You’re not alone. And there’s help out there, if you know where to look.
By Kara Baskin Globe Correspondent, Updated June 30, 2023
This week, by popular request, I set out to write a tidy, 900-word dispatch on perimenopause, the gray area leading up to menopause (the natural cessation of ovarian function and menstruation). Perimenopause creeps in as estrogen begins to dwindle. It tends to hit when we’re in the thick of caring for young kids and, often, coping with the decline of aging parents, usually while hitting some kind of stride in our careers. It’s like reaching the top of a roller coaster: You’ve worked hard, climbed for a long time, and suddenly you’re at the peak when hot flashes, debilitating cramps, weird bleeding, brain fog, and dozens of other symptoms (that may or may not be hormonal — do not Google!) arrive to cut you back down.
“I’m 48 and playing a daily game of: Is it ADD? Is it menopause? Is it an anxiety disorder? I work full time in a stressful, public-facing role. I lose patience [with my kids] constantly, have a lot of brain fog, a lot of forgetfulness, and dramatic loss of muscle, and have heard next to nothing from my primary care doctors about how to manage all of it. … The only people who seem to understand are other women my age who are just as apoplectic as I am,” one woman wrote to me.
As I began to dig deeper, it became clear that 900 words wasn’t going to cut it. I heard from women who wanted to talk about pelvic floor physical therapy; others wanted to vent about hormone replacement. Others wondered why it was so hard to find adequate mental health care at this stage of life. And almost everyone wondered: Why is this passage still so shrouded in mystery, with such a strong outcry for more support?
Perimenopause symptoms are a veritable grab bag of woes. What’s perimenopause, what’s plain old midlife ennui, and what’s something worse? Mood shifts, bloating, irregular periods, night sweats, GI symptoms: It’s easy to file these under “perimenopause” when something else could be going on. And, at middle age, we’re reaching a point when sometimes scary things, like cancer, do happen, which only makes our anxiety worse. In the best-case scenario, a patient already has a close relationship with a trusted provider who can act as a guide.
“I think that’s what doctors are supposed to do. They’re supposed to try to be able to distinguish what’s related to perimenopause and what’s something else, but I do think that you’ve hit on a pain point in terms of it being difficult to sort it out. … I think that we shouldn’t be using perimenopause as an excuse for everything, but that’s what I expect competent clinicians to be able to work on,” says Dr. Marcie Richardson, director of the Menopause Center at Atrius Health.
But: Providers are stretched. As the Globe reported in March, many Massachusetts residents are finding it harder to even get appointments with doctors. In 2021, a third of patients in the state said they struggled to obtain necessary health care. Primary care — usually our first call when we experience a new symptom — is especially hard-hit: In Massachusetts, the rate of doctors leaving the field exceeds the national average. About one-third of primary care physicians are over 60. Which leaves us with … the Internet.
The market is flooded with random products (and people). Ah, the Internet, which giveth and taketh away. For every legitimate, physician-run account (such as those from Dr. Jen Gunter or Dr. Stacy Sims), there are accounts promising enlightenment through smoothies. This is a double-edged sword.
“I think that there’s a democratization of health information, which is really exciting. I think that having that information — hey, I can speak to my provider about this! — is really empowering for a lot of people,” says Cait Van Damm, a pelvic floor physical therapist based in Jamaica Plain, who frequently sees patients in perimenopause. But the danger happens when there’s too much information and not enough real answers.
For this column, hundreds of women wrote to me with their favorite Instagram handles, podcasts, books, and Facebook support groups, which I’ll share in a future story: an underground network of perimenopause sufferers helping one another. This is great, in theory. Some of these places are full of vetted information.
Others are pseudoscientific drivel that contribute to our vast well-being and self-care machine, promising calmness through yak-hair extract or lighter periods via salt lamps. Online support groups are also a mixed bag. For every person who recommends a compassionate vulvodynia specialist on the North Shore, there’s someone else who writes in with a terrifying but rare side effect of a medication. If you’re already tired and moody, prowling the Internet at 2 a.m. looking for answers while sweating into your sheets, horror stories from strangers aren’t going to soothe you.
There’s a knowledge gap. We all sat in sixth-grade health class in our braces and retainers, listening to puberty talk. Nobody sits down a bunch of 45-year-old women to talk about discharge and night sweats en masse, even though perimenopause is an equally significant life transition.
“Until recently, we didn’t know there might be links between what arises during perimenopause and menopause and future health. Those links are just being explored,” says Nina Coslov, who runs Women Living Better, an evidence-based website about perimenopause, where Richardson is a collaborator.
“The office of women’s health at the NIH wasn’t established until 1990. Only in 1991 did the inclusion of both sexes become required in clinical trials in the US. In 2016, NIH mandated that animal research include both sexes. Previously, most was conducted primarily in male animals,” she says — meaning this area has been historically under-researched.
Plus, perimenopause is ambiguous: It’s not an illness; it’s not a broken bone.
“It isn’t a disease state, and we know that our health care is very focused on sick care. Because there is this approach to menopause and perimenopause from a medical standpoint, looking at it as something that needs to be fixed or something that needs to be cured, we run into a bit of a problem,” says Kathy Fritz, a Needham-based health and wellness coach who specializes in perimenopause.
She launched her business after feeling unseen during her own perimenopause experiences. Fritz struggled with symptoms in her late 30s — poor sleep, irregular periods, intense mood swings.
“I was having real emotional intensity, especially around rage. I’m not a rageful person. I’m not an angry person. What was going on here?” she says. She went to her doctor, knowing something was “off,” and asked for options. They told her to go on birth control.
“But giving just that one option? I didn’t believe that the only thing I could do was take the pill,” she says.
(It’s important for women to know that some physicians do specialize in perimenopause and menopause: The North American Menopause Society offers a directory.)
Perimenopause patients are desperate for help, and we’re tired of being quiet. “I feel like the response is often, ‘You’re too young,’” says Arlington’s Jaime Church, 46, who underwent a hysterectomy for fibroids several years ago, and whose own mom went through menopause at 41. Now, she’s on a quest to figure out the source of her constellation of symptoms. It’s taking a mental toll.
“I’m constantly frustrated by just not having the answers,” she says.
Where do we go from here? For one thing, we talk about it. We share our symptoms; we discuss trusted resources; we ask questions; we don’t pass our symptoms off as normal or something to swallow in between work and kids.
“As women, we blame ourselves: ‘Why can’t I deal with this?’” says a Danvers mom of a 5-year-old who finally found relief from heavy bleeding and anxiety at the Menopause and Midlife Program at Brigham and Women’s Hospital.
“I want to encourage all women to take action. Perimenopause finally seems to be getting some attention in the media, but many women still don’t understand what a profound impact this time of life has on everything from their biology to their emotions and mental health. I couldn’t understand what was going on with me at first, and I blamed myself. It was so liberating to realize that there were real reasons behind my symptoms,” she says.
And real people, too. This is a normal stage of life, and you’re not alone.
Kara Baskin can be reached at kara.baskin@globe.com. Follow her on Twitter @kcbaskin.
https://www.bostonglobe.com/2023/06/30/lifestyle/women-need-speak-up-about-perimenopause/
NO COAST MENOPAUSE 