

For Sandra, now 44, the worst of her symptoms has passed. She now uses a device called the Mirena. This is a tiny coil that fits in the womb and releases minute daily doses of a bio-identical progesterone.

"After a couple of months, my periods had stopped and so had many of the symptoms," Sandra says. "I did want another child, but my husband and I have accepted that my symptoms were so bad that they needed to be treated." Sandra has also started taking Estrogel, a bio-identical estrogen available on prescription as a form of HRT. "I had no idea urinary tract infections can be caused by low estrogen levels," she says. "Yet my symptoms began to be sorted within a week of starting the medication.

"I would urge any women experiencing what I did to pressure their doctor for a specialist referral if they feel they are not being taken seriously. It could be the only way of ending the misery you are going through."

For more information on perimenopause, go to www.power-surge.com.

Note: Sandra's name has been changed to protect her identity.

Source: Daily Mail; London (UK). Provided by ProQuest Information and Learning. Powered by YellowBrix.

What's everyone talking about at ThirdAge? Find out with twice-weekly issues of our Community Connections newsletter, where real readers like you voice their opinions!