Happy World Menopause Day. The purpose of marking this occasion is to drum up more conversations and awareness around the time in a person’s life when their periods start to cease. For any woman or person who menstruates this, of course as inevitable as the end of Magnum and flip flops season. But it’s still rarely discussed and, sometimes, still feels like something we should shoulder without frank chats, compassionate guidance and real support. While this transition phase is often thought of in negative terms (and the symptoms are certainly no holiday to Bali), some women report it leading to a time of change and renewal.
While the typical onset of the perimenopause – the months or years in which you experience menopausal symptoms before your periods actually stop – occurs between 45 and 55, it can happen earlier.
'Despite being the editor-in-chief of a health brand, and pretty clued up on wellness issues, I had no idea the symptoms I started experiencing at 39 were the perimenopause,' says Women's Health editor-in-chief Claire Sanderson. 'Extremely sore breasts, vanishing patience, growing anxiety, off the scale PMS and fatigue all left me confused and feeling low. I thought menopause and hormone replacement therapy (HRT) was something I'd have to deal with in my 50s, not as I approached 40.'
'After about 12 months I finally sought help. I started taking oestrogen, progesterone and testosterone and my symptoms improved. Menopause and perimenopause can happen sooner than you think. I wish I'd known that before I suffered for too long. I'm fit, healthy and I take HRT. It helps me every day.'
To help you to get your head around what might go down when you enter this life phase, Jo McKewan, 54 and Ann Stephens, 56, founders of the Positive Pause blog, share the things they wish they had known.
1. Perimenopause comes before menopause
'We knew that the mysterious menopause would hit us at some point in middle age, but we lived in blissful ignorance of what this looked like and when it might happen. Nobody had bothered to tell us that, on average, women are in perimenopause for four years before their periods stop. Consequently, we blundered around feeling moody, tearful and at times, murderous, without making the link to our dwindling supply of hormones.'
2. It's like Pandora's box
'Hitting perimenopause can feel like opening Pandora’s box - you don’t know what you’re going to find. There are at least thirty four accepted symptoms of perimenopause that can knock you off your feet. Ann’s frozen shoulder, or "fifties shoulder", as it’s called in China and Japan, was a sign that her hormones were running low. Jo’s itchy, crawling sensation under her skin? Now it had a name - formication. That new ringing in her ears? Hello, menopausal tinnitus. Who knew there were so many different symptoms?'
3. You may leak when you laugh
'Stress incontinence - caused by pelvic floors weakened by a reduction in oestrogen - means that laughter, coughing, sneezing and downward dogs are sometimes accompanied by leaks. However, with the help of our women’s health physiotherapist friends, we learnt that not only are we among the one in four UK women who experience bladder weakness at some point in their life, we’re also among the 85% of women who can strengthen our pelvic floors with the help of daily exercises.'
4. There may be anxiety, mood swings, with occasional tearfulness, ahead
'This is the menopausal forecast for so many women. Ann calls these her "Shelley Duvall moments" after a character from The Shining. Anxious about making mistakes, she lost self-confidence and her decision-making hit rock bottom, leading to frustrated outbursts of rage that took her and her poor, unsuspecting family by surprise. Anxiety is one of the most misunderstood symptoms of menopause and knowing that fluctuating hormones are the cause really helps.'
5. Weight gain is a possibility
'Hormonal changes affect weight gain and fat gets redistributed around the body - our midriffs were living proof of this. We reassessed our diets. Out went those processed, fatty, sugary foods that weren’t doing us any favours. In came the healthier plant-based foods, complex carbs and exercise.'
6. There’s loads of management options
'Menopause can be discombobulating, but fortunately there are a number of practical steps you can take to be in control, whether that's re-evaluating your diet and lifestyle, taking HRT (for those who can and choose to), or considering supplements and alternative treatments. These simple steps can help to improve your overall health and wellbeing.'
7. It’s brilliant on the other side
'The general perception is that menopause is all doom and gloom. Take it from us, once you understand what’s happening, make sure you ask your doctor for help to get on top of any symptoms, as the other side is like nirvana in comparison. There are no periods, you have more energy and there's plenty of living and loving to be done.'
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* International consultation on incontinence (ICI), publication 2013, Abrams et all
** Dumoulin C, Hay-Smith J, 2010, Largo-Janssen TLM et al, 1991
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