Perimenopause and its Impact.

Perimenopause.

Text by Barbara Dawn Smith.
Additional text by Laura Skilton.
Photography by David Cross.

Women’s hormonal milestones in life from the onset of menstruation, through fertility years and finally menopause is both a cultural conditioning of expectations and a personal one. Some cultures have taboos surrounding a woman’s natural hormonal stages and some cultures create rituals honouring such transitions. The Perimenopause, can be described as an invitation toward becoming an Elder or Wise Woman entering menopause. A natural hormonal shift is taking place and each woman experiences the changes in her own unique way. Symptoms may include irregular periods, hot flashes, mood swings, sleep disturbances, and physical body changes. From empowering to debilitating, as any rite of passage, requires attention to self-care, self-affirmation, self-love, and a willingness to re-”view” her life purpose and wisdom of her life experience up to that point. Remember, each woman’s journey is as unique as her fingerprint.

Awareness and conversations between women of all ages and including men, with respect and attention to feeling is a hugely overlooked part of our sexual interactions. Bombarded, as we are by advertising and fashion that often represents women’s hormonal stages as pathological, or the brunt of jokes about mood swings. Asking, inviting, listening, and a willingness to be compassionate, toward ourselves as women, and those with whom we are intimate is essential. Research in the U.K. suggests that 8 out of every 10 women going through this phase are still in the work place and thus we should be aware and open to supportive dialogue, in practice this means opening conversations gently, being sure to engage in what is called active listening. Equally one should avoid trying to offer immediate solutions and instead acknowledge her feelings and express a willingness to learn and adapt.

We can following this up by checking in regularly and keeping the dialogue open, ongoing, and that their pace. Keep in mind, the key to open dialogue is creating a comfortable environment where she feels her experiences and feelings are validated and respected. It is about empathy, patience, and the willingness to be there for her without judgment. Empathic partnering is taking on extra chores, surprising her with flowers or as involved as attending medical appointments. Be present, observe, there is nothing to “fix”, and do not fall into the mind-set “it is her problem.” Learn about perimenopause. Read articles, books, or attend seminars. The field of women’s health is continuously evolving, so it is always a good idea to look for the latest publication or editions for the most current information. Understanding what she is going through is a form of support in itself. Knowledge enables empathy.

Photo at top:
Roller Skating around the housing estate after work.

Photo below:
Applying Oestrogen HRT gel, (note the rubber gloves). This helps to support the body to regulate the supply of oestrogen that becomes erratic and reduced whilst experiencing perimenopausal symptoms.

Patience is paramount, especially during mood swings or emotional periods. Empathize with her situation; try to see the world through her eyes. It is not about enduring but understanding. Providing positive affirmations is a great way to offer emotional support during perimenopause. These affirmations should be genuine, reassuring, and empathetic. Remember, the key to effective affirmations is sincerity. They should come from a place of genuine care and empathy. It is not just about saying the words but also about demonstrating your support through actions and understanding. Supporting someone can be draining. Take care of your health, both mentally and physically. Engage in activities that rejuvenate you, and do not hesitate to seek support for yourself. Create an environment that fosters comfort and understanding. Encourage a support network involving friends and family. It is about creating a community of care.
Outlined below is a glimpse into one women’s story - we thank Laura for her candid approach.

“For me, I had no idea that I had entered this phase. I confess to being completely ignorant to the now acknowledged phenomena known as 'perimenopause'. My only understanding of the menopause was witnessing my own mother go through 'the change' as it was understood perhaps 25 years ago, and this mostly consisted of her suffering from embarrassing hot flushes. I can't recall being aware of her having any other symptom than that, yet I think it's fair to say she experienced many more. This was of an era where women did not freely discuss personal details and I suspect I am not alone in my previous ignorance to being aware of the changes that occur and how they might affect all women individually.

I would say this is still true today. The moment I was told I had entered this phase in my life, I mentioned it in passing to David's sister Emma, it was like a tap had been turned on. (I’ll come on to how this occurred). For half an hour I couldn't get a word in edgeways, but it was a worthy moment, and it was the first time someone shared with me information, options, and experiences of others. It opened up a whole new world that I hadn't realised existed.
I have had similar experiences with female colleagues at work. It is never mentioned, yet when I do, I cannot stop the flow of experiences, issues, remedies, offers of advice, or questions from the colleague that I have said the dirty word to. This simply encourages me to raise it, both with younger colleagues, similarly aged colleagues, and older ones too.

My first official acknowledgement of perimenopause came as a surprise, and it came from a nurse at my local doctor’s surgery. I had an appointment for a smear test, and once that rather undelightful process had completed, I was invited to take a seat and have a general conversation about my overall health. The nurse surprised me when she asked me to confirm my date of birth and responded by saying 'oh, you will be 50 next year' (to which it turns out we were both born in the same year) hence her reference to my age. It was at that moment she told me that regardless of whether my periods were still regular, I would, without a doubt, be in my perimenopause phase.

