It typically starts in your 40s and its symptoms can be debilitating, so why do we women know so little about perimenopause?
Looking back, it’s easy for Rebecca Clancy to see that her symptoms were the result of perimenopause. Crippling anxiety. Broken sleep. Lack of self-confidence. Panic attacks. Heart palpitations. At the time though, she blamed a stressful job on her emotional and physical turmoil.
When one panic attack resulted in the 46-year-old being rushed to hospital with a suspected heart attack, she decided to step away from her senior role. Despite a lighter workload, Rebecca still struggled with self-doubt, a lack of sleep, and the persistent palpitations. She talked to her husband about quitting her job altogether.
And then she had a conversation with a friend who asked if she might be perimenopausal. “I had never even heard of it,” says Rebecca.
Perimenopause means ‘around menopause’ and is the term used to describe the lead-up to a woman’s final menstrual period, the menopause. As Rebecca discovered, it can affect women physically and psychologically.
It typically starts for a woman in her mid-40s, but for some it can begin in their 30s. How long this life stage lasts is variable – for some it can be a year and for others, a decade.
The next stop? Menopause, which is the final period. As periods can be very erratic during perimenopause, we say that a woman has undergone menopause when she hasn’t had a period for 12 months.
At perimenopause, your ovaries are starting to run out of eggs and wind down. This causes fluctuations in the female hormones oestrogen and progesterone. Not all women experience symptoms; in fact, 20% will have none at all, while 60% experience mild to moderate symptoms and 20% have symptoms so severe that they significantly interfere with daily life.
Perimenopausal symptoms can include hot flushes, night sweats, exhaustion, brain fog, loss of libido, vaginal dryness, mood changes and weight gain.
“Changes to your menstrual cycle can be one of the most obvious clues that perimenopause is taking place,” says Dr Elizabeth Farrell, gynaecologist and Medical Director of Jean Hailes for Women’s Health. “Periods may become more irregular, spaced further apart, heavier, or have a different pattern every month or every few months.”
However, perimenopause should not be blamed for all bodily changes. Dr Farrell warns that if bleeding becomes especially heavy, if there is spotting between periods, or they become painful and erratic, it’s important to consult your doctor. Fibroid growths, changes to the lining of the uterus and – in very rare cases – cancer, can then be ruled out.
You might be surprised to learn that during perimenopause you may ovulate some months, and others you may not, and sometimes you may ovulate twice in a cycle. So even though fertility is much lower in your 40s and 50s, contraception is still needed if you wish to avoid pregnancy.
For Rebecca, her most troubling symptom was rage, a fierce emotion she felt bubbling deep inside her. “I had been hanging up the phone on colleagues because I couldn’t deal with the conversations,” she recalls. “I just felt this rage inside. It tried to manage my symptoms with herbal remedies but when I got to the rage point, I knew I had to speak to my doctor about my options.”
Jean Hailes endocrinologist Dr Sonia Davison believes strongly that women should seek treatment if their perimenopausal symptoms are disrupting their quality of life.
Menopausal hormone therapy (MHT), can be highly effective in treating symptoms – provided the woman has no history of a hormone-sensitive cancer, or other significant health problems that can mean hormone therapy may put them at risk. In general, for healthy women under the age of 60 when starting MHT, the benefits far outweigh any risks.
There are other treatments available too, including other medications, natural therapies and the contraceptive pill (for those under 50 years of age). A healthy diet, exercising, drinking alcohol only moderately, and not smoking will also help in dealing with bothersome symptoms.
Dr Davison encourages all women to discuss her options with a GP who has expertise in women’s health.
Rebecca followed that advice. Overseen by her GP, her symptoms are now managed with an integrated approach using MHT and herbal remedies. Her health journey has also given her a greater level of self-acceptance.
“I now recognise what these changes are all about and I have strategies in place to navigate my way through the wonderful, forever changing and unpredictable cycle of this life phase.”
Perimenopause is the beginning of the journey toward menopause. These tips are a roadmap to give to your partner – if you have one – so that together you can take the twists and turns as they come:
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