Lately, all I do is talk about perimenopause and the injustice of women’s health care. (I’ve been a whole lot of fun to be around.) The day we are born, we have all the eggs in our basket, so to speak (or one to two million oocytes in our ovaries, if you want to be specific). By the time we are 30, we have 10% of those eggs, and by 40 we have just 3% left. As our eggs dwindle, our estrogen and progesterone levels also start to lower. This is perimenopause, and you can begin to notice what’s called the change as early as 35. Once we have no more eggs, we stop menstruating and our ovaries stop producing estrogen, the hormone that was essential for our bodies and minds to run relatively smoothly for the first half of our life.
From there, you’ll likely develop one of the more than 50 different symptoms of perimenopause. The vasomotor symptoms (hot flashes and night sweats) are the ones that get all the publicity. However, less-known symptoms can be debilitating fatigue, brain fog, unexplained weight gain, depression, panic attacks, decreased libido, dry skin, hair loss, digestive issues, vertigo, dizziness, heart palpitations, joint pain, and itching/crawling sensations on the skin. It’s a natural part of ageing, and we as women must endure its symptoms, or so we’ve been told.
My perimenopause journey began with a frozen shoulder or adhesive capsulitis. My right shoulder hurt, and then one day, I couldn’t raise my arm or put my hand on my hip without excruciating shock waves of pain reverberating through my shoulder, arm, and neck. The issue soon moved to my left arm as well, and for 10 months I went to multiple doctors and got x-rays, MRIs, physical therapy, massage, and acupuncture. I literally could not pull up my own pants without assistance. I knew I didn’t feel like myself and wanted to know what was happening to me. I experienced many of those 50 symptoms (exhaustion, depression, weight gain, and aches, just to name a few) and, over the course of a year, went from the picture of health to total misery. But get this—not once during that time did any of my doctors mention my hormones.
I discovered a Duke study from 2022 that linked lower estrogen levels to frozen-shoulder syndrome, which is most common in women between 40 and 60 (my age bracket). After that, things began to clarify. Although my doctors were sceptical (one even said, “I don’t see a correlation—it’s a repetitive-strain injury,” but I’m not an MLB pitcher), I was convinced this was what was happening to me. And I was pissed.
Ob-gyn Mary Claire Haver, author of The New Menopause and a member of the social media force known as The Menoposse, explained that doctors aren’t trained to recognise perimenopause symptoms, making it both under-recognised and unlikely to be treated. “I got maybe an hour lecture in medical school about menopause,” Haver said. “In residency, I got about six hours out of a four-year curriculum.” Even though half of the population spends a third of their lives or more in this depleted hormonal state (perimenopause, menopause, and postmenopause), the medical field hasn’t deemed more education on the subject necessary. Because of this, women like me are sent to 10 different doctors for 10 different problems and given an array of medications without addressing the root cause of the symptoms, hormones.
Another problem is the lack of good medical research on the subject. Lauren Streicher, a clinical professor of obstetrics and gynaecology at Northwestern University and founding medical director of the Northwestern Medicine Center for Sexual Medicine and Menopause, explains that about 20 years ago the Women’s Health Initiative released findings that indicated that one measure to treat perimenopause symptoms, hormone therapy, increased the risk for cardiovascular disease, breast cancer, and stroke.
“This study caused millions of women to flush their hormone therapy down the toilet and is still the reason why many practitioners are hesitant to give estrogen to patients who are suffering, even though subsequent studies of the WHI pointed out flaws that skewed the data,” Dr Streicher says. The new data from the WHI published in the Journal of the American Medical Association found that for younger women dealing with perimenopause, those under 60, the benefits of hormone therapy could outweigh the risks.
Dr Streicher tells me that subsequently “hormone therapy has been shown to decrease the risk of hip fracture, uterine cancer, heart disease, and breast cancer, along with a 30% decrease in overall mortality.” Even with this information, federal funding for menopause research has been little to none. Because of this, actor Halle Berry, supported by senators Patty Murray and Lisa Murkowski, is pushing for $275 million in support from the federal government to destigmatise menopause and begin to catch up on valuable research and medical training.
With this new arsenal of information, I spoke to my gynaecologist about hormone therapy but feared I would not be a candidate because of a family history of breast cancer. The first doctor I met with did a blood test with a full hormone panel and said estrogen levels seemed fine at the time. Dr Haver explains that a one-time blood test has limitations due to the big fluctuations that occur throughout our cycles in perimenopause (which she calls the “zone of chaos”), so it’s not a great indicator. “I am doing blood work but rarely a hormone panel in perimenopause,” says Dr Haver. “I’m looking at thyroid, inflammation markers, nutrition labs, and basic health markers because things can overlap or look like perimenopause, so I want to rule out other causes first. But most of the time, the lab work is normal and it is perimenopause.”
Still suffering, I went to a different gynaecologist, who recommended genetic cancer testing. “Very few women are not candidates for hormone therapy, which can include estrogen, progesterone, and testosterone,” Dr Haver says. “Certain cancers, blood clots, and liver problems or other specific health issues are contraindications, but family history alone does not preclude someone from hormone therapy.”
I was frustrated: I didn’t want to suffer another minute but felt like neither of the appointments came with a resolution—and I live in a city with many resources. I couldn’t imagine what it’s like for those who don’t. Dr Streicher says menopause.org is a good starting place for research, as well as Telehealth or sites like Alloy, Midi, and Evernow. I chose Midi because it focuses specifically on menopause care and accepts many different types of insurance. In the end, I chose hormone therapy.
Dr Streicher does what she calls a “menopause master plan” with her patients: It’s a 90-minute one-on-one that goes through a patient’s entire medical history and every symptom, deciding what the patient wants to address the most, then they discuss all the options while she provides her expert opinion. “I’m looking at the long-term—what are the things that will impact the length and quality of your life 20 to 30 years down the line,” says Dr Streicher. Unfortunately, this isn’t the standard level of care most women get during this time.
Every expert stressed that when speaking to your doctor about perimenopause symptoms, it’s important to be specific about what you are going through. Try tracking the symptoms during a given month to see if some are more prevalent at different times in your menstrual cycle, noting each and every change, even if you think it has nothing to do with perimenopause—because it just might.
According to the followers of The Menoposse, some common statements they’ve heard when seeking help are “Just have a glass of wine and relax” or “Symptoms should lessen over time.” (Perimenopause can last 10 years!) Hormone replacement therapy may not be the best option for everyone—there are risks and benefits—but every woman deserves to have a conversation with their doctor.
And every woman deserves to have doctors who are well-educated on perimenopause. But if your doctor dismisses your concerns or simply doesn’t listen—that’s a red flag to seek another professional. You’re the best advocate for your health until you find the perfect partner to help you.
This article first appeared on vogue.us
Also read:
How to support your body as you go through menopause, according to experts
