Perimenopause is everywhere. How do you know if you’re in it?

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Are you tired, angry, have brain fog, gained a bit of weight, brittle nails, heart palpitations, itchy skin, memory lapses, or did I already do that 1? If you're a woman over the age of 35, chances are you might have been told this could be down to 1 big change: perimenopause. The lead up to the end of menstruation has become a hot topic. And while it's great, it's in the spotlight, there is a lot of misinformation out there.

Younger and younger women are self diagnosing based on social media content that is not always clinically accurate.

So today, how women are being misled on perimenopause and the facts you need to know. From The Guardian, I'm Madeleine Finlay, and this is Science Weekly. Nicola Davis, as science correspondent, you've been looking at all the misinformation that there is online about perimenopause. And this seems to be a topic that everyone is talking about right now, not just us because we're, you know, women of a certain age. Why is suddenly everyone obsessed with perimenopause?

Well, I think there's several reasons. 1 is that, you know, in recent years, there have been some very high profile TV documentaries, there have been a lot more news articles, women talking about it a lot more, which is a good thing. This is an important change that women go through. I think there's also the fact that a lot of women have been experiencing symptoms which may or may not be down to the perimenopause, whether that's brain fog or problems with sleeping and so on. There's also the fact that for many, many years women have sometimes felt dismissed by healthcare professionals and that feeds into also to the other point, which is that this has become a big thing on social media.

Why is perimenopause now all of a sudden such a hot topic? Because now women are more influential than what we used to be. Our inconveniences cannot be ignored.

If you're someone who's in their thirties or forties, cause that is at times when perimenopause tends to show up, what are the potential symptoms you're looking at?

Despite numerous blood tests and visits to doctors, nobody like picked up on the signs. Now of course some of this can be very beneficial. It's really important that women feel comfortable talking about the symptoms that they're experiencing and concerns that they may have about their health. But there can also be some problems with some of the narratives that are happening around perimenopause. And I spoke to Doctor Paula Briggs, who's a consultant in sexual and reproductive health and former chair of the British Menopause Society, about exactly this.

It's the go to diagnosis and not sleeping, being anxious, these are symptoms associated with a multitude of underlying causes. And there's a barrage of not just information but misinformation on social media channels. I think it's really difficult for patients to truly understand the implications of what information they are being provided with. I think there is cherry picking of clinical trial data, clinical papers to suit whatever narrative is being pushed at that particular point in time. And you know, when patients say, I've done my research, now my heart sings because I know then that they're likely to have been exposed to misinformation.

So there's all this information online about what symptoms might be associated with the perimenopause. How do you actually work out if you're in perimenopause or not? What are the kinds of things that a doctor or a healthcare specialist might be looking out for?

So there are lots of different symptoms and different people might experience different things, but a key 1 is a change in your periods. Them shifting from being quite regular to being more erratic, change in how heavy your periods are. There are also other symptoms though, so weight gain can be 1, urinary tract infections, vaginal problems, so itchiness, dryness, that kind of thing, brain fog, sleep disturbances. But I think it's important to note that there isn't a sort of single definitive test to say you are perimenopausal. You know, even if you have a blood test to look at your hormone levels, the hormone levels shift all the time and they can be very unpredictable in perimenopause.

And this is something Paula talked about as well.

There is no point in thinking about blood tests to diagnose perimenopause. I think NICE recommends testing between the ages of 40 and 45, but if somebody's still having relatively regular periods, the chances of those tests being abnormal are quite low. And this is the group in which it's really difficult. It's a difficult diagnosis to make because it's all done on symptoms. Some social media influences you know will say if you

have those symptoms and you know you're in your late 30s it's perimenopause. But perimenopause typically starts somewhere in your 40s and even if you go in your mid 40s or late 40s or whatever, again, may or may not be perimenopause. There might be other reasons why you're having these symptoms. And so the answer might not necessarily be HRT. It might actually be that you need some other kind of treatment or therapy.

Nicola, you mentioned HRT there, hormone replacement therapy. This is 1 of the things that might be offered if you are presenting with perimenopausal symptoms. But what are the risks of going on HRT if you don't actually need to be on it?

So HRT typically consists of oestrogen and if you still have your womb, you haven't had a hysterectomy or something like that, you will also need a progestogen to help to protect the lining of your womb. So it's a it's a replacement of hormones essentially that are naturally declining in your body as you go through to menopause. If you aren't in that perimenopausal state and you have HRT, particularly if you have the the estrogen there, what can happen is you get very heavy bleeding, which can be very problematic. The other thing is that people can assume that if they are perimenopausal, that they're no longer fertile, that they can't get pregnant, and that's not the case. There have been cases of women turning up to clinics and finding out that they're pregnant and being quite shocked by that.

So contraception also remains really important. And of course the other thing is that if you are desperate to have HRT because you think that's the answer but you aren't actually perimenopause and you don't need HRT, it might be that you're having a treatment not only that you don't need, but that you're not getting a treatment that you do need for the condition that's actually causing the symptoms you are experiencing. And this again is something that Paula spoke to.

