Perimenopause: It’s the “big, new topic” women want to talk about, says The Menodoctor Menopause Clinic’s Dr Linda Dear, who shares with Carly Gibbs what women can expect, and what can help with symptoms. Plus, Sarah Lewis is a woman in perimenopause and shares her journey with readers.
Linda Dear calls herself “very peri”.
That’s because the 44-year-old doctor has symptoms of perimenopause or “peri” as she shortens it, including skin breakouts.
Perimenopause is defined as the final years of a woman’s reproductive phase leading up to the end of her periods, or menopause.
“Menopause is when the ovaries retire, peri is when they hand the notice in,” Dear says.
Perimenopause begins anywhere between the late-30s and mid-40s and is marked by fluctuating hormones and a raft of mental and physical symptoms that can be challenging but are rarely talked about.
Dear owns Tauranga’s The Menodoctor Menopause Clinic and labels perimenopause as a “blind spot”.
“That’s the phase that’s been ignored, mislabelled, or missed completely,” she says.
There are only a handful of menopause clinics in New Zealand, but Dear predicts that number to grow as the “complex life phase” gains increased awareness.
She worked as a GP before branching into specialised menopause treatment 18 months ago, noticing a demand from female patients whose consults couldn’t be squeezed into 15 minutes.
“This became my baby and because I was on the wrong side of 40, I started to get some of these unwanted gifts myself,” she says.
She is currently collating the results of a survey she conducted with more than 4000 Kiwi women showing the impact of perimenopause and menopause.
“It will show what I have heard over the years, many times, in my room one-on-one, with thousands of women. How sad some of their stories are. How some are struggling and their hormones are playing a massive role in it.”
While hormones can’t be blamed for every bodily disruption, they are a “big gap in the jigsaw” and medics now recognise that female hormones start to change earlier.
In perimenopause, the ovaries haven’t retired, but they’re struggling to produce hormones at previous levels.
“They’ve gone a bit out of control and this is why women in perimenopause can feel out of control,” Dear explains.
Symptoms
The hormones that ovaries make do more than make a woman fertile.
They go everywhere in a woman’s body and brain and can disrupt all parts of her life, including her concentration, memory, mood, bones, muscles, sleep, and ability to regulate temperature.
One example of Dear’s survey, results of which will be released later this month, is that 84 per cent of the female respondents said their menopause symptoms have an impact on them in the workplace and one in 12 menopausal women leave the workforce altogether and many more consider it.
Dear said the main symptoms reported were fatigue, anxiety, and brain fog.
She has previously said secrecy and shame are also associated with perimenopause and menopause.
While females are educated on what to expect when they get their period, and again when they fall pregnant, no one talks about perimenopause.
Perimenopause ends with menopause, when levels of estrogen, a major female hormone, fall low enough to stop periods for a full year.
Those who’ve had a hysterectomy or have a Mirena IUD fitted may find a menopause blood test useful, Dear says, as “you lose a big clue” when you don’t bleed.
It is normal for women to have their final period between the ages of 45 and 55.
If it stops between 40 to 45, it’s considered early menopause.
For one in every 100 women, it will stop under age 40. This is known as premature ovarian insufficiency (POI).
For one in 1000 women, periods will stop under age 30.
As you approach your period stopping, perimenopause symptoms will vary from one person to the next.
Some will “breeze” through perimenopause, and some will “crawl” through. And there can be normal months and months when things are all over the place.
And to bust a myth, classic symptoms like night sweats aren’t always perimenopause, so Dear advises seeking medical advice, as there are increasing wellness organisations “cashing in on a grey area”.
Women who have pre-existing hormone conditions may also need a different treatment approach.
A natural part of life
When it comes to a fix, there isn’t a cure; it’s a natural part of life. But doctors do prescribe drugs for particular symptoms and an improved lifestyle is powerful in reducing the symptoms too.
But some women will struggle to feel good, no matter what they do or how good their lifestyle is.