Photo above:
Low energy and brain fog, make problem solving difficult, at home, work and at the bouldering centre.

Once she got me past the 'the what phase?' she looked at me and said let me ask you a number of questions and think about whether any of these apply to you. I can't recall all of them. Or word for word. But they were along the lines of the following: Do you feel like you have less energy than before?
Are you constantly tired?
Do you have night sweats?
Are you experiencing anxiety? Mood swings? Heart palpitations?
Have you stopped doing things that you would normally enjoy doing?
Do you find it difficult to do or complete simple tasks? Do you have difficulty concentrating?
Have you been getting headaches or migraines that you previously did not suffer from, or have they suddenly become worse?
Has your self-esteem dropped?
Do you suffer from insomnia?

For all of those questions, I was sat there in shock, thinking me, me, yes me, definitely me, oh crikey, that's me.... And then she asked me. 'Are you sad?' From absolutely nowhere, and to my absolute shame, I said ‘Yes. I am sad!’ and promptly burst into tears.

This was the start of my journey; learning to understand what was happening to me physically and accepting that it was something I had absolutely no control over.
It was such a relief. For over 2 years I had been genuinely suffering and suffering for all manners of reasons. I had thought I was going mad, and I couldn't understand why I could no longer cope very well under duress and additional stresses from work. I didn't recognise myself anymore. I lost all motivation to go out, to go climbing with David.
I was incandescent with unreasonable rage at times that would leave me shattered and curled up with shame. I was the issue, but I couldn't control or help myself in those moments. When the rage descended, it felt justified in the moment. I wasn't sleeping. If I was lucky, I would sleep for 2 hours a night. Some days I would drink a bottle of wine to knock myself out. Nothing worked. Once awake, I remained awake, despite being and feeling exhausted. This would be how I carried myself into each day.

Photo above:
For many women, this change in their lives can at first leave them confused and feeling acutely alone.

Everything I had been experiencing was something I felt I could explain to myself. I was tired and stressed out due to workload and working 70+ hours a week, every week for months on end. This was the reason why I was becoming inefficient at work, and perhaps not being as productive as I used to be or should be. I had a low mood because I was grieving for my cat MeMe who was my absolute companion in life, and I lost her to heart failure which came as such a shock from diagnosis to the inevitable end. I didn't have the energy to go climbing because of workload, demands, never ending deadlines, stress, insomnia.... Adding to the mix was a huge loss of self-esteem and confidence. I was gaining weight and I felt uncomfortable in my own body. I felt my performance for work was below what I expected of myself, and I was being undermined and passively, yet aggressively bullied.
It really wasn't what I could refer to as a good time.

On reflection, there is a part of me that believes I was grieving for the loss of the woman I had once been. Youth was no longer a luxury that I could enjoy. My body was now unable to regulate the hormones it was used to producing and its effect was as physical as it was emotional. I had to accept that I was at its mercy, and unable to control what was happening to me. After some research I made an appointment to see the nurse to discuss options around HRT. There are many choices and options on the market today, and these are dependent on many factors. We settled on a combination to try, with the understanding that this might take 3-6 months to take effect. It isn’t guaranteed the first combination will be the right treatment, but at this point, I was willing to give anything a try and above all, be patient.

Photo above:
Laura has continued to lift the veil and raise awareness of peri-menopause at work and in her private life. 

For the first time in a long time, I felt empowered. It felt like this was the first positive step to helping myself and I haven't looked back. I take two different types of HRT. One with progesterone, as I still have a womb. This is essential if you take oestrogen too. The progesterone also has the benefit of including a sedative to help me sleep combating the intense insomnia I had been experiencing. I sleep. Like I haven't been able to in years. It may take me longer to fully wake up, but it's worth it. I also have an oestrogen gel which I apply to the top of my arms. This references to the photograph that David caught of me which I can't decide if I am happy with or not! But I accept that this is a moment relevant to my journey. In the photo I have plastic gloves on to apply the gel. Whatever is in the gel caused the skin on my fingers to become thin and I simply could not climb anymore as my skin would split and bleed. (You can't make this up, can you?)

I feel so much better these days. I'm not back to the woman I was, but I am improving. David and I are climbing again, yet to go as regularly as we enjoyed in the past, but I confess this is mainly down to working around my work commitments. Newfound self-esteem has meant I had the courage to apply for a new role, and I am now in the process of working out my notice period to start a new job in March. I am hoping my work life balance will be restored and the focus can include doing the things that bring me peace and happiness too”.

Photo above left:
Laura, post op’ and with her cat a year before she passed away. This period of time was also the start of the perimenopausal symptoms

Photo above right:
Moving forward, feeling empowered, understood and appreciated.

Thanks for reading.