Before the pause

Recently, Hollywood actress Gillian Anderson, who is best known for playing FBI Agent Dana Scully in the American sci-fi supernatural TV series, The X-Files, has opened up about battling perimenopause two years ago. “I was used to being able to balance a lot of things, and all of a sudden I felt like I could handle nothing. I felt completely overwhelmed.” “When I talked to the menopause specialist, she said that she often gets phone calls from female CEOs screaming down the phone, ‘I need help now! I am losing my mind!’ And that’s completely right. I felt like somebody else had taken over my brain,” she was quoted as saying. “How wonderful would it be if we could get to a place where we are able to have these conversations openly and without shame,” she added. “Admit, freely, that this is what’s going on. So we don’t feel like we’re going mad or insane or alone in any of the symptoms we are having.” While there’s some awareness about menopause, not many are aware of perimenopause.

What is it?

“We call it menopause when a woman does not have a menstrual period for 12 consecutive months. The ovarian hormones steadily decline after the age of about 40. Hence, a woman typically experiences symptoms of low estrogen levels a few years before menses stop permanently. This period is known as perimenopause. ‘Peri’ means about or around thus, perimenopause is the few years before menopause or the ‘menopause transition period.’” explains gynaecologist, Dr Suman Bijlani.

She adds that perimenopause varies from woman to woman. Most women experience perimenopause for about four to five years before menopause. Some women may not experience any symptoms at all. For some, symptoms may last for a few months only and for others symptoms may start even 10 years before menopause.

Symptoms

Dr Gauri Gore, gynaecologist, Zen Hospital, says that perimenopausal symptoms can be physical or psychological. A woman can have abnormal menstruation, mood swings, lethargy, lack of sexual desire. Some women have crying spells and symptoms of depression. Also, breast pain, weight gain can also be associated with perimenopause.

Lack of awareness

“There is a need for increased awareness on perimenopause in our country, there are hardly few who understand the real problem. Many women head to the psychiatric or orthopaedic as the symptoms are vague. It is at a much later stage after they do not experience any relief or when they undergo irregularities in their periods that they approach the gynaecologist. In most cases, it is only when menopause sets in that the patients approach a gynaecologist,” says Dr Bandita Sinha, consultant obstetrician and gynaecologist, Apollo Clinic. 

Dr Bijlani says, “In my practice, it is only the affluent and educated who seek professional help for menopause or perimenopause. Others do not approach the doctor unless they have distressing symptoms. Urban women are fortunately more aware of menopause and perimenopause than ever before. She adds that for most women, however, perimenopausal symptoms are a wake-up call and they approach a doctor. Yet others are silent sufferers who attribute these symptoms to ageing or simply ignore them as they do not know whom to approach or what to do and are not aware that these symptoms can be treated.

Seeking help

“During menopause many hormonal changes are going on in the body and other psychological problems. That is why women should go to a gynaecologist who can counsel them and regulate their condition through certain hormone therapies and medications. Once menopause period passes other troubles gradually subside. Timely check-ups during perimenopausal period is essential,” advises Dr Sinha.

Perimenopause is not a disease, it is a natural transition. All that is needed for most women is to make positive lifestyle changes — healthy diet, de-stressing, adequate rest, exercise and nutritional supplementation, opines Dr Bijlani. “Since perimenopause is also about mid-life and aging, it is difficult to attribute all symptoms to hormonal changes alone. Nutritional deficiencies and thyroid disorders are common in this age group. Only a doctor can properly diagnose and treat you. Your doctor can be also an important part of your support system at this delicate phase of life. Also, annual health check-ups are important to look for hidden maladies such as diabetes, high blood pressure or early cancer,” she informs.

Treatment

Treatment of these symptoms is multidisciplinary. Many symptoms can be controlled by diet and lifestyle modifications. Counselling plays a vital role in managing psychological symptoms. Some women may need anxiolytics medicines and hormonal therapy, says Dr Gore.