When Daniella was told she was in perimenopause, she cried with relief
Not all women will experience adverse effects of perimenopause, but for those who do, they say it can be a confusing and isolating time.
When Daniella Zucchetto was in her late 40s she found herself suddenly exhausted to the point where she was unable to get out of bed for weeks at a time. As a self-employed single mother, that was not only distressing, it was problematic.
“There was a time where I just didn’t know what was going on and why I couldn’t function,” she recalls. Her exhaustion got so severe, she struggled to work for around six months.
“I remember getting up and I was still in my pyjamas dropping my daughter to school, I can’t tell you how I functioned. I don’t know what the turning point was, to be honest with you, but it was just more that my finances were dwindling away and I obviously didn’t have any income.”
Her altered behaviour coincided with other changes, including to her body shape and general wellbeing. It was Ms Zucchetto’s then 11-year-old daughter who eventually confronted her, saying she did not seem to be herself and had a shorter temper than usual.
“That was an eye opener, because I thought, if this little person is seeing these behaviours, then what do other people see?”
Ms Zucchetto was not aware of perimenopause and knew very little about menopause, saying she was always the type of person who “just got on” with life.
Perimenopause is a reproductive phase of a woman’s life prior to menopause, which is determined to be 12 months after a woman’s final period. Perimenopause can last for years and is characterised by hormonal fluctuations, and women can experience a vast range of symptoms. Every woman who lives to midlife will go through perimenopause and menopause.
But peri and menopause were not topics ever discussed in Ms Zucchetto’s family or friendship circles. It was a psychiatrist who suggested she could be in perimenopause, something that was later pro
ven to be correct. The relief was overwhelming.
“I cried because it was this release of emotions where I just thought – I’m not crazy! There’s genuinely something happening, and I suppose it was that was the start of the journey in terms of being, not in control of it, but just being able to manage it.”
She started by trying to treat her symptoms with natural therapies but found they did not work. What did work for her was a combination of interventions including menopausal hormone therapy, building a good social support network, changing her diet, and establishing an exercise program she could stick to. Then came the self-acceptance.
“I think the biggest thing for me was acknowledging that, for a period of time, I’m going to be heavier than what I always was in terms of weight and kind of learning to accept my new body. It’s all still trial and error. There are days when you think you’ve got it … and then all of a sudden something happens, and it changes again. So, I suppose just really being aware of how my body responds to things, and knowing when I’m OK and when I’m not OK.”
Her advice to other women approaching or potentially in perimenopause or menopause is to talk about it to remove any taboo. She believes her experience could have been more positive had she been aware of it in the first place.
She is now trying to be that change and is preparing to share her story at the upcoming Women’s Life Cycle Summit in March, looking into issues of women’s health and the workplace.
Another woman who is encouraging a greater conversation about menopause and perimenopause is Kate Fleming.
She was fortunate to have a GP who instantly recognised her symptoms as perimenopause as soon as she complained of unusual levels of anxiety and rage, aching joints, cognitive changes, and night sweats. Her doctor prescribed her MHT.
“That was a game changer for me, I felt like I got myself back,” she said. Ms Fleming also made several lifestyle changes that have improved her overall wellbeing and helped to reduce her vasomotor symptoms and sleeplessness.
“I cut back on wine. I had spent many years working in the wine industry. A nightly glass of wine was a regular occurrence in our household. Catching up and socialising with friends on the weekend always involved wine, and I very quickly realised wine was not my friend anymore. Certainly, perimenopause forced that hand.
“Strength training has been a big thing, making sure I get enough fibre and enough protein in my diet. I do meditation, which I’m still terrible at, and I just try to make sure I get enough sleep. I do still get disturbed from time to time, but I try to make a point of going to bed slightly earlier.”
It’s been approximately three years since Ms Fleming first sought medical help for perimenopause, but she estimates her symptoms began around a decade earlier. One of the main changes early on was cognitive decline where she struggled to make simple decisions. She said it was not only a frightening experience but it was also distressing and zapped her confidence. A saving grace was the love of her husband and two sons.
