“If the tables were turned and men were the ones who were wide awake drenched in sweat at 1am, if their cognitive function changed and their penises shrivelled up, how much money do you reckon would be coughed up to help them?” asks Maisie Hill in her second book Perimenopause Power. She’s referring to the insufficient research into the impact of hormonal changes experienced by pre and postmenopausal women.
Hill is a menstrual health coach who has trained in traditional Chinese Medicine and used to be a doula. In 2019 she published her first book, Period Power, a bible on all things periods and hormones that sets out practical tips on aligning your daily life with your cycle. She has now taken on the “taboo” of the menopause, alongside the likes of Penelope Cruz, Michelle Obama, Meg Matthews, Ulrika Johnson and Davina McCall, with her follow up title which came out in March earlier this year. Perimenopause Power was the natural progression to her debut book, Hill says, as her DMs were full of women asking “what happens next?”.
There was also a personal motivation, about to turn 40, and “starting to do the dance,” as she puts it, she wanted to arm herself with as much knowledge as she could as she “tiptoes into the menopause.”
Perimenopause typically begins in your 40s, but symptoms can start as early as your 30s, “and even if it does happen in your late 40s, there are things you can do now to influence later on, rather than just waiting until you’re in the thick of it and really struggling,” Hill says. In the book, she describes the perimenopause as “a window of opportunity” to “radically change how you think and feel about yourself and your life.”
What’s the difference between perimenopause and menopause? The menopause is actually only one day, “it marks 12 months since your last period, after which you’re postmenopausal,” Hill explains. The perimenopause refers to the years leading up to your periods stopping, when you are still having a menstrual cycle, but it might be shorter or longer or “flipping between the two,” while also experiencing menopausal symptoms.
“I don’t think it’s any coincidence that the time in a woman’s life when she’s most at risk of suicide is between the ages of 50 and 54 - the average age that we go through menopause is 51 - so we know that’s when oestrogen is typically really low,” Hill says.
Changing oestrogen and hormone levels can have a huge impact on cognition, brain function and mood which can cause anxiety, depression and poor memory. That’s on top of a long list of physical symptoms, including vaginal dryness, painful joints, palpitations and hot flashes. In addition to hormone fluctuations influencing other chemicals in the brain like the happy hormones dopamine and serotonin, there is also what she calls “the build up of life.”
“Women are stretched, as mothers, partners, working, thinking about ageing parents, as well as doing the bulk of unpaid labour and emotional labour. We can probably get away with that in our cycling years — whether we want to or should do is another question — but once you hit the perimenopause it’s crucial to address this, ideally before, because if we keep going at this rate it exhausts us and can have devastating results.”
Dispelling the myths around the menopause
Hill says she is on a mission to dispel the many myths around the menopause, one of which is the demonisation of HRT, though she prefers the term “menopause hormone therapy,” or MHT. “There has been a lot of scaremongering around the use of HRT, we’re used to reading and hearing about how it causes an increase in breast cancer and cardiovascular disease.” In her book she dissects what she describes as a “fundamentally flawed” study from the Women’s Health Institute that continues to have “an enormous — arguably harmful — effect on the health of those who are peri- and postmenopausal. “People need to realise that it’s a safe strategy, but it doesn't have to be the only strategy - I definitely plan on taking it!” she says.
Part of the problem is a lack of education and training on behalf of GPs, which is often a woman’s first port of call for help, she argues, “topics like the menopause just aren’t prioritised.”
Another common misconception is the association of the menopause with slowing down and giving up on life. “I have found the opposite in my clients, perimenopause itself can really be a time of reckoning, when we get a really clear sense on what’s important to us, start prioritising our needs and desires over those around us and stop giving a s*** about what people think about us.” While some women report a loss of libido as a symptom of perimenopause, others report increased sexual desires, she offers.
Ultimately, each woman’s experience with the menopause is unique, some will barely notice they’ve gone through it, while others will experience far more extreme and varying symptoms. Either way, arming yourself with as much information as possible is key.
Below are Hill’s top tips on steeling yourself for the perimenopause (at any age).
Maisie Hill’s toolkit for peri- and postmenopause
Track your cycle
“In many ways, tracking and working with your cycle during perimenopause is where you can get the most out of it. You can use the Get Cracking with Cycle Tracking guide on my website to help you with this. You’ll get a sense of your personal patterns, powers and pitfalls, and be able to make adjustments here and there to improve your experience of your cycle and make use of each phase,” Hill writes in her book.
“Building bone density and doing resistance and weights-bearing exercises is hugely important. Even if you’re already in your 40s it’s still really important to start to protect against things like osteoporosis.”
“We have the tendency to people please and say yes to things that we’d actually like to say no to, so often we’re running around in a stress response because we’re fearful about what people think of us.” Work on your boundaries (there’s a section on this in the book).
“Eating a varied diet of lots of nutrients goes a long way. Make sure you’re not skipping meals, eat regularly and sufficiently - so often my clients just aren’t eating enough.”
“Sleep gets more and more important as we age but can get more challenging as we age.”
Limit alcohol or cut it out
“Alcohol increases body temperature (hello hot flushes and night sweats) and raises your resting heart rate (hello hot flushes and palpitations). It also disrupts your production of melatonin and screws up your circadian rhythm,” she writes.
Consider holistic options
“Some people find things like cognitive behavioural therapy (CBT), acupuncture and taking certain herbs can be supportive through perimenopause, just make sure you’re consulting with a qualified health professional to make sure what you’re taking is safe and appropriate, particularly if you’re also taking HRT (as some should not be combined with HRT).”
Maisie Hill’s book Perimenopause Power: Navigating your hormones on the journey to menopause (Bloomsbury, £14.99) was published in March 2021