Perimenopause - Part 1: Enough is ENOUGH
I’m generally not the kind of person to get up on a soapbox. In fact, I’m fighting the urge to hide under a rock as I write this, but…enough is ENOUGH. This is just too important.
No matter your gender or sex, this is relevant to you and I hope you’ll read it and benefit. I’m writing this because, whether I know you or not, I care about you, and I don’t want you or any of your loved ones to suffer needlessly. It’s about damn time we put an end to the suffering.
If you find this blog useful, please show some for this post and share it widely so I know this content is appreciated and Google will help more people find it who need it. Part 2 here.
Hi friends.
I’m on a mission.
And I’m MAD!
Why?
Because over the last 8 years of working with women over 40, I’ve quietly haboured the slow and devastating realisation that women - ALL women - will face a silent, hidden form of discrimination and neglect at the hands of “the system” as we grow older. It goes like this:
Perimenopause is often an incredibly confusing and challenging stage of life for women (and this often extends to their partners, kids, friends and colleagues).
The suffering and disease risks are VERY real, ranging from mild to completely devastating.
But it DOES NOT NEED TO BE THIS WAY. It should not be this way!
The suffering and risks are COMPLETELY PREVENTABLE, yet the support women receive from Western Medicine is frickin’ abysmal. (Same story for puberty and post-menopause, for that matter).
Don’t get me wrong: of course, Western Medicine is amazing for many things, and we really have come so far…. AND, it truly SUCKS at supporting women with hormonal issues in general. Women are sick of it (literally) and it’s time for us to speak up and demand better.
And in case you’re wondering where I’m going with this, no, it’s not the fault of doctors (or anyone in particular). Doctors are sick of it too! They barely get any training on these issues, especially around peri/menopause care.
“Overall, training on menopause management is profoundly inadequate even nowadays...Although menopause education is included in some medical and specialty training curricula, physicians are not adequately trained to provide the standard of care to women transitioning to menopause. ”
So what is hell is going on here?
The real issue is that scientific research - and consequently, medical school curriculae - have been woefully and disgustingly inadequate when it comes to women’s health.
And frankly, this inadequacy spans ALL areas of women’s health.
Case in point: only 0.5% of neuroscience studies look at women’s health (Nov 2023).
…Seriously?
I’m sorry, but what the actual F***??!!
And how many billions of dollars in R&D have gone into dick pills???
…Woof. I’m gonna let that train leave the station. And breathe…
“Ageism and sexism and their intersection probably contributed to this not being a priority”
This “gap” in research on women’s health also explains why women are falsely led to believe that they should keep the same lifestlye habits that work for men when it comes to nearly everything: nutrition, exercise, fasting, work, sleep, stress, hormesis, longevity and on and on AND ON. ALL of our ‘best practices’ are drawn from research conducted on men, and women just get told to do the same.
But, as Dr Stacey Sims, a fierce advocate for women’s health, likes to shout from the rooftops:
WOMEN ARE NOT SMALL MEN!
When women try to live according guidelines based on male physiology, our hormones, metabolism and our entire female physiology get all screwed up. This makes the symptoms of our menstrual cycles and of perimenopause SO MUCH WORSE. 99% of women don’t yet know this!!
I’m on a mission to change that.
(This is why I’m soon launching an online course for women - especially over 40 - to learn what to take care of their bodies, undo this damage, and reestablish metabolic and hormonal balance.)
Sadly, the trend of male-centric research continues even now, as outlined in this recent Guardian article (Nov 2023).
The good news? A recent surge of interest, from celebrities to scientists, is helping draw attention the the problem, as outlined in another Guardian article from just a few days ago (March 1, 2024):
“Women are demanding to know more about what to expect, and providers want improved guidance for their patients. This reflects a dismal norm: research suggests that 60% to 86% of women seek medical care for their menopause symptoms, but many feel misunderstood and disappointed after their appointments. Most women under 40 are underinformed about menopause, and only a small slice of providers feel prepared to answer their questions adequately.”
Why has research excluded women?
