Perimenopause Power: Navigating your hormones on the journey to menopause

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The subject of language and what it’s freighted with comes up repeatedly in her book. ‘Hysterectomy’ comes from ‘hysteria’, and all that implies; vets use ‘uterectomy’ instead. Hill uses the term ‘genito-urinary syndrome of menopause’ (GSM) to describe the effects of less oestrogen on your vulva, vagina and lower urinary tract that include painful sex and UTIs. Better that than the kegel-clenchingly horrible term ‘vulvovaginal atrophy’. Terminology, she argues, really does matter, especially with embarrassing symptoms: only 25 per cent of women with GSM, she says, will go to a health care practitioner about it. Instead, NICE guidelines say perimenopause should be diagnosed ‘based on vasomotor symptoms [hot flashes, sweating and heart palpitations] and irregular periods’. ‘Which is why it’s so important to go to your GP with an awareness of what’s going on with your cycle. If someone was to have HRT, that will point to what specific formulations would work well. Ideally it’s an ongoing conversation – as hormone levels change and you maybe go from having plenty of oestrogen to not much oestrogen, then your prescription will shift.’

perimenopause: ‘I was overwhelmed and full of rage Surviving perimenopause: ‘I was overwhelmed and full of rage

If you are not sure whether you are menopausal, because your contraceptive method has affected your periods, then you can ask your doctor for a blood test called FSH, to be done at any point over the age of 50. If the result is in the menopausal range then you can stop contraception one year after the blood test is done. Mom,” I said. “Did you just call the Bounty paper-towel company to complain about these teddy bears?” As it turns out, the reason Gen X women have grown up believing that hormone replacement therapy – again, one of the only proven treatments for menopausal symptoms – is dangerous is something that happened in the medical community in 2002. It’s like saying that you’ve closed up shop as a sexual being

The symptoms of perimenopause

The are many aspects of female/non-male biology that are still in their infancy in terms of our understanding, but Perimenopause Power does provide a lot of information from what IS currently known. Low doses of an SSRI or SNRI antidepressant can combat hot flashes, as can gabapentin (Neurontin). For heavy or irregular periods, Dr Minkin says you can take a birth control pill or get a progesterone IUD called Mirena. When it comes to herbs and supplements like evening primrose oil or bee pollen, there’s no proven benefit, though some women say that those things make them feel better. 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. “The average age of menopause in the UK is 51, and it’s sometimes called a second puberty,” Hill says. Second puberty? All the more reason to understand it ahead of time. Menopause is actually just a single day

What you need to know about perimenopause - and how to get

Fluctuating oestrogen levels may be partly to blame for the weight gain that often happens, particularly around the tummy and bottom areas. Headaches

So these are just some of the benefits to the menopause transition. Yes, perimenopause can be hugely confronting and challenging, but there are positives to the process and it is a window of opportunity to look at your health, to look at your life and to make powerful decisions about what you want and need. And that was the moment I realised that Jenny the turtle had become my very own paper-towel teddy bear. There are lots of reasons why mental health can suffer in midlife. Some of it will be to do with changing hormone levels and the resulting influence on other chemicals in the brain. These are the physiological reasons that can impact on things like mood, anxiety, motivation, your ability to focus and things like memory recall and cognition. So it can be a time where there is less resilience because of the hormonal changes that are taking place. But this is also a phase in life in which we are usually stretched and the past year will have done so even more I suspect for many of you. Many of the symptoms experienced during perimenopause are a result of decreasing hormone levels. A lower level of oestrogen is the main change, but progesterone and testosterone also play a part. Irregular periods

Maisie Hill

Number seven, there’s no benefit to the menopause transition. What do you think, true or false? This is an important one and especially after everything I’ve mentioned so far it can sound like this is all going to be pretty shit, there’s going to be no positives to this. And for sure this one is very much down to opinion. But for me this is false. Do bear in mind that I’m on this side of it, not the other side of it. So this woman read the guidelines and when her GP suggested more blood tests she was able to say, “Look, I think I meet the criteria, this is what the NICE guidelines say.” And because of that she was just referred to a menopause clinic. And I will link to the NICE guidelines in the show notes so that you can read them too and perhaps take them into your appointments if you’re having any discussions with GPs or other healthcare professionals. For some women, it’s not a big deal. For others, it can be crushing. In a survey by the American Association of Retired Persons, 84% of participating women said that menopausal symptoms interfered with their lives. Right, number six, true or false. Women are at highest risk of suicide around the time of menopause. This one is very sadly true. Between the ages of 50 and 54 is when we are at greatest risk of suicide. We often think about the menopause transition as in perimenopause and then going into our postmenopausal years as being a time when we experience physical symptoms like hot flushes, headaches, breast tenderness, and changes to our cycle, and changes to our periods. But it’s important to consider mental health too. People of Generation X tend to be demanding, and they’re having all these things happen to them. Why?” asked Dr Minkin. “What’s going on? They’re being told: ‘Just ignore it; it’s going to get better,’ or ‘You can take an SSRI [antidepressant], which will help your hot flashes – though, yeah, it’s going to make you love sex less and get fat.’ Your options are not too fabulous, but they don’t know how to handle hormonal therapy, because they think it’s going to give you breast cancer. The other part of the problem is that you have such authoritative spokespeople as Dr Kim Kardashian, Dr Suzanne Somers, Dr Oprah Winfrey, Dr Gwyneth Paltrow…”implying it’s not enough to do some resistance training, CrossFit specifically is where it’s at (Member of a CrossFit box by any chance Maisie?) Problems with vaginal dryness and intercourse are another common complaint in perimenopausal women. A drop in hormone levels (predominantly testosterone) is responsible for a reduced or absent sex drive - also called libido. Changes in skin and hair This book is so accessible - the language is very clear and conversational. The first chapter is called 'WTF is happening?' which immediately sets a conversational tone. A later chapter is entitled 'Moody Bitches'... hilarious! The scientific terms are broken down and simplified - the hormones are even likened to celebrities (The Beyoncé, The Kirsten Stewart)! When discussing symptoms of perimenopause, Maisie Hill offers a range of potential treatments for each. These vary from medication to alternative therapies to psychological interventions. There really is something for everyone. And the author totally normalises all of these, empowering you to make an informed and rational decision about how you might want to approach treatment for perimenopause. She provides case studies detailing how she has worked with specific individuals. Perimenopause is when you have symptoms of menopause but your periods have not stopped. Perimenopause ends and you reach menopause when you have not had a period for 12 months.