Enough is ENOUGH: let’s talk perimenopause (Part 1)
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.
Whether you’re male or female, 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 pissed off!
Why?
Because over the last 8 years of working with clients, 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 almost always 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 to speak up.
And in case you’re wondering where I’m going with this, no, this 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.””
So 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?
Source: forthwithlife.co.uk
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?
Because there is NOT A SINGLE PROCESS in your body that isn’t affected by your various 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…
So, 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 perimenopause.
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 health study! I was in this “OMG WHAT??” camp until 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 allow me to lay out a couple of key FYIs on female hormones and perimenopause here:
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 RARE exception.
The rest of us are left to flail through, blind and clueless, often suffering needlessly.
And as we’ve established, this is partly because there’s a lack of research and corresponding medical support available, but it’s also that we as women and society at large haven’t been talking about these things openly, and we never have (at least in Western culture).
So here are a couple of key things:
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!! Fatigue, poor sleep, weight gain, memory loss, brain fog, and mood swings are some of the most common. But there are also some really unusual ones 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, anxiety, depression….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:
[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 (WAY earlier than most women think), but 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. Not trivial!
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 at the bottom), so my body is transitioning earlier than I would have hoped.
Fun, huh?
I have to add a bit of editorial here: it’s extra uncool that this NEEDLESS suffering comes at this stage in life because for many of us, our late 30s through 50s would otherwise probably be some of the best years of our lives: by this point, most of us have blossomed into knowing who we are and what we want, we’re mid-career and going strong, we’ve got energy and vitality, we give less f***s about what other people think (usually happens ~46yo), 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.
…But then…
BAM!
Instead of being reaping the fruits of our first 35/40 years of blood, sweat and tears on this crazy planet, figuring out this human body, things start to change: our ovaries are like, “woman, we tired - peace!”
And things can get reeeeeeal wonky.
#realtalk
This might all sound like doom and gloom, but I assure you, there’s SO MUCH hope! There are many simple, effective ways can support their hormonal and overall health, and work WITH their hormones rather than fighting them so they can feel vital for many years to come… and this is the other half of the conversation I’m looking to help start.
I’ll dive into that stuff - the fun stuff! - in another post, coming soon!
For now, 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.
