For too long, it has been a taboo subject but it looks like we are finally starting to talk about the menopause.
Of course, it’s all part of female life, but what seems even less open for discussion is perimenopause – the early onset where the symptoms start long before your periods have even stopped.
Just like menopause, it can have a significant impact – with 86% of women saying they experienced mental health issues as a result, according to a new survey by Healthandher.com.
For 58%, low energy and motivation were the main issues, while 53% said it was low mood and depression, along with anxiety (50%), anger and mood swings (42%). One in 10 even said they’d had suicidal thoughts.
So, what do women need to know? We talked to leading gynaecologist Dr Nitu Bajekal to find out more…
What is the perimenopause?
Menopause is generally when your periods stop, and you haven’t had a period for 12 consecutive months.
“The average age for menopause is anywhere between 45 and 55, with most becoming menopausal around 51,” says Dr Bajekal.
“Perimenopause means ‘menopause in transition’. It’s the time leading up to the complete cessation of periods.
This usually lasts around four years but can last from two to eight years. So, you can see if your periods are going to stop at 45, some women with perimenopause can start to have symptoms in their late-30s.”
What are the signs?
The symptoms are basically the same as menopause – hot flushes, sleep problems, reduced sex drive, low mood, anxiety.
With perimenopause though, Dr Bajekal says symptoms can “wax and wane”, and your periods may become irregular for a few months, then return to normal for a bit.
This up and down pattern can add to the mental health impact: “You might sometimes think you’re going crazy, because for two or three months you’re having symptoms, then you’re not, your hormone levels fluctuate.”
Why is awareness important?
Dr Bajekal agrees there is a lack of awareness, among women and sometimes healthcare professionals.
This means not only might women be missing out on treatments and advice, not knowing what’s going on can make issues worse.
“Empowering women with knowledge is key, as once you know something, you’re not so scared of it,” says Bajekal.
“Your brain isn’t going into overdrive thinking, ‘What’s wrong with me? Do I need anti-depressants, why do I sometimes not feel like doing anything, why do I feel a bit removed from my relationship?’”
Dr Bajekal says it’s important women don’t feel “fobbed off” by their GPs.
But it’s also important doctors investigate any other possible underlying causes if necessary: “Because people may be depressed, for example. But it’s about being open to the idea that perimenopause is something that also needs attention.”
Can doctors help?
Perimenopause isn’t something that’s diagnosed with tests, explains Bajekal. But if you’re experiencing symptoms that suggest perimenopause and they’re having a detrimental impact, you could try hormone replacement therapy.
And if your doctor just dismisses it or tells you to come back when you’re 50? Dr Bajekal recommends asking to see someone with a special interest in this topic.
“Within the GP group, there will be people who have special interest in, say, cholesterol, diabetes, women’s health and menopause,” she says.
Knowledge is power
Dr Bajekal says just having these conversations, and having your worries explained and validated, can be extremely helpful.
“It’s about being more aware of the symptoms, the condition, and then women can decide what they need,” she says.
She is an advocate for the role of lifestyle too, citing nutrition, sleep and regular exercise as key. Bajekal says a diet loaded with plants and wholefoods is rich in fibre, nutrients and plant oestrogens. This is good for health in general and for supporting yourself through perimenopause.
“And stress,” says Bajekal. “Identify your sources of stress and find ways of managing it, whether it’s through breathwork, yoga, meditation, walking with a friend.
“Avoiding alcohol and excessive caffeine and smoking; all these can make menopause and perimenopause worse.”
Heed red flags
Even if you’re certain you’re perimenopausal, never ignore gynaecological changes that may need to be checked out more thoroughly and stay up to date with smear tests.
“I see it every day, patients who’ve been told, ‘Don’t worry, you’re having heavy periods because you’re heading to the menopause’.
No – it’s not normal. If you’re having heavy periods, very irregular periods, new pain in your periods, you should not ignore it.
And if you’re having pain or bleeding after sex, make sure it’s investigated.
“It might be nothing, or there might be something else going on. Getting things checked will put your mind at rest.”
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