Facing the Perimenopause...What are we So Scared Of?

by Sarah Hughes

Last week I answered the phone and immediately heard hysterical cries from one of my closest friends. My stomach knotted as I tried to extract from her exactly what terrible thing had occurred. I imagined I was about to hear about the death of a parent, or that her husband was having an affair…

“Deep breaths” I said; “You’re going to have to tell me what’s going on.”

“I’ve just come off the phone to the doctor”, she sobbed.

“Ok” I replied, terrified I was now going to hear about a cancer diagnosis.

“Apparently I’m… perimenopausal!” she blurted out and then promptly started crying again.

Obviously at this stage I was flooded with relief and had to try my best not to shout at her for nearly giving me a coronary event. But as we talked for the next half an hour I absolutely came to understand why she was feeling so distressed and whith the word perimenopause, and all its connotations means to her. I have to say it planted some creeping anxieties in my own head about what will happen when this stage inevitably arrives for me.

Firstly I need to say that I have always been of the opinion that ageing is a privilege. A privilege that not all of us are granted. Having watched one of my oldest friends go through brutal cancer treatment which instigated an early menopause before she’d had a much longed-for child, I know in my rational mind that for most women, going through the perimenopause/menopause is a natural transition and not a curse.

Plus, everywhere we look, society is telling us to embrace the ageing process isn’t it? 50 is the new 40, that’s what the media tells us. Helen Mirren beams out at us from the L’oreal ads, resplendent and attractive at 76. Brands choose quinquagenarians like Jennifer Aniston and Kylie Minogue to sell us collagen supplements and haircare, so youthful do they seem. And they’ve all bossed the menopause haven’t they surely? Completed it mate. Sailed through the carnage, swishing their glossy locks right out the other side.

So why is becoming perimenopausal so scary for lots of women? We’re not foolish enough to think that we’ll suddenly fall off the edge of the ageing cliff and wake up disoriented, looking and feeling twenty years older. To answer this question we really have to examine the role hormones play in our day to day mood and also our outlook on life.

What even is the perimenopause?

Perimenopause refers to the time during which your body makes the natural transition to menopause, marking the end of the reproductive years. Once you’ve had 12 months without a period, you would medically be classed as being post-menopausal. Now for some of us; those who have either had all the children they want to have, or who decided to remain child free, the cessation of fertility might not seem like a big deal. In fact, it might be a relief. But for the millions of women around the world still hoping and trying to conceive during perimenopause, it can feel like one of nature’s most cruel jokes. Even if you have kids and never planned to be pregnant again, lots of women report psychological distress on finding out that the option is no longer available to them.

Women start perimenopause at different ages. Some in their mid-thirties but more commonly from the age of 40. And one of the things that was sending my poor friend into a panic after her call with the doctor the other day, is that the perimenopause and menopause combined can last commonly between four and twelve years. That’s a long time to be experiencing some of the really unpleasant symptoms that come hand in hand with this transition.

So what are the symptoms and what’s causing them?

The level of oestrogen ( the main female hormone) in our bodies rises and falls unevenly during perimenopause. Our menstrual cycles may lengthen or shorten, and we may begin having menstrual cycles in which our ovaries don't release an egg. The symptoms that result from this change in oestrogen production include hot flushes, sleep problems, reduced libido, vaginal dryness, low mood and raised anxiety levels. Fun, fun, fun hey!? It’s little wonder women are inclined to feel pretty worried about entering this stage of life.

In one of her more emotional moments during the call, my friend told me she felt like she was now on “the long march towards death.” Yes, yes I know she sounds like a drama queen but the more thought I’ve given it the more I totally get where she’s coming from. The perimenopause I guess marks an ending. An ending which can make us feel like time is running out, we can see the sand slipping through the hourglass. Let’s be honest, none of us want to say goodbye to youth, not just because the concept of it is so glorious, but because the alternative is you know, the opposite… the long march to death.

For my friend I could see that this everyday, banal announcement from the doctor had brought into sharp focus the passage of time and she was panicking at what she might have to leave behind.

I get it. All the careers we’ll never pursue, all the boys we’ll never kiss, all the different paths we could’ve taken, the gates to which are now firmly closed.

Being told you’re perimenopausal can feel like time is up, your world is getting smaller. And unfortunately it’s still something of a taboo topic. Like puberty in our early teens, we approach the menopause with a degree of shame and secrecy. Vaginal dryness just isn’t a particularly popular dinner party topic is it?

So how can we flip the script?

Since this phase of our life is happening whether we like it or not, I feel like one of the best things we can do is prepare ourselves. To be prepared is to be empowered y’all.

First of all, let’s make a conscious decision to talk to our friends openly about these symptoms and feelings, preferably before we reach crisis point.

Next, let’s consider five ways we can regulate our hormones at any stage of our lives, then tailor it to the perimenopause:

● Exercise - getting regular exercise regulates our production of serotonin and cortisol, aka the happiness and stress-control hormones. For more information on tailoring your workouts to the changes in your menstrual cycle, check out this article.

● Sleep - having a restful nights sleep is key to facing the following day with optimism and positivity. But as the perimenopause kicks in, deep sleep can elude us. Cultivate healthy sleep habits such as cutting down on caffeine before bed, staying away from your phone screen and sticking to set bedtimes and waking times. If these tactics don’t improve your sleep then it’s always worth talking to your doctor who might be able to advise.

● Eat a healthy balanced diet - when we suffer from low mood it can be very tempting to console ourselves with sweet treats. But you know folks, contrary to what my kids insist; happiness isnot found at the bottom of a jar of Nutella. To help regulate hormones like serotonin, eat a rainbow diet filled with antioxidants and wholegrains.

● Relax! And before you say it; yes I know… relaxing can feel like the most impossible of tasks in our hectic lives. Experts advise that we find structured ways to relax such as practicing mindfulness or yoga rather than just vegging out on the sofa which can leave us feeling sluggish and unproductive.

● If all else fails; ask for help from a doctor. You will not get a certificate at the end of your menopause saying “Congratulations on completing the menopause alone. Top marks!” As with any other hormonal change, the symptoms can be distressing and exhausting , but the miracle of modern medicine means we don’t have to endure them to the detriment of our mental or physical health. Synthetic hormones can be used to balance out the changes our bodies are undergoing, talking therapies can be useful in helping process the changes and it’s worth exploring those avenues if you feel you can’t get a handle on the symptoms yourself.

I finished the phone call to my friend by encouraging her to look at this next phase of her life more positively. After the menopause has done it’s thing there’ll be no more periods or PMS. Potentially an increased sex drive (without the fear of pregnancy). Many women report feeling emotionally stable for the first time in years. Others describe life post-menopause as ‘the second act’, a time with more energy , fewer commitments and a prioritisation of self.

My friend’s sniffles quitened down a few decibels and I knew she was smiling as she said, “Ok. Maybe it’s not quite the long march to death… maybe it’s just the long march to looking like Jennifer Aniston.”