Physiologically, women are “more complex” than men owing to our cycling hormones, so we have been systematically excluded from research for a very long time.
Why?
Because it’s difficult for researchers to “control for” our monthly sex hormone fluctuations (or in other words, compare results against a steady hormonal baseline).
Why does this matter?
Source: forthwithlife.co.uk
Because EVERY SINGLE PROCESS in your body is affected by your hormones (whether you’re female or male). And for women, the hormonal symphony is much more complex than for men.
So, when hormones are not the “variables of interest” in a study, they have to be controlled for because they will likely will influence the outcomes. Makes sense?
(I like to tell clients to think of hormones as our body’s symphony conductors: they direct the timing and intensity of the gazillions of processes that occur in our bodies 24/7, 365, every blessed day of our blessed lives.)
…And you know, as someone who was a biomedical research scientist for over 15 years, I do understand why women have been excluded from research: standard operating procedure was and still is only to use male rats / mice / flies / humans for experiments and discard the females, to put it rather callously, because female hormones really complicate the data.
I get it…but do I find it acceptable?
HELL TO THE NO.
The question is: how have we not changed this by now??
Female hormones are indeed complicated, AND they need and deserve more attention in labs, in medical schools and across health professions, from nutrition to fitness coaching to psychology to medicine.
But they also deserve more attention in our homes, with our kids and in casual dinner conversation…
What’s the deal with perimenopause?
Generational silence on matters surrounding female hormones has left many of us totally in the dark: we have no idea what to expect, let alone how to navigate. Did your mother ever talk to you about what she was going through, or did she suffer in silence? How many mothers still suffer in silence, needlessly?? It makes me incredibly sad to think I never understood why my poor mama would throw down the car window in the middle of winter, why she would greet us so thoroughly exhausted some mornings or why she would sometimes start crying for seemingly no reason.
Even in ‘woke’ culture, squeamishness around women’s issues holds strong: say the word “period” or “menopause” or “tampon” in the company of most people and they’ll likely either visibly squirm or disappear.
In fact, our general lack of awareness is such a problem that whenever I work with clients between 35 and 50, I always start with questions about hormones and whether they’re experiencing any signs or symptoms of peri/menopause.
And you know what I find?
MOST women have no idea WHEN to expect perimenopause or WHAT to expect, even those who are in it, or even well beyond!
And the ones who are “in it” say “OMG NOBODY EVER TOLD ME!! What do I do??”
It’s not our fault we don’t know.
I DIDN’T EVEN KNOW, despite all my years of rigorous health studies! I was in this “OMG WHAT??” camp until recently too.
And, you better believe, it SHOCKED and frankly horrified me when I started having symptoms at 41 years old. I thought I was too young…
So, with that, allow me to lay out a couple of key FYIs on female hormones and perimenopause here.
What to expect and when
It may sound trite, but it’s fitting here to say “expect the unexpected”, which is actually more empowering than it might sound...let me explain.
Women undergo 3 MASSIVE, life-changing hormonal transitions: puberty, perimenopause, and post-menopause. (Menopause actually refers to the moment in time when a women stops having her period for over 12 months.)
Some women glide smoothly between these transitions with no bumps in the road or issues at all.
They are the exception.
It’s important that the rest of us know that what to expect:
1. Symptoms vary widely among women. Most women don’t even realise they’re having perimenopausal symptoms because the general belief is that hot flashes are “the symptom” to watch for, when in fact, there are MANY far more common symptoms. 34(!) of these are widely recognised, BUT a very recent white paper based on a survey of 3,082 women documents over 100 symptoms of perimenopause!! Fatigue, poor sleep, weight gain, memory loss, brain fog, and mood swings are some of the most common (see image below).
There are also some really unusual symptoms you might not expect: itchy ears, frequent urination, change in body odor, increased hunger, unwanted hair growth, hair loss, brittle hair/nails, dry skin, digestive problems, phantom smells, shoulder pain….and so many more. If you want to know more, have a look at that paper - it’s fascinating.
