Jessica* was 44 when she started suffering from insomnia and night sweats. She was also convinced she was a bit moodier than usual. Work was stressful but it had always been. After her periods started becoming heavier she went to her gynae and was diagnosed with perimenopause. “The news came as a huge shock,” Jessica says. She is far from alone. Many women begin experiencing symptoms related to changes in hormones as early as in their 40s and some even in their 30s.
Most of us know that around age 50 our periods will stop, and we’ll have hot flushes as our ovaries shut up shop and we go through what stand-up comics refer to in bad jokes as ‘mental pause’. But for the rest, it’s seldom mentioned, even in an age when we share everything from the births of our children to the state of our bowels in graphic detail on social media.
The reason stigma persists is probably because, like Jessica, we associate approaching menopause with ageing, and our society is obsessed with youth. But this is starting to change, with the likes of Meg Mathews, ex-wife of celebrated Oasis Britpop rocker Noel Gallagher, beginning a blog in 2017 (megsmenopause.com), and launching a Managing Menopause Campaign with an international following. Meg reports that she became perimenopausal in her early 40s, but because her period continued and she had no flushes, she hadn’t a clue.
Perimenopause signs
Perimenopause means ‘around menopause’, and marks the transition from your reproductive years to menopause – menopause being defined as going 12 months in a row without a period, notes the Mayo Clinic.
The signs of perimenopause are different for every woman, and can range from worsening PMS, to irregular or very heavy periods and episodic flooding, migraine headaches, anxiety, irritability, mood swings, insomnia, exhaustion, ‘brain fog’, hair loss, chin hair, vaginal dryness, low libido and weight gain. Then again, some women have no symptoms and sail smoothly through both perimenopause and menopause.
Symptoms, when they occur, are the result of waning levels of oestrogen and progesterone, as your ovaries slow and eventually stop production of these hormones.
“Menopause is a natural phase of life, not a disease process,” says Joburg obstetrician and gynaecologist Dr Judith Carter, a council member of the South African Menopause Society – an association of healthcare professionals dedicated to promoting women’s health ‘during midlife and beyond’. “It’s valuable to try to find a way to embrace perimenopause as the start of another fabulous phase in your life, with the opportunity to find new meaning in all your relationships, your work life and passions outside of the workplace,” she says. “Given our ageing population, many more of us will be fortunate to live for many years after our last period.”
How to ease perimenopause symptoms
1. Phyto-oestrogens. Replacing our waning hormones with plant ones is one of a number of options. These phyto-oestrogens, including isoflavones, are marketed as alternative treatments for symptoms of perimenopause and menopause such as hot flushes and night sweats. They include soya beans and their derivatives, such as tofu, tempeh, soy sauce, soy milk, miso soup, chickpeas, lentils, flaxseeds and red clover.
“Interest in phyto-oestrogens is due to the observation that Asian women suffer from significantly fewer vasomotor menopause symptoms or ‘VMS’ (hot flushes, night sweats), compared with their North American counterparts – 20% versus 80%,” says Dr Carter. “However, as yet there’s no good quality evidence supporting the use of phyto-oestrogens, and we can’t be sure that it’s effective or safe, as it’s an unregulated industry worldwide.”
She adds that many of these substances form part of a healthy, particularly plant-based diet and are eaten almost daily by vegans and vegetarians. “There’s no conclusive data, though, on how much should be eaten and how often.”
2. Menopausal Hormone Therapy (MHT). Perimenopause and menopause don’t need to be medicated, but MHT has a significant role to play in women who are symptomatic and open to using it, says Dr Carter. “Most benefit is derived for the least risk when MHT is begun in the younger midlife perimenopausal woman – this usually means women in their later 40s – or for menopausal women in their 50s and early 60s who are still symptomatic. It shouldn’t be started for the first time if you’re over 60 or more than 10 years post-menopause, as the risk ratio is considerably less favourable then.”
MHT benefits include improved quality of life through relief of symptoms such as flushes, poor sleep, poor libido, poor mood and tiredness. It also helps maintain heart, bone and brain health, Dr Carter says. MHT risks include thrombosis (“which can be almost completely removed by using transdermal hormone preparations like patches or gels”), and the promotion of the growth of a pre-existing breast cancer, or a breast cancer you were destined to develop regardless of using hormones.
“Much research has been done and we have a wide range of registered hormone preparations available to us that minimise this risk to the breast,” she says. We also need to understand that avoiding hormones doesn’t remove the risk of breast cancer – it’s common, and there are many other risk factors, including obesity and too much alcohol. We need to be well-informed, though, so we’re in a position to weigh the pros and cons.
Do the weighing with a trusted medical professional who can factor in your personal and family history, have your hormone levels checked accurately with a blood test, and monitor you. Be guided by them.
3. Exercise. “This is very important as you go into perimenopause and menopause, for the maintenance of cardiovascular and respiratory health, muscle and bone mass, and balance and stability,” says Dr Carter. “Exercise is also very useful for maintaining a sense of physical and emotional well-being, as well as helping you cope with some of the commoner symptoms, such as low energy and poor sleep. However, there’s no evidence to suggest that exercise helps with VMS, and vigorous exercise can actually bring on VMS.”
4. Lifestyle. Striving for a healthy lifestyle by exercising, eating well, avoiding obesity and vices such as smoking and having too much alcohol, and managing stress are crucial for a long and healthy post-menopausal life, says Dr Carter. “This is the cornerstone of menopausal medicine and should ideally be the primary focus for disease prevention whatever your age.” Long-term activation of our body’s stress hormones such as cortisol and adrenaline can worsen oestrogen imbalance, she adds. Manage stress by stepping away when you feel overwhelmed, setting boundaries, prioritising and learning to say no. Meditate, have a massage and get support when you feel stress rise – call a friend, or if need be, talk to a therapist.
5. Screenings. Discussions with a trusted gynae or other health professional on perimenopausal or menopausal symptoms, and the merits of using or continuing MHT, should take place yearly, says Dr Carter – as should screening mammograms.
6. Spread the word. Help break the stigma around perimenopause and menopause: talk it through with other women and share support, and with your partner and family, so they take it less personally and feel less hurt if you have mood swings or low libido. Also explore lubricants and have fun pursuing other sexual options.
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