I wasn’t sure for a long time. You might be! In the UK, the average age for menopause is 51 and it generally occurs between 45 and 55 years of age. Diagnostically, you are in menopause when you have not had a period for 12 months. It’s difficult to know when you’re in Perimenopause (the time in a woman’s life where she makes the transition to menopause) because signs and symptoms of oestrogen reducing can be so varied. Some women can enter this phase in their late 30s while others won’t start until their late 40s or early 50s. The NICE guidelines state that lab tests do not help with diagnosis because hormones are fluctuating at this time. Your GP therefore won’t order lab tests if you are over 45 but might if you are younger. Generally, diagnosis is made on clinical history alone. Perimenopause symptoms can last for a few months or a decade and can change over time. Knowing that you might live with these symptoms for such a long period of time can be the motivator to getting help, or treatment and making lifestyle changes.
One of the first signs of Perimenopause for many women is a change to your periods. When I look back I think brain fog and tearfulness were the first signs, but when my periods changed this was a bigger problem so more noticeable. Your period might be more irregular, longer, shorter or heavier. This has been one of the most challenging aspects for me, as my periods became much heavier, more painful with cramping throughout the cycle, and they occurred more erratically, often having only one or two weeks between them. I did not initially connect this to Perimenopause because I presumed periods would become more spaced out and less frequent but this was not the case for me and many women. I think it’s important to say early on that it’s easy to explain away body changes, “Oh it’s probably my other health problem, or Covid, or that medication I took or what I ate or how stressed I’ve been”, and not do anything about it. It’s also easy to think it’s not happening to you, not yet anyway if you’re still young. I think I did this for too long and should have gone to the doctors earlier than I did. Obviously the pandemic kind of influenced this for me too, but if this is what you do too, don’t put it off. The sooner you get treatment, and or support, the better. That applies to any health changes. Because I was 45 when I eventually did seek help and just at the cut off and still having regular (too regular!) periods, the GP did a series of blood tests and I had a pelvic ultrasound to check there was no other explanation for the heavy bleeding. By the time I had these tests I was feeling pretty drained. The whole process from consulting GP to getting the results took months as it does at the moment. The results showed some minor fibroids which are very common and that I was anaemic but that’s not new for me as it’s something I’ve struggled with since I was a teen. So I left the doctors (a male doctor – yikes maybe that’s sexist but you know) with a prescription for iron pills and that was it. No other advice was given or support offered. Just before Christmas last year I talked to my mum about it all (again I waited far too long to talk to her and she was so helpful). She told me she’d started Perimenopause early and that it lasted a decade and urged me to go back to the doctors. This time I saw a female doctor and the experience was slightly better. I still felt like she didn’t look at the big picture and just honed in on the bleeding. She told me my options were the pill, coil, or surgery. I thought this was a bit dramatic but she shrugged and said many women with heavy periods go for this. I spoke to a few friends who had the coil and discovered that they haven’t had periods for years because of the coil! Why did I not know this? I vaguely recall a doctor thrusting a birth control leaflet at me after the birth of my son but that’s about it. This was not my priority or on my radar and it got shoved in a drawer and never considered again because my other half had the snip. This got me thinking about how many periods I’ve suffered maybe needlessly and how many products I’ve bought over the years! Anyway no point dwelling! But you guys should know this! We don’t have to put up with periods!! Enough exclamation marks. Of course different methods will work differently for each individual and I’m not here to give out health advice but please, if you’re struggling with periods- go and see your GP equipped with knowledge about your options.
I’m certainly not here to start criticising our amazing NHS. I worked in it for years and the staff are all amazing warriors fighting against low funding, low resources and huge waiting lists. I can also put my hand up and apologise that if you were a woman who consulted me before I was in Perimenopause and you were in your 40s with symptoms of low mood or anxiety or anger related to Perimenopause- I would have missed it because I didn’t know about it at all. Tides are changing but I think there is still a lot of awareness raising and training needed for those working on the front line, to see the big picture.
Thankfully, I decided to go for a Mirena coil to see if that would help the bleeding which was the biggest problem for me. Oh, back a step, I didn’t tell you about the flood that happened when I was volunteering at the national trust. Thankfully I was wearing black leggings! Oh my goodness it was an actual flood – I think they call it a flash period. Of course I had no supplies with me and had to tie my coat around my waist, head for the car and go home. After that it happened a few more times, totally out of the blue so I started wearing a pad all the time and dark bottoms every day. Couldn’t be having a Charlotte from Sex and the City moment! Grim. Totally grim. We’re talking about bleeding that saturated a tampon and a pad after 30 minutes, some days I didn’t leave the house.
So the coil, I thought that’s the fella for me. If it stops this I can cope with the rest. I can’t remember to take pills so that’s out and surgery seems too invasive. This procedure was done at my local GP by a lovely GP who talked to me about other symptoms and was very patient and offered me HRT there and then. I couldn’t believe it after the year I’ve had of appointments, follow ups, tests and the rest. I snapped her hand off.
The moral of my story is this. You know your body better than anyone . Trust your instincts and ask for what you want. I wanted support for what I suspected was the Perimenopause and I should have asked for it a year ago. It’s just the way of it that we need to ask if we have read about something that might help because it might not be offered.
You’re on this journey with me because I started the HRT just a few weeks ago and had the coil done at the same time. So far so good but I’m under no illusion it’ll be the perfect all in one solution and I’m open to trying other things too. The main thing is I’m in the system now as mum would say. Replacing the hormones I know is just one part of the picture but it seems to be a fairly massive part.
Take home points
1. There will be women around you who are a little or a lot older and wiser so speak to them. They’ll definitely be able to relate, will be able to empathise and advise you so reach out to a family member, colleague or friend.
2. Since I’ve started writing some of my closest friends have said “Me too- why have we never discussed this?” It’s easy to omit the tricky things we’re dealing with. We don’t want to bring others down or talk about grim details over a meal out but we must reach out somehow to support each other. So arrange a walk or a drive somewhere and put it on the agenda.
3. Be assertive and don’t give up with the doctors. There are lots of great GPs out there ready to help us explore our options. Ask for what you want if it’s HRT or psychological therapy, or help with bleeding or tiredness. Tell them you think it’s Perimenopause.
4. Keep reading. Equip yourself with knowledge because knowledge is power. Connect on social media, follow #perimenopause as there’s loads of great advice out there.
Sea change 