“When did you first start experiencing perimenopause?” asked a co-worker of mine recently.
It seems like such a simple question, but I really had no way of answering her. Was it the first time I lost a fistful of hair in the shower? The first time I screamed at my husband with pure rage, then cried about it in the bathtub? Woke up at 4 AM in a panic, overcome with a sense of impending doom, unable to fall back asleep until dawn? The first fourteen-day period of my life? The time I couldn’t recall my co-worker’s name? The summer I gained fifteen pounds? The onset of unbearable itching in my inner ear?
And who had time to notice any of this, or put it all together, really, when the world was beset with a global pandemic, my father was transitioning into a retirement home, my daughter was applying to college, and I was building a women’s health company from scratch?
I wasn’t even aware of the phenomenon of perimenopause until after I left my career of 25 years to start a menopause company. The first time I heard the word was from a former boss, who happened to be ten years older than me and British. I thought “perimenopause” must be what they called it in England. It wasn’t until at least a year after we started Alloy Women’s Health that I realized that I myself might be in perimenopause.
I had interviewed many medical experts and heard the symptoms described countless times . . . and still, it didn’t occur to me that this stage I was learning about applied to me. I remember tentatively bringing it up to Dr. Sharon Malone, Alloy’s Chief Medical Advisor, and before I even finished the sentence, she said, “Anne, I can tell you right now. You’re 48. You’re in perimenopause.”
Was it that simple? Kind of. The root cause of menopause is actually that simple. It occurs because we stop ovulating, and our ovaries stop producing estrogen. There are estrogen receptors in every cell of our bodies, and the sudden loss of estrogen is responsible for every single symptom of menopause: hot flashes, night sweats, sleep disruption, brain fog, anxiety, rage, depression, mood swings, hair thinning, vaginal dryness, dry eye, dry ear, and so many more. And while the average age of menopause in the US is 51, “perimenopause” refers to the period of time leading up to your final menstrual period, when your hormones are fluctuating wildly before conking out. It can last up to ten years.
What this means in lay-woman’s terms is this: Perimenopause is the secret scourge of our 40s.
The cruel joke of perimenopause is multilayered and complex. First of all, each one of us will experience our own unique cocktail of the roughly 34 symptoms of menopause, so there is no immediate way to recognize it.
Secondly, it occurs at a time of life that is often busy and stressful, and because we manage everyone else’s lives, we only tune into our own bodies sporadically. So, while none of us is aware that this mix of symptoms adds up to perimenopause, even if we were, we would have to be paying much closer attention to track them and bring the complete list to the attention of a medical professional.
Thirdly, we would also have to get an appointment with that professional. The wait time to see a doctor who takes my insurance is about six months. I know this because my gynecologist retired and I have been trying to get an appointment with a new one. Half the counties in the United States have no gynecologists — not even to deliver the babies. And lastly, that professional would have to understand menopause, which, thanks to the misinformation spread in the wake of the WHI study in 2002 (more on that later), is quite unlikely. Less than ten percent of residents in family medicine, internal medicine and gynecology told the Mayo clinic they felt “adequately prepared” to manage patients in menopause. So even when you get the appointment, and even if your healthcare provider is a compassionate listener, you will most likely receive the wrong advice and be sent home.
Blood tests are no help either (and not recommended by the Menopause Society as a diagnostic tool). Since our hormones are all over the place throughout the perimenopausal phase, a blood test taken one day at noon will show a different estrogen level than one drawn the next morning.
So how are we supposed to learn about perimenopause when even the professionals don’t have the right information? You’d think maybe our mothers or aunts could help. I got my period when I was 11 years old, and my entire family, including the cousins we were traveling with at the time, were treated to a champagne toast in a crowded restaurant to Anne “becoming a woman.” I wanted to die. In retrospect, I certainly appreciate my mother’s pro-female-body spirit, if not her delivery. But for all of her 1970s, Our Bodies Ourselves-based enlightenment, she never said a word about The Change. I remember her sweating occasionally in her 50s, but I definitely do not remember any mention of the word menopause. No bubbly celebrations, mention of life’s milestones, or the power of what our bodies can do. The generation that ushered in the birth control pill, natural childbirth, and free love really left us in the lurch for the third chapter of the story that begins with periods, includes babies, and ends with our ovaries closing up shop.
It’s not their fault. By the time they hit menopause, most of our mothers were either taken off or denied the hormone replacement therapy that previous generations had benefited from, going back decades. In a now infamous 2002 press conference about the alleged risks of hormone therapy found in a billion dollar study called the Women’s Health Initiative, estrogen was so severely maligned (incorrectly, it turns out) that most of the millions of women across the country who were taking it to ease their menopause symptoms flushed it down the toilet, and the total percentage of women taking HRT fell from 40% to 5%.
I honestly don’t know how they managed. Luckily our generation is starting to change the conversation around this universal phase of life. We’re demanding answers, information, and solutions. Best of all, we are beginning to talk about it with one another, and even beginning to reframe this phase as a new beginning. My mom is gone now, but I’d like to think she’d say, “cheers!” to that.