Thanks to the work that’s been done to reduce the stigma, perimenopause is now becoming an open, honest conversation. But searching for answers or support can leave you with miracle cures, quick fixes and contradicting advice. We wanted to speak to an expert, and there was only one woman for the job: Dr Fionnuala Barton, GP and BMS Menopause Specialist, known aptly online as @TheMenopauseMedic.
From how perimenopause differs from the menopause to the unusual symptoms you can expect during this time (even itchy ears), we’ve unpicked common misconceptions so you can enter this transition feeling well-informed and empowered.
But firstly, what is perimenopause?
You’ve heard the word, but what does it actually mean? ‘Menopause is a singular point in time that marks the end of a woman's reproductive life,’ says Fionnuala. ‘That means they have no more active ovarian follicles and will cease to ovulate and menstruate.’
Fionnuala explains: ‘We can make a clinical diagnosis of menopause once somebody has not had a menstrual cycle for 12 months; after that point we refer to it as post-menopause but that’s recently been shortened to just menopause.’
So perimenopause is this ‘ill-defined phase’ in the run up to menopause. ‘When we’re starting to see systemic symptoms and underlining biological and physiological changes as a result of declining ovarian follicle numbers, declining ovarian hormone production and declining ovarian function,’ she says. ‘You’ll get big peaks and drops of oestrogen, progesterone and testosterone and these big swings often give rise to a lot of the symptoms.’
Myth: Perimenopause starts in your 50s
The misunderstanding that menopause was reserved to those in their 50s led to women being turned away from medical help. ‘Historically, women in their early or mid 40s going to the doctor with symptoms would be dismissed and told you’re too young, because we viewed menopause as this event that would happen around age 50,’ explains Fionnuala.
Historically, women in their early or mid 40s going to the doctor with symptoms would be dismissed and told you’re too young
Dr Fionnuala Barton
But new discussions around menopause are making us realise we need to be preparing for it much earlier. ‘Now, we appreciate perimenopause can last 8 years before menopause and often up to 15 years, so even if the average menopause is starting at 50, we’ve got to be thinking about how we can optimise our hormone health from our 30s.’
Myth: Hot flushes are the main symptom
Although not the only symptom, hot flushes are common during perimenopause – but they’re not to be undermined. ‘When you feel suddenly incredibly hot it can be really overwhelming, one of my clients described how she felt like she was having a heart attack,’ says Fionnuala. ‘They can be really intrusive and really debilitating.’ And it isn’t just heat: ‘Some people will get cold chills, so instead of feeling hot they’ll get very cold very quickly.’
This is because perimenopause causes nervous system dysregulation. ‘This can manifest as feeling more anxious, having temperature dysregulation and seeing the sleep/wake cycle change.’
There are a whole host of physical symptoms beyond hot flushes that Dr Fionnuala sees in clinic:
- Skin changes
- Dryness
- Irritation
- Itching (this is really specific to oestrogen insufficiency – yes even itchy ears!)
- Getting new allergens
- Gastrointestinal symptoms
- Weight gain
- Joint pain
- Feeling bone-tired as if you’ve got absolutely nothing left in the tank
She advises to always check in with a medical professional, to make sure there isn’t something else going on.
Truth: You can feel like you’re losing yourself
Often the psychological and cognitive symptoms get less airtime than the physical ones, but they can be equally challenging. ‘I hear women say I used to be really organised, I’d just get everything done and now I'm really struggling and that loss of executive function can be hard to articulate,’ says Fionnuala.
Snapping at your partner, struggling to hit your goals at work, remembering words or withdrawing from loved ones can create ‘a bit of an existential crisis’. Fionnuala describes: ‘It can be really dispiriting for women who are just trying to do their best, when they start changing. Remember, it’s not your personality but a neurological response.’
Being kind to yourself during this transition is one of the most important things you can do. ‘Treat yourself with enormous amounts of compassion – we can be our own worst critics! I think how would I talk to myself if I was my best friend? I would tell her we’ll work on this together and get through it, so I’d really love to start changing that internal dialogue to say: I am deserving of care.’
Truth: Sometimes you need a second opinion
Suffering in silence benefits no one. ‘One of the other messages I hear all the time in clinic is I didn’t want to bother anyone about this but you’re not bothering anyone! If you’ve been living with miserable symptoms then your quality of life is really important – not just for you but for everyone who depends on you,’ Fionnuala explains.
In an ideal world, every medical profession would be a perimenopause specialist; sadly that isn’t the case, but it doesn’t mean you can’t access the right support. ‘If you’re seeking support and are finding you’re meeting a closed door I want every woman to know that she can continue to ask – she shouldn’t feel like a closed door means she should be quiet and just crack on. Go and ask somebody else, demand a second opinion.
I want every woman to know that she shouldn’t feel like a closed door means she should be quiet and just crack on. Go and ask somebody else, demand a second opinion.
Dr Fionnuala Barton
And remember, you can self-refer for psychological symptoms too. ‘There is no shame in having a therapist! It’s not a luxury, it’s a really valuable tool to have in the toolkit and on the NHS you can self-refer for talking therapy wherever you are. Sometimes there’s a little bit of a wait but most of the time you’ll get triaged quite quickly so you can get the support that you need.’
Myth: Menopause is an ending
The idea that menopause is something to dread could be the biggest myth of all. ‘Most of us will live into our 80s if we’re doing things right and, if we menopause right, most women will live 50% of their life post menopausal so I do see it as an opportunity.’
‘I love the word rebirth or ‘second spring’ as they refer to it in Japan, because you’re unshackled from some of the reproductive-era related things,’ she says. ‘There’s a wisdom that comes with it. You see things differently and there’s less need to impress people.’
If we prepare, it has the potential to be a powerful new chapter. ‘If you’re alone in it and don’t know what to do then it can feel quite overwhelming, but if you see that it’s going to come and have a framework to prepare, then you can empower people to have positive experiences that they don’t need to fear… maybe even look forward to.’
