Is it perimenopause?! It’s something I’ve thought fairly often in the last five years. Am I tired because I’ve had a few bad sleeps, or is it perimenopause?! Did I just forget my credit card pin because it’s been years since I last used it, or… is it peri? I caught up with Dr Libby this month and our conversation quickly turned to perimenopause – she tells why she thinks it’s a great thing that it’s become something we all know about, but why, there’s also a flip side to that, and some serious drawbacks…
Perhaps as early as only five years ago, I’d never heard the word perimenopause before. Like so many women, menopause was something I was well aware of and had heard about in hushed tones, or from women I worked with (normally as they frantically fanned their faces, telling me about their horrible hot flushes and insomnia).
But then, thankfully, perimenopause came into the vernacular. Suddenly, the word and topic was everywhere I looked. How vindicating and wonderful that must have been for women who had been through it – or were currently in the midst of it – to have perimenopause finally be acknowledged and the realities of it be so thoroughly discussed. And, for those of us hurtling towards it, it’s such a positive thing that we are now armed with this information and are aware or what might happen to us during this transition.
Yes, agrees Dr Libby Weaver, it’s so wonderful that perimenopause has gone from being a word that only health professionals used to something that everyone has an awareness of. But… while that knowledge and awareness has benefits, it also has its drawbacks.
“There are definitely many benefits – there’s way more awareness about perimenopause now,” says Dr Libby. “Women get the help that they need and deserve. There’s far more understanding about the wide variety of ways that perimenopause can present.”
But, there’s another side to that coin – and it’s not all positive news.
“The worry for me,” says Dr Libby, “Is that if you’re aged between about 38 and 55 and you experience something new – maybe it’s sore feet, aching calves, headaches, anything new, really – I’ve seen there is this tendency right now to attribute anything new you experience to being perimenopause. Essentially, all these women are attributing the thing they’re experiencing to being a change in hormones. And, it might be that – but it also might not be that.”
In the case of both women diagnosing themselves with perimenopause, or their medical practitioner chalking their symptoms up to it, it can mean that other diagnoses are missed. Maybe it isn’t perimenopause. Or maybe it is, but there is something else going on as well that isn’t explored.
Dr Libby points to two other conditions – having an underactive thyroid, or having an iron deficiency. Two conditions that can present in a very similar fashion to perimenopause.
This month Dr Libby – the author of 13 best-selling titles – published her latest book: Fix Iron First. It’s an incredible read – and, if you’ve ever felt tired, flat, foggy, anxious or just disconnected from your spark, it might prove to be very helpful and illuminating. As Dr Libby tells me when we catch up for a smoothie, iron is the most common nutritional deficiency in the world – and certainly is right here in New Zealand.
In Fix Iron First, Dr Libby includes a section on perimenopause, because an iron deficiency is sadly a very common experience in the perimenopausal transition.
“However, in my clinical experience, the majority of women aren’t aware this is the case,” she says. “Or if they are, they just tolerate it rather than acting to change it, not realising the iron deficiency can be the sole driver (or co-creator) of what they want to change or alleviate that they are attributing to other factors – like changing hormones.”
As Libby mentioned earlier, both an iron deficiency or an underactive thyroid can often have very similar symptoms to perimenopause. “In the book there’s a whole double page where I compare the symptoms of iron deficiency to the symptoms of an underactive thyroid to the symptoms being attributed to perimenopause. And there’s a huge amount of overlap! Testing is the only way to know what it really is for an individual.”
Dr Libby says she’s seen great success in seeing women who think they have perimenopause, and they just have to ride it out – but who she then tests for low iron, helps them bring those levels up and then sees an improvement in their symptoms.
“Most of the time – not all of the time, but most of the time – there’s some relief there,” she says. “It doesn’t necessarily solve it, but there’s a big improvement.”
Dr Libby says it’s important to talk about this wider conversation around perimenopause – particularly for the sake of younger women, particularly those in their early thirties.
“I want younger women to understand that there are many, many women who go through a perimenopausal transition with very little or no suffering,” she says. “And yes, absolutely, there are also women who suffer in such a debilitating way. At the moment they’re the voices that we’re hearing – and that’s great, because they can support each other and they give us a deeper understanding of all the ways that perimenopause can present. But that’s also terrifying to 30-year-olds, and it’s not an accurate representation of how it can be.”
Dr Libby says the conversations around perimenopause can also be particularly frightening for those who have a family history of breast cancer. “Because, when we’re saying the problem is being caused by changes in hormones, people just naturally think the solution must be hormones. But what if you can’t take hormones? What if you have a family history of oestrogen-sensitive, oestrogen receptor-positive breast cancer, for example. They’re left thinking ‘oh I’m going to miss out! My brain is going to fall apart and I don’t have hormones to help. They have this belief they’re going to fall apart if they don’t have access to HRT.”
She says those fears can often be unfounded, because those women may indeed have very mild perimenopause symptoms. Or, they may develop an iron deficiency as many women do during that transition, but may be unaware that it’s the underlying cause of their symptoms and there’s a relatively easy way to improve them.
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