PERIMENOPAUSE: WHAT YOU NEED TO KNOW

More and more women over 40 are speaking out about perimenopause, breaking a veil of silence that has shrouded this significant and misunderstood life stage. Here’s what you need to know.

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I’m going through perimenopause now. It's really frying my brain!” With those words, actress Tracy Ellis Ross articulated the experience of so many women in their 40s and 50s (and even late 30s) who’ve been blindsided by the hormonal tempest that is The Change. And she’s not the only celebrity openly declaring her tango with this transition, a life stage that is often suffered in silence and shrouded in mystery for previous generations of women. “There is not a lot of conversation [with my friends] about menopause,” said Michelle Obama in an interview with People magazine. “I’m going through it, and I know all of my friends are going through it. And the information is sparse.” 

Naomi Watts, too, talks about the strange censorship around the subject: “When I was in my late 30s, I was finally ready to start thinking about creating a family. Then the M word swiftly blew my doors down. It felt like a head-on collision with a Mack truck. How could I figure this out when no one was talking? I was earlier to it than my peers. My mentors and mum didn't seem up for discussing it...”

But what is perimenopause – and how is it different to menopause? And what the heck is actually going on in your body right now?

WHAT EXACTLY IS THIS THING?
People talk about perimenopause and menopause as though they’re separate stages, but this is actually misleading.

Perimenopause is a term that encompasses both pre- and post-stages of menopause. It's used to describe the entire menopausal transition: a hormonal rollercoaster that can last up to eight years. We asked obstetrician and gynaecologist Dr Sundran Moodley, a spokesperson for the South African Menopause Society (SAMS), to break it down for us.

PEOPLE TALK ABOUT PERIMENOPAUSE AND MENOPAUSE AS THOUGH THEY'RE SEPARATE STAGES

“Perimenopause is the time around the menopause – before and after – when your ovaries gradually stop producing eggs,” explains Dr Moodley. “A clinical diagnosis of menopause is made only once a woman has not experienced menstruation for more than a year – in other words, retrospectively,” he adds. “The average age for menopause is between 45 and 55 years, however early symptoms can appear a few years prior.”

Dr Moodley says that, clinically speaking, the entire transition can be broken down into three stages: early menopausal transition (characterised by a menstrual cycle that is out by about seven days), late menopausal transition (characterised by gap of about 60 days or more between periods); and early post-menopause, when that gap widens to an entire year. So, what are these infamous symptoms – and why is perimenopause making us feel so crazy?

WHAT'S TO BE DONE?
Before the symptoms of perimenopause can be treated (perimenopause itself can’t be treated, as it is a natural stage of life), they need to be identified – and this is not so straightforward. “Many of the symptoms can mimic other conditions and may lead to seeking care from inappropriate practitioners, who may not realise that hormonal changes are contributing to the symptoms,” says Dr Moodley.

SAMS is on an active drive to help improve education among GPs, who, says Dr Moodley, tend to have variable levels of knowledge with regards to perimenopause. To treat the symptoms of perimenopause, your doctor may order a blood test to check your hormone levels. Once a diagnosis is confirmed, they will likely discuss several treatment options with you. “Hormone therapy (HT) – usually, oestrogen supplementation – remains the gold standard for relief of hot flushes,” says Dr Moodley.

Although HT has been associated with dangerous side effects in the past, new forms of HT are safe. “There is robust evidence that recent forms of HT have lower side effects, and negligible risk of complications,” he adds. HT can also help to alleviate the brain fog, joint pains, mood swings and vaginal dryness associated with perimenopause. Dr Moodley stresses that HT should be considered to stabilise mood disorders before antidepressants or anti-anxiety medication is prescribed.

Of course, there is the possibility of some contraindications and HT is not entirely suitable for all women, so a thorough conversation with your healthcare provider will be necessary to evaluate whether it is the right choice for you. “A low dose oral contraceptive can also be considered to alleviate symptoms,” says Dr Moodley. If you decide to forego HT or a contraceptive, symptoms may be treated independently. For example, antidepressants for depression, lubricant for vaginal dryness; along with regular exercise and dietary adjustments.

There is also evidence to suggest that Ozempic, a medicine for type 2 diabetes, can help perimenopausal women to lose weight and reduce the risk of developing diabetes and cardiovascular disease. In a way, women heading into their ‘meno era’ are fortunate to be alive at a time of rapidly rising awareness – among women, among healthcare professionals and society at large. We are also living in a time when women are choosing to see this transition as empowering – rather than a sign that their most fruitful, impactful or romantic years are behind them. “My friend Michaela told me, ‘This is an invitation into your wild-woman phase’,” says Tracy Ellis Ross. “Another friend was like, ‘Your womb will no longer have to be thinking it’s going to make a baby. You can fill it with all your creativity.’” Indeed. May we all fill our wombs with creativity.

You can find contact details for the South African Menopause Society (SAMS) at menopause.co.za

Words by: Robyn Maclarty
Photos: Gallo/Getty Images, Supplied