Affecting millions, perimenopause still a mystery
Cultural shroud of secrecy has left women in the dark about symptoms
Angie McKaig calls it “peri brain” out loud, in meetings. That’s when the 49-year-old has moments of perimenopause-related brain fog so intense that she will forget the point she is trying to make in the middle of a sentence. Sometimes it will happen when she’s presenting to her colleagues in digital marketing at Canada’s largest bank in Toronto. But it can happen anywhere — she has forgotten her own address. Twice.
McKaig’s symptoms were a rude surprise when she first started experiencing them in 2018, right around when her mother died. She had an irregular period, hot flashes, insomnia and massive hair loss along with memory issues.
She thought she might have early-onset Alzheimer’s, or that these changes were a physical response to her grief, until her therapist told her that her symptoms were typical signs of perimenopause, which is defined as the final years of a woman’s reproductive life leading up to the cessation of her period, or menopause.
It usually begins in a woman’s 40s, and is marked by fluctuating hormones and a raft of mental and physical symptoms that are “sufficiently bothersome” to send almost 90% of women to their doctors for advice about how to cope.
McKaig is aggressively transparent about her “peri brain” at work, because she “realized how few people actually talk about this, and how little information we are given. So I have tried to normalize it,” she said.
An oft-cited statistic from the North American Menopause Society is that by 2025, more than 1 billion women around the world will be postmenopausal. The scientific study of perimenopause has been going on for decades, and the cultural discussion of this mind and body shift has reached something of a new fever pitch, with several books on the subject recently released and a gaggle of “femtech” companies vowing to disrupt perimenopause.
If the experience of perimenopause is this universal, why did almost every layperson interviewed say something along the lines of: No one told me it would be like this?
“You’re hearing what I’m hearing, ‘Nobody ever told me this, my mother never told me this,’ and I had the same experiences many years ago with my mother,” said Dr. Lila Nachtigall, a professor of obstetrics and gynecology at NYU Grossman School of Medicine.
The shroud of secrecy around women’s intimate bodily functions is among the many reasons experts cite for the lack of public knowledge about women’s health in midlife.
In the first half of the 20th century, the hormone estrogen was discovered, and its role in menopause was clarified somewhat — after a woman’s period ceases, her estrogen levels are lower than they were during her fertile years.
It wasn’t until the 1980s that longitudinal studies — which followed the same cohort of women for years — deepened public knowledge about the role of hormones during menopause.
Before that, doctors thought perimenopause was a slow draining of estrogen levels until you hit the end of your period. “But what we’ve learned is it is more of a turbulent process — hormones are bouncing around,” said Dr. Stephanie
Faubion, the medical director of the North American Menopause Society.
Even now, perimenopause is described in medical research as an “ill-defined time period” primarily marked when the ovarian reserve is depleted and by irregular periods. This time period is still often referred to as menopause in common parlance, but the medical definition of menopause is just one day — the last day of your final period — though it is only diagnosed when a whole year has gone by without menstruation.
There are four symptoms of perimenopause that are most common: hot flashes, sleep disruption, depression and vaginal dryness. But the full panoply of symptoms “is not yet known with any great degree of certainty,” said Dr. Nanette Santoro, the chair of obstetrics and gynecology at the University of Colorado School of
Medicine. The perimenopausal period is associated with as many as 34 different maladies ranging from hair loss to “burning mouth syndrome,” which is a tingling or numb feeling in your lips, gums and tongue.
What McKaig is trying to do on a micro level by sharing her perimenopause travails with colleagues, health care start-ups, beauty companies and writers are trying to do on a macro level: raising awareness about the experience of this period of a woman’s life (and sometimes selling them products and services along the way).
“Femtech” companies such as the telemedicine providers Elektra Health and Gennev are moving into the perimenopause market; Stacy London, the stylist and reality TV star, just started a skin care company called The State of Menopause; and celebrities such as Michelle Obama and Gwyneth
Paltrow have spoken honestly about their perimenopause symptoms.
Books on the topic from Heather Corinna, a sexual health expert, and Dr. Jen Gunter, a Times contributor and OB/GYN, were published this spring; newsletters and online communities like Tue/ Night and The Black Girl’s Guide to Surviving Menopause are gaining traction with tens of thousands of readers.
Though perimenopause presents as so many different symptoms, there are treatments available, however there “is not one single solution,” Faubion said. The treatment is symptom dependent: If heavy or irregular bleeding is the issue, an intrauterine device or a birth control pill could help. A low-dose birth control pill may also relieve hot flashes. If mood issues are the biggest complaint, an antidepressant might be appropriate.
Despite expanded and continuing research, finding a knowledgeable physician who won’t dismiss your symptoms or tell you there’s nothing they can do to help is a struggle for many women. The North American Menopause Society’s website lists qualified physicians, but if you live outside major metropolitan areas, the pickings may be slim. Telemedicine is aiming to fill the void, but there are limitations and complications to practicing medicine across state lines.
Though finding a qualified and sympathetic doctor may be a challenge, shifting the cultural narrative may be just as vital.
“I actually think it’s extraordinarily important to change the conversation. Because so much of what you hear about perimenopause is spoken about in an anti-feminist and ageist way,” said Dr. Lucy Hutner, a reproductive psychiatrist in New York.