“We’ve been married for 30 years and my husband was very worried about me,” she said. “We’re a really tight family, so I had full support of my husband and my kids. But I feel for women who don’t have that sort of support network around them, or maybe they’re in a new relationship or a fractious relationship, it would be a nightmare.”
She would like to see better education provided to women about perimenopause and menopause, suggesting the government could send information sheets to women when they turn 40 or 45, like they do for other health campaigns. She believes doing so could also help to cut down on misinformation about peri and menopause that is rife online.
“There are really good checklists out there now; The Australasian Menopause Society has a really good symptom checker and so I would start with that, and then take that to your GP and say, ‘I’m ticking, you know, 90 or 100 per cent of these boxes’. And if that GP doesn’t or can’t help you or won’t help you, find another one,” Ms Fleming said.
Not all women will experience adverse symptoms of perimenopause. Even with menopause itself, it is estimated a quarter of women will have no adverse symptoms at all, while one quarter will have severe symptoms, and the remaining half will have minimal to moderate symptoms.
The biggest giveaway that you might be in perimenopause is if you have changes to your menstrual cycle. Those changes could be to the flow, duration, or frequency of your period or even a combination of any of those three, so long as you have a predictable cycle to begin with. So for women with conditions like PCOS, it can be more difficult to determine.
But as women globally demand better awareness and education of perimenopause and menopause, research is also under way to help fill those gaps. One area of growing research is around cognition. Pauline Maki is a US-based professor of psychiatry, psychology and obstetrics and gynaecology with the University of Illinois in Chicago and a global leader in understanding menopause and the brain.
Professor Maki is a past president of the North American Menopause Society and has been studying the effects of sex steroid hormones on cognition, mood, brain function, and stress response in women for more than 20 years.
She has also overseen several high-quality clinical studies and is currently examining the role of vasomotor symptoms on cognition and brain function after her earlier work showed that physiological hot flashes were associated with memory deficits, ischemic brain lesions, and functional alterations in the brain at rest.
Professor Maki said there were now six high-quality longitudinal studies that showed a statistically significant, albeit small, reduction in cognitive performance in women during the perimenopause transition when it came to memory and verbal recall.
“I could tell you a little story and then ask you to tell it back to me, and then wait 20 minutes and say, ‘What do you remember from that story?’ What you see is, longitudinally, a woman’s own performance declines as she transitions into the perimenopause.” she said.
Testing has not shown an impact on other areas of cognition, like a woman’s capacity to strategise, organise, or pay attention. However, she said one test she ran for a decade showed some women who lived with a lot of social disadvantage were more likely to have a decline in cognitive ability and processing speed.
“That gives rise to the idea that there may be certain groups of women for whom the menopause transition leads to more than just this kind of very common experience of a decline in memory, and those may be women whose menopause symptoms go untreated.”
She is also quick to point out that, for the most part, any cognitive decline experienced by women in perimenopause or menopause is temporary.
Another indication of perimenopause is an onset of sleep interruption with no obvious cause, such as stress. Professor Maki said around 60 per cent of women reported experiencing sleep interruption at perimenopause.
“So they’ll have what’s called wakefulness after sleep onset. You do not need a PhD in cognitive neuroscience to know that if you don’t sleep well, your cognition isn’t good,” she said.
“Women can ask themselves, do I have a new onset of symptoms, like night-time hot flashes or like night-time awakening that are coinciding with this onset of memory problems.”
When it comes to a fix, she said clinical trials had not shown any improvement in cognition alone from menopausal hormone therapy during the perimenopause. This is an area of intense debate within academic and medical menopause circles, with some clinicians saying their patients have reported improvements in both cognition and mood with the use of MHT in perimenopause.
Analysis of data from randomised trials in real world settings have also suggested improvements. However, Professor Maki said four clinical trials – the type considered to be the gold standard and on which medical guidelines are based – had not shown the same results. Instead, she said oral contraceptives were found to be effective in perimenopause.
She said changes to lifestyle habits may help women with mild symptoms, and suggested health changes such as lowering alcohol consumption, getting enough exercise, eating more of a Mediterranean diet, and not smoking.
However, medical experts caution women and doctors against classifying every ailment a woman experiences at midlife as being related to menopause, saying doing so risks other illnesses or even diseases being misdiagnosed.
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