It happens to half of the population at some point—but how much do we really know about the menopause? Turns out not a lot, if Maisie Hill’s new book, Perimenopause Power, is anything to go by. Filled with information about the process, which has traditionally been seen as a taboo topic of conversation, it’s an informative must-read for any woman—whatever their age.
Hill herself says that many of us dismiss the idea of the menopause as something that will “happen in our fifties”, but knowledge is power, and understanding your body and its hormones can pay dividends when the perimenopause (the lead up to the menopause), starts. In Singapore, the average age of natural menopause is 49 years old, according to Singapore Medical Journal.
“This is pretty consistent the world over. The signs and symptoms that women experience tend to start around the age of 45 years and reflect the decreasing levels of oestrogen,” Dr Susan Logan, senior consultant, Department of Obstetrics & Gynaecology at National University Hospital tells Vogue Singapore.
Menopause is actually just a single day
“Menopause itself marks the 12 month anniversary of having your last period,” says Hill. “Let’s say you’re 50 and you have your last menstrual period—it is 12 months after that—on that one day—that is the menopause.” The time which leads up to that single day is called the perimenopause, that describes the phase accompanied by the symptoms we hear so much about, from hot flushes to vaginal dryness. “It has to be 12 months, otherwise it’s not the menopause.” The perimenopause commonly starts in a woman’s forties, with slight (barely noticeable) hormonal shifts that start the process occurring in the mid to late thirties.
The symptoms of perimenopause
Typically, perimenopause starts and we don’t even know it. “Often, production of progesterone tapers down first so you get a shorter cycle and might have fertility issues, premature spotting and insomnia,” explains Hill. “And because oestrogen and progesterone are two hormones on a see-saw, when progesterone drops, oestrogen goes up.” When oestrogen rises, rage and irritability become common, as well as bloating, breast tenderness and brain fog. You can also suffer painful joints, vaginal dryness, problems with memory and verbal recall, forgetfulness and other changes in cognition and mood, most of which occur towards the end of perimenopause, when your period is about to stop for good. “Hormones affect everything, and because you have such low levels of oestrogen, it can affect a lot of things,” says Hill.
It’s often misunderstood—even by healthcare professionals
Since perimenopause arrives at a time of life when many different events are at play—and because symptoms are so numerous—it can be misdiagnosed by GPs and other healthcare professionals. Hill says that many of her clients, who “report suddenly getting panic attacks from nowhere”, are often thought to be depressed or suffering heart problems, when really it is their fluctuating hormones that are responsible. “There is a case study in the book where I speak about a client of mine whose GP had been giving her antidepressants instead of giving her HRT (hormone replacement therapy), and she finally demanded it. But she had gone six years not getting any treatment, suffering severe symptoms including intrusive thoughts, and really she just needed oestrogen,” says Hill. Her advice is to be familiar with the NICE guidelines, so you know what to ask for and the different treatments available to you. “Another thing a lot of women are told is that it isn’t the menopause because they’re still having periods,” says Hill. “That’s just misunderstanding what menopause actually is.”
HRT has had an unfairly bad rap
“A lot of people are very put off by the idea of HRT, but it’s far safer than we’ve been led to believe. We’ve had 20 years of scary headlines, saying that it doubles the risk of breast cancer and of cardiovascular disease, but the research that those headlines are referencing was conducted over 20 years ago now, and it was flawed. They used participants that should never have been included in a research trial as they wouldn’t now meet the classification of what would be deemed healthy,” says Hill, who also points out the data was analysed incorrectly. This research still informs not just women’s opinions, but those of GPs too, and many are reluctant to prescribe it.
Hill says that while some may be able to get through the menopause without hormone replacement therapy, it’s important to take the perimenopause as a window of opportunity. “Scientific literature refers to it as a time we can have lasting influence over our future, and HRT not only helps to manage symptoms in the here and now, but it can also help fend off everything from osteoporosis and cardiovascular disease to neurodegenerative diseases like Alzheimer’s and Parkinson’s,” she says. Nowadays, body identical hormones are used, and they’re identical to the hormones we naturally produce—a fun fact is that they’re also made from yams. Whether you take it in a pill or as a topically-applied gel, Hill is emphatic that HRT can make a huge difference to quality of life, both at the time of use and in the future.
It isn’t all doom and gloom
While many women dread the perimenopause—and/or have heard their mums moan about it—it can actually be a very positive time and a pivotal moment in life. “The point of the menstrual cycle is to have sex and create another human, whether you do that or not, so oestrogen makes us interested in other people, and more social and accommodating,” says Hill. “When it goes, we don’t care so much about what other people think—and that is a huge gift.” She says it’s amazing to see her clients thrive as they begin to prioritise themselves, and forgo people pleasing in favour of doing what they want, when they want.
Perimenopause Power: Navigating Your Hormones on the Journey to Menopause (Bloomsbury, $32.72) by women’s health expert Maisie Hill is available to buy now.
This story originally appeared on British Vogue.