Is it perimenopause or menopause?

Is it perimenopause or menopause?

Funnily enough there are a few different answers to this question, depending on the way you're asking it.

Medically, there are pretty clear definitions of when you reach full menopause.

It's when you've gone a year without a period. Unless you are under 45 and then it's two years. It's worth noting that about one in 20 of us will reach menopause before 45 and about 1 in 200 before 40. So far, so good!

However if there's a reason you don't have periods - maybe a coil, an ablation or a hysterectomy that didn't include taking your ovaries - then it's tough to know.

In that case a test can be used. A hormone called FSH will shoot up as your oestrogen levels drop so it can be used to test for full menopause. Tests can be done by your doctor or can be bought cheaply and easily online.

However this test won't tell you reliably if you're in perimenopause because your hormones are fluctuating so wildly.

How is perimenopause diagnosed?

This is trickier, because it's diagnosed on symptoms. Some of those symptoms can also be caused by other things, so it can be subjective. But when you've got a pattern of symptoms that can't be explained by other things, you can be pretty sure. It's reasonable, however, for your doctor to do tests to rule out other causes.

The best way for you to know is to keep a track of your symptoms. There are tools to help with that here https://bit.ly/gettogrip

Why are we suddenly talking about perimenopause?

I find this interesting. When I was going through it no-one talked about perimenopause. It was all just called 'the menopause'. I read in the dictionary that the word was first used in the 60s, but it wasn't popularly used until quite recently. It seems as if suddenly everyone is talking about 'peri'.

It's been suggested that this is a fad. It's been suggested that there's an ageism at work - that admitting to peri rather than menopause does not make us feel so old. But I suspect it's something else.

Part of it is an acknowledgement that the transition lasts longer than we used to think, in many people's experience around a decade. That means that it's not unusual to be experiencing some symptoms in our late thirties and early forties - even earlier if we have a premature menopause. And it's really important to be aware of that.

I think it's also a new generation seizing hold of the discussion - and articulating an experience that has been silenced in the past. Part of that kind of movement always seems to include claiming language.

Does it matter?

We might as well be precise with the language. And certainly if we're talking to a doctor it's worth being clear about what we think is happening. It's really important to be clear if we're talking about bleeding.

In our conversations with each other, less so. If we slip into 'the menopause' as there is a fellowship between those in perimenopause. As long as no-one feels excluded.

Is there a difference in the experience?

There's no doubt that in perimenopause our hormones often fluctuate wildly - although different people experience that differently - and each of us will probably experience it in different ways as we pass through that transition.

However those symptoms don't necessarily settle down as soon as we reach that magical date. By then we're free of the bleeding issues (and if you do bleed after that please see your doctor) but the brain stuff, the mood swings, the memory loss, the mood swings can last a while. Conventional wisdom suggests that they settle down in a year or so but brain scans from Lisa Mosconi suggest that it's four years before brain activity returns to normal.

Louann Brizendine believes that once we're finally free from the hormonal fluctuations we've dealt with all our lives that our brains work better. That we're happier, clearer and more purposeful.

However for some women hot flushes, memory loss and mood swings do continue much longer and we don't really know why.

We are post-menopausal for the rest of our lives

Our bodies will exist in a low oestrogen state for the rest of our lives. Even if we chose to continue with HRT it's not what it was. In particular that means dealing with the impact of low oestrogen on our tissues - in particularly our bones, our muscles and our bladders and bits.

We're going to have to put effort in to keeping those tissues healthy, whether it's getting the right kind of exercise or using vaginal oestrogen or moisturisers.

But for most of us this starts in perimenopause so again the distinction is blurred.

Why I often use the term peri/menopause

In terms of our experience the distinction between perimenopause and menopause is blurred and the needs of those in perimenopause and menopause overlap. We're all different and have to be treated as individuals and our individual needs attended to - but when we're offering support we have to make sure no-one who needs it is excluded.

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