It's easy to get tunnel vision and we need to remember that people may have a thyroid disorder, they could have TB, they could have cancer and to think much more holistically about baseline investigations. It could just be stress and it's stressful living, isn't it? And I think post COVID it's been very difficult and this is the population that we're probably thinking about sort of 35 upwards. We've seen conception rates rising in women aged 35 and over and that's locally to me in sort of the Northwest Of England. And I think that's because women are thinking everything's menopause and they are forgetting that they're not menopausal and that they're still potentially fertile.

Right, so there's this risk that you might actually come off contraception a little bit too early. And if you go on HRT, you might experience irregular or heavy bleeding. And then there's also this point that perhaps you're missing the thing that's actually wrong with you. But on top of all of that, you know, this opens people up to the huge wellness industry that has really taken on perimenopause as 1 of its causes.

Absolutely. I mean there's all sorts of things being flogged to women now. So we've got things like menopause cooling wristbands, we've got menopause crystal bracelets, we've got menopausal socks. This is a handmade crystal bracelet that is said to help relieve symptoms of the menopause and the perimenopause.

This is a menopause stage indicator AFSH test, so you will know what stage of perimenopause or menopause you are in.

This has got to be the best supplement, no lie, I have ever, ever tried and tested. I am into my 3rd month of using this. No night sweats. There's supplements. There's supposed tests.

Definitely suspect. There's all sorts of wellness gadgets and trackers and shampoos and all sorts of products. The really important thing to point out here is that there's a vested interest here. These are being sold by people who want to make money.

It's interesting that this kind of started off as something that was very positive to women that, you know, this is something that kind of initially was counteracting the the misogyny of us not talking about women's issues very much and has kind of veered into ultimately kind of selling products.

I think that is quite often the way that these things go. And it might well be that there are, you know, some items which really do help you or which you find beneficial and which are benign and not harmful. And that's, you know, it's not to just dismiss everything, but I think it's just always worth bearing in mind what the motivation is and in many cases it's just to make money.

Coming up, forget the gadgets and crystals, what you should really do if you think you're perimenopausal.

Cheers to fall savings at Whole Foods Market, home of higher ingredient standards. This Halloween, share chocolates and candies made without that spooky high fructose corn syrup. Throwing a party? Make it easy with a berry chantilly cake, ready to cook pizza, no antibiotics ever chicken wings, and sushi made fresh daily. Fall gatherings never tasted better.

Save through November 3 at Whole Foods Market.

So, Nicola, if there are women who are thinking perhaps I am perimenopausal, what options are open to them in terms of finding relief perhaps for some of their symptoms?

Well again it's really worth chatting to your GP about what your symptoms are and therefore what it is that you might need to improve your quality of life there. So it might be that you have vaginal dryness and need some lubricants or something or it might be that you're experiencing night sweats and hot flushes and it's about managing those symptoms and changing your environment a bit. There are cognitive behavioural therapy approaches to managing symptoms. Exercise can be really good for helping you manage things like anxiety and other mood changes you might have. It can also be really important for keeping your bones healthy.

So weight bearing exercise can be very important and then diet as well. Making sure you've got a good healthy balanced diet, making sure you've got calcium in your diet, again to help with your bones, or it might be that you want to change the kind of contraception that you are on.

We're so lucky that we have so many choices for contraception, many of which are associated with added non contraceptive benefits. And I think people tend to think the pill is 1 thing, but you know, there are 20 plus hormonal combinations with different types of progestogen, some of which have quite unique benefits. You know, they can help with acne, fluid retention and mask symptoms of menopause. There's nothing wrong with using the pill to manage early menopausal symptoms where you might not be sure. I call it surfing the menopause so it kinda gets rid of that whole is it perimenopause, is it not perimenopause and focus on well-being and definitely focus on additional non contraceptive benefits.

And then around sort of the average age of menopause is 51, then maybe move to hormone replacement therapy.

Nicola, with the perimenopause, it's like any other women's health issue where historically there just hasn't been enough trusted good information out there. And yet now it feels like we've reached a place where it's become so complicated and there's so much out there that it's really, really difficult to figure this out, you know. This is a natural process that almost all of us women go through and yet it's really hard and overwhelming to find the information you need. I mean, we haven't even spoken about things like different kinds of hormones, like body identical hormones or cancer risks. No wonder women are finding this difficult going online, trying to figure all of this out any way that they can.

Absolutely.

And I think the really important thing here to say is there's nothing wrong with asking questions. You might see something online and think, that's actually, oh, I hadn't thought about that. What's important is to be slightly wary and think about the source, think about where who's saying what, why they might be saying that, are they trying to sell you something? But then also feel free to ask your clinician about those things. Say, well, I've seen this thing and it says this, is that right?

Would I benefit from that? You can have those conversations. It's not a case of saying everything you see on social media is gonna be wrong. It's about embracing the fact that we are talking about this more, but it's not necessarily the case that everything you see is either correct or reliable or in your best interests.

I think that's such good advice. Nicola, thank you so much.

Thank you for having me, Maddie.

Thanks again to Nicola Davis and to doctor Paula Briggs. You can find all Nicola's reporting on theguardian.com. And that's it for today. This episode was produced by me, Madeleine Finley, and Helena Selby. The sound design was by Joel Cox, and the executive producer is Ellie Burry.

We'll be back on Thursday. See you then.

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