“They are missing the levels of hormones that used to be flowing around in their bodies and brains. If you can help stabilise and bring those levels back, it’s like the missing piece,” Dear says.
“The analogy I often use, especially if someone’s husband is sitting in the consulting room with them, which they often are, is that if nature made men’s testicles fall off in their 40s, they probably wouldn’t feel like the same man.
“Essentially, our ovaries are our testicles. And nature takes them away from us because we are not designed to make babies forever.”
Diagnosis
Before a woman visits Dear for a 45-minute consultation, they’re sent a questionnaire asking about her medical history, symptoms, and risk factors.
As a side note, accessing the Greene Climacteric Scale online gives a list of symptoms commonly associated with perimenopause and menopause.
However, Dear cautions that symptoms are “almost limitless” and there is no specific testing for perimenopause.
If suspected though, there is help at hand with hormone replacement therapy (HRT).
HRT aims to stabilise estrogen levels.
Dear calls estrogen “woman fuel” because that’s how women feel when they are given it.
“They’ve got their mojo, fuel and oomph back,” she says.
Estrogen is one of the main hormones used in menopausal hormone therapy. But in New Zealand, only one way to take transdermal estrogen is publicly funded.
Dear believes this needs to change.
She is among three women who have started a petition calling for Pharmac and Medsafe to consider increasing options for estrogen to be used in menopausal hormone therapy, and later this month she will submit her finished survey results to Parliament.
She says estrogen patches do not work for all women, and there are also global supply issues with patches.
“So we need to have an alternative option more easily available.”
Sarah’s story
When Sarah Lewis started to go through perimenopause 15 months ago, she thought her symptoms were the result of a bout of Covid-19.
As well as low tolerance, brain fog, and fatigue, the 46-year-old had put on weight and was experiencing night sweats, because of which she had to change her pyjamas several times a night.
Despite experiencing some classic symptoms, the communications consultant hadn’t considered it could be perimenopause until she visited her GP, who told her that’s what she was experiencing.
The Pāpāmoa mum says, when she looks back, she recalls her late mother complaining of similar symptoms at her age.
Perimenopause usually coincides with a time in life when women give their all to their careers and family, and symptoms can easily be put down to other things, she believes.
However, for her, symptoms were extreme.
“It was the inability to cope. I’ve always been very capable, had a lot of energy, and was a multi-tasker. I only had six days of maternity leave before I started juggling some work again. But [when perimenopause hit] it was a marked personality change for me. I couldn’t do everything that I wanted to do and my patience for everything became limited. And it was sudden, not gradual.”
Tolerance with friendships dipped and she experienced negative self-talk, neither of which was normal for her.
She’d recently had Covid, her mother had died, and there were pressures in her business, so when she went to her GP for help with how she was feeling, she wasn’t expecting perimenopause to be raised.
“The doctor, looking at my age [and symptoms], said I ticked all of the boxes.”
Lewis was prescribed estrogen patches in conjunction with the Mirena and says the change in herself was so drastic she was “stunned”.
Because of the global shortage of patches, she often needs to cut 100mg patches in half or use two 25mg patches to get her prescribed 50mg dosage, which lasts four days before needing to be changed.
She was also prescribed sleeping medication to help with her insomnia and she tweaked her lifestyle.
“Now, I understand the impact and the power that hormones have. Not just on you physically but on you mentally.
“It made me change the way I look back at my relationship with my mum and realise how she was obviously struggling without any options for help.
“I’ve become a sort of accidental advocate in my social group because it isn’t something women are necessarily aware of.”
She feels more prepared for menopause and her experience has inspired her to begin a podcast, where she’ll be interviewing influential Kiwi women in midlife on how ageing and/or physical changes affect the way they live their life.
Her advice to other perimenopausal women is to find a sympathetic GP who is “engaged in the conversation”. And don’t be afraid to speak out and discuss with friends.
“In the advent of the ‘MeToo’ generation, I do think there is evidence that things that are spoken about become [better]. If people can fix it, there are options. Why is everyone suffering in silence when they don’t need to be?”