Dr Michelle O'Driscoll: Women are often left in limbo during perimenopause

Awareness around menopause is increasing amongst the public, thanks to many different initiatives by healthcare professionals in the field, the media, and a recent increase of government funding in the area.

The average age of menopause is 51. What many don’t realise however is that ‘menopause’ is actually one specific moment in time – the time at which you are exactly 12 months without having had a period. If you’ve gone six months without a period then get one randomly, you’re technically ‘back to the start’ of that final countdown again – 12 months away from menopause, provided you don’t experience any more menstrual cycles.

From that moment of menopause onwards, you’re considered to be ‘post-menopausal’, which doesn’t mean that you’re out of the woods when it comes to symptoms, but it is a new chapter nonetheless.

The problems experienced by women in relation to menopause don’t begin at that moment 12 months after their last period though. 

Symptoms gradually build in the years leading up to this. That time before you reach menopause, but are experiencing symptoms is called ‘perimenopause’.

The uncertainty around whether you’re approaching menopause or not can be unsettling and confusing. A lot happens in the body prior to that average age of 51 when periods have officially ceased. And a blood test won’t determine this for you in most cases as levels are too erratic day to day – it’s not as straightforward as this, unfortunately!

Physically and mentally, there are many symptoms that women may begin to experience from their mid-thirties onwards that can serve at little clues that your body is beginning that downward trajectory of eggs and certain hormones, into perimenopause and menopause. 

Often, however, these symptoms are quite vague, and could be attributed to a whole number of things, including the time of life that many are at – busy careers, busy family life, in the midst of a chaotic juggle.

However, a number of small clues consistently over time should add up to a larger question mark over this area of your menopausal status, particularly if you’re finding your daily functioning is being impacted.

Here are some of these vague, non-specific symptoms that you might encounter, and recognising them could inform your next steps in terms of how to manage them.

Feelings: It’s common for moods to fluctuate during perimenopause, a little like very bad pre-menstrual syndrome. You may have bouts of unhappiness; rage; tiredness; low energy; tense; anxious; teary; irritable. It’s common for these feelings to be regardless of what is going on around you, or at least disproportionate to the challenges you’re facing and would have previously taken in your stride.

Cognition: The brain uses oestrogen to function and remain ‘sharp’, therefore its decline can lead to symptoms such as difficulty concentrating; memory problems; brain fog; loss of interest; difficulty finding the right word. 

We can feel so alone in these symptoms, but they’re actually very common – and often treatable if becoming problematic.

Physical: Some of these are the more typically recognised symptoms, although others are usually put down to a muscle strain, stressful life event, or just ‘getting old’. These include menstrual irregularities; palpitations; sleep disturbance; feeling faint; frozen shoulder; hot flushes/night sweats; cold flushes; burning tongue; thinning hair; brittle nails; urinary symptoms; breast tenderness; change in taste or body odour.

In particular, we’re becoming more conscious of the hormonal effects of perimenopause on our mental health. All of the above symptoms are easily attributed to a mental health condition without exploring a deeper cause. 

While CBT and counselling are beneficial regardless of the reasons for these struggles, the medication treatment approach could be reviewed through the lense of potential perimenopause/menopause.

If it’s low hormones that are causing the symptoms, would hormonal replacement be a reasonable approach versus an antidepressant? It’s very person-specific and will be guided by your doctor – but you can raise any concerns you might have about perimenopause or menopause, if you wonder whether this might be a root cause of your symptoms.

Perimenopause is a bit of a limbo-like time. It’s a progression towards menopause, and a sometimes challenging time to navigate.

The important thing is to be aware of vague symptoms that may be adding up to significant life disruption. And reach out to your healthcare providers at any point for further information or guidance.

ABOUT THE AUTHOR 

 Dr Michelle O’Driscoll is a pharmacist, re searcher and founder of InTuition, a health and wellness education company. Her research lies in the area of mental health education, and through InTuition she delivers health promotion workshops to corporate and academic organisations nationally.