Spend any time reading about women’s health on social media and it won’t be long before you read posts like this: “Perimenopause! I’m turning 40 soon and realising that I may spend the next decade dealing with this.”
“I recently turned 40 and have a few annoying symptoms develop,” adds another worried participant, “including suddenly heavy periods and mental health issues.”
Women seeking help often then receive completely inaccurate advice such as: “Perimenopause typically starts from 35 to 45 years. Your oestrogen is fluctuating all over the place. These fluctuating levels will impact your cycle.”
The narrative thread running through social media discourse is of medical “gaslighting”. That doctors like me are failing to recognise perimenopause in their patients, or downplaying its effects, or don’t know how to treat it even if we do recognise it.
A quick check of Google Trends reveals that, over the past couple of years, the number of searches for perimenopause has increased exponentially. So what exactly is the perimenopause, and how worried should young women be about its effects?
The term “perimenopause” refers to those years between the first changes signalling that the number of a woman’s remaining eggs is low and the final permanent cessation of the menstrual cycle. It is the beginning of the transition into permanent menopause and the cessation of periods.
For many women, the first clue that they have reached perimenopause is irregularity in their menstrual cycle. The duration of perimenopause differs but the average is about four years before the final period. Women initially experience missed periods but as things progress the cycle becomes much more irregular with gaps of a couple of months commonly occurring.
After menopause, women can experience a number of unpleasant symptoms resulting from low levels of oestrogen. Hot flushes and night sweats, interrupted sleep and fatigue, breast discomforts, skin dryness and itchiness, headaches, brain fog and changes in libido all can result from the lack of oestrogen.
What about oestrogen in the perimenopause? Gynaecology specialists Dr Lara Delamater and Dr Nanette Santoro take issue with social media “experts” who think oestrogen is the issue.
“A popular but incorrect belief is that the dwindling supply of ovarian follicles that leads to menopause manifests during the transition as a progressive decrease in oestrogen,” they say.
Queensland-based hormone specialist Dr Georgina Hale, in a scientific review of the perimenopause, points out that most women will enter perimenopause from the age of about 45 onwards.
A major study led by Dr Nancy Avis and Dr Sybil Crawford found the usual duration of symptoms was just over seven years, but with more than four years of that after the menopause proper, not before. In fact, “falls in oestradiol only occur at the very end”, they explain. Nor does “the available data favour the notion that androgen deficiency is a common feature of the perimenopause”.
A great deal of misinformation is being peddled to vulnerable women. In fact, a recent study by the Australian Menopause Society, the Jean Hailes Foundation and other academic groups found the majority of Australian women experienced only “minor or manageable symptoms” of menopause.
The study’s authors expressed deep concerns, writing that “we caution all parties to avoid ‘catastrophising’ menopause in the framing of public discussions, and particularly in the advertising of goods and services, as it could have the unintended consequences of eroding women’s resilience and stigmatising women as they approach midlife”.
Because menopause and its antecedent, perimenopause, is an almost universal experience for women, it is important to frame our discourse appropriately. To respect the lived experience of women while not causing unnecessary anxiety at a time of vulnerability.
Studies tell us the age that perimenopause typically begins is 47 years and, for most women, the symptoms will be mild and manageable. Yet it’s common to read social media posts from women in their late 30s and early 40s worried that perimenopause is causing everything from heavy periods to low libido.
This is a major health issue for women around the country. Social media-led concerns about perimenopause in young women distract from other common and important health issues such as polycystic ovary syndrome, endometriosis, fibroids, thyroid problems and a long list of important conditions that need careful evaluation for successful management.
A common example is that of “brain fog”. Many women in midlife describe difficulty recalling words and numbers, forgetfulness and losing things, trouble concentrating and forgetting appointments. Sure, hormones can play a role, but so can other common conditions such as depression, sleep apnoea, and diabetes.
Many women are turning to social media with their health problems and seeking answers. It is important that doctors listen to what women are telling them. A nuanced discussion that validates women’s experiences while making sure that evidence-based care is provided is the way forward – and that is definitely not the strong suit of social media pundits.
Dr Steve Robson is professor of obstetrics and gynaecology at the Australian National University and outgoing president of the Australian Medical Association.
More information
- National Library of Medicine
- Brain fog in menopause: a healthcare professional’s guide for decision-making and counselling on cognition
This column is published for information purposes only. It is not intended to be used as medical advice and should not be relied on as a substitute for independent professional advice about your personal health or a medical condition from your doctor or other qualified health professional.
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