Some stats and figures from that paper linked above:
[Gentlemen friends: if you’re reading this, and I hope you are, I do hope this explains a few things if you have a female partner / friend / family member who is “in it.” Your compassion is deeply appreciated. So are foot rubs, chocolate and Kleenex.]
2. The perimenopausal transition usually starts in the late 30s to early 40s. This is WAY earlier than most women think. And, it can happen to some women as young as 30 or as late as late 50s. It often lasts 3-4 years, but can last up to 10 years.
What determines when you’ll start the transition? Many factors are at play, including genetics, lifestyle, stress, health status and environment, and it’s pretty unpredictable. For me, I have crappy genetics when it comes to this, and I put waaaay too much stress on myself and my body through my entire life prior to about 40 (see Footnote), so my body is transitioning earlier than I would have hoped.
3. You can support your hormones to reduce or prevent symptoms. It’s really important to reiterate here that even though we may be in for a bit of a roller coaster ride with our hormones, we can mitigate most or all of the symptoms by supporting our hormones naturally or with supplemental hormones.
I’ll dive into how you can support your hormones and ease the perimenopausal transition - the fun stuff! - in another post, coming soon!
This might sound like doom and gloom, but there’s really a lot to celebrate. The years beyond our late 30s/early 40s and beyond - are often some of our BEST as women: by this point, most of us have blossomed into knowing who we are and what we want, we give less f***s about what other people think (usually happens ~46yo), we’re mid-career and going strong, we’ve got energy and vitality, maybe the kids are a little older, things at home and finances are more manageable…etc. We’re mature but not yet ‘feeling our age’, and our poop is generally in a neat(ish) pile.
So, if our hormones are giving us grief, it’s time to take action! There are many simple, effective things we can do in order to work WITH our hormones rather than fighting them so we can feel vital for many years to come… and this is the other half of the conversation I’m looking to help start.
Stay tuned!
In the meantie, if you think your hormones are changing, see Part 2 of this series for insight on the current state of affairs for perimenopausal care: what to watch out for when you go to the doctor and a few steps you can take to empower yourself.
Stay tuned: more blogs like this coming your way, including “Perimenopause: WTH is happening to me and what do I do about it?” and “Easing the perimenopause transition: natural ways you can support your hormones.”
If you’ve made it this far, THANK YOU. I appreciate you being here, empowering yourself with wisdom on this topic.
I hope you’ll leave a comment, share this post and/or have more conversations about women’s health with your doctor and with women and men in your life who you care about. Let’s normalize this conversation! <3
P.S. If you found this engaging, my newsletter, Well Beyond, is right up your alley. It drops every other week. Feel free to check it out and subscribe here. And, if you want more help, check out The Better Beyond 40 Formula.
Footnote:
I’m fired up about this topic not only because of my work with clients and the fact that I’m entering perimenopause, but because I my previous experience getting medical support for hormonal issues was also mind-numbingly abysmal. I suffered burnout in 2015/6, it came with hypothalamic amenorrhea (my cycle stopped) for almost 3 years. I saw various 2 doctors and an endocrinologist, and all they wanted to do was put me on the birth control pill. I now know that was the last thing I should have done (my gut knew that too, so I didn’t). The pill was a band-aid solution that certainly wouldn’t have resolved my issues, which were entirely lifestyle-based. It would have actually made things worse. Shockingly, there was ZERO discussion of diet, my stress levels, or how I was sleeping (or rather, not sleeping)… I felt broken, lost and alone. I eventually quit my life and devoted myself to healing: I left my academic position and the track I was on towards my dream job as a professor at UBC, gave up my beloved apartment, sold all my belongings and moved to Kauai. A complete U-Turn. There, I took up painting again for the first time since I was a teenager and became obsessed with healing my body through learning about functional health, lifestyle-based medicine and the science of wellness (rather than the science of illness, which was my focus as a scientist for so long). I realised that I had had it all backwards, and so did the medical professionals I’d consulted in my desperation. And now I know it wasn’t their fault. The research is flawed and women are excluded, our hormones erased from the data. It’s time for this to change. It’s time to speak up. So I’m working hard to start some conversation…and I hope you’ll join me. Thanks for reading.
