We all know someone in perimenopause, so why don’t we know the signs?

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If you're a woman of a certain age (hint: if you had a Jonathan Taylor Thomas poster, ripped from the pages of TV Hits magazine as a tween) then your algorithm is likely set to 'heavy flow' when it comes to a certain type of content. 

In the last few years, a new term has exploded in popularity. Suddenly, everyone's talking about perimenopause. And much like when terms like 'the mental load' or 'gaslighting' suddenly burst into the zeitgeist, there's a sense of collective relief from women that, finally, we have a word for what we're experiencing (albeit one that's been around for much longer than a few years).

With symptoms ranging from the physical (hot flushes, vaginal dryness, aches and pains, heart palpitations) to the emotional (irritability, brain fog, anxiety, feelings of dread and paranoia, to name a few), the hormonal rollercoaster is one ride we're desperate to get off. But for all the perimenopause-based marketing (seriously, everything from skincare to supplements and *checks notes* peri-friendly sex-toys), there's a dearth of public understanding as to what signs we should actually look out for. Even, worryingly, in the medical system.

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"It feels like every woman my age is currently being diagnosed with 'burnout', ADHD or anxiety," says Danielle, a 41-year-old Gold Coast woman who is struggling to find adequate treatments for her perimenopause symptoms

"I'm not a doctor, but I have to wonder if a portion of these women are actually going through perimenopause and don't realise it because it overlaps with so many of these other conditions.

"I don't know if our mothers didn't talk about it in the same way, or if perimenopause has become more brutal for us, but on some days, I honestly feel crazy."

Danielle says she's felt constantly dismissed, even when advocating for herself.

"I've been to my doctor no less than four times to try and get some relief. First, she told me it was anxiety and I should go on an SSRI. I told her my symptoms were hormonal — they were cyclical — and she said I was 'too young' for menopause. Then she put me on the birth control pill. Then she sent me for a blood test, which she says came back normal. But what I'm experiencing definitely isn't 'normal' in any sense of the word."

GP Dr Rebecca Goadby cautions that while some GPs still request blood tests as part of a perimenopause diagnosis, there is no reliable way to rule it out through bloods. 

"A thorough assessment of symptoms is more useful than blood tests in a diagnosis of perimenopause," she explains.

"It is important to know that normal hormone levels do not rule out perimenopause as a cause of your symptoms. As mentioned above, perimenopause is a time where hormone levels fluctuate from month to month and a blood test is just a snapshot of these levels and not an indicator of your hormone levels over time."

What is perimenopause?

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"Perimenopause is the natural transition period that occurs before menopause," explains Dr Goadby. 

"It's when a woman's body starts to run low on eggs (oocytes), which she's born with, and loses throughout her life. This decrease in eggs leads to a fluctuation in hormones such as oestrogen and progesterone."

Dr Goadby says that while a perimenopausal woman might still ovulate some months, in others she may not, which causes her hormone levels to drop. 

"This drop is what triggers perimenopause symptoms," she explains, adding that this phase typically begins in a woman's forties and lasts between four and six years, though it can vary from one to 10.

"Once a woman has gone 12 consecutive months without a period, she has reached menopause," she says.

'Stuck in hormonal purgatory'

Danielle says that in the past few years, she's begun to experience crippling anxiety at certain points in her cycle, with symptoms at first mirroring other disorders such as PMDD (Premenstrual Dysphoric Disorder), where symptoms emerge in a woman's luteal phase, to gradually extending to other points in her cycle as well. 

"I'm a successful small business-owner with a master's degree, and suddenly I can't remember scheduling a meeting unless I set four reminders in my phone," she laments, "it's like being stuck in hormonal purgatory!" 

"I feel like I can't control my emotions sometimes, like I'm a liability who will shout or get angry at the slightest provocation. I remember that feeling from when I was a teenager going through puberty. Sometimes this rage will overcome me, but instead of being able to run to my room, slam the door and listen to the Romeo & Juliet soundtrack on my discman like I did when I was 13, I have two kids, three cats and a middle-aged husband to worry about." 

Confusion, frustration and misdiagnosis

Counsellor and psychotherapist Julie Sweet says she is seeing an increase in women struggling with the emotional challenges of perimenopause.

"So many of my clients disclose increased anxiety, mood instability, depression, irritability, insomnia, cognitive difficulties such as 'brain fog,' and feelings of intense anger and sometimes rage or emotional overwhelm that can feel unfamiliar," she says.

"A common theme is the confusion and frustration these changes bring about, often because symptoms can appear suddenly and more importantly, aren't always discussed - although I'm seeing that awareness is slowly improving."

Sweet says many of the women she sees are frustrated due to misdiagnosis of other mental health conditions by doctors who aren't properly educated in menopause/perimenopause.

"A few clients have shared feeling dismissed by healthcare providers, with their symptoms attributed to stress, age, or mental health issues rather than hormonal changes," she explains. 

"This dismissal can compound the emotional burden and contribute to feelings of being misunderstood or, as one client recently said, 'medically gaslit'."

One of the most effective strategies for navigating perimenopause is self-advocacy. Along with trusting our intuition, articulating personal needs and experiences clearly, and actively seeking appropriate care. Obtaining second medical opinion can be critical in ensuring correct diagnosis and treatment.

Dr Goadby says there are a range of treatments available, including lifestyle modifications, allied health professionals such as exercise physiologists or physiotherapists, non-hormonal interventions and, of course, hormonal interventions including hormone-replacement therapy (HRT).

The most important thing, says Sweet, is to understand how to advocate for yourself and get the right answers, while acknowledging that as women, we are often each other's best allies. 

"Women have always been a crucial source of support for one another," she says, "the power of women supporting women should never be underestimated."

Sweet recommends offering empathetic listening and emotional encouragement, along with genuine, nonjudgmental support to help validate feelings and reduce isolation.

"Sharing effective lifestyle habits and symptom management strategies, whether through personal experience or recommendations from medical professionals, therapists, or alternative therapies can empower others by growing their toolkit for coping," she continues.

"Creating an open, safe environment allows women to access resources they might not otherwise know about. Educating yourself about perimenopause is a vital step toward providing meaningful support."

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The conversation is changing. Slowly.

The Federal Government announced in February this year a landmark $573 billion towards women's health, including changes to Medicare to include menopause health checks, funding to train health professionals, the first-ever clinical guidelines and a national awareness campaign.

Women in perimenopause are struggling. Hugely. And we still need to find better ways to talk about it.

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Feature Image: Getty.

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