Short Wave - Preparing For Perimenopause: You Don't Have To Do It Alone

Episode Date: September 22, 2020

Perimenopause, the period of transition to menopause, is still a largely misunderstood chapter of reproductive life. It brings about both physical and mental health changes that doctors rarely educate their patients about. We're joined by health correspondent Rhitu Chatterjee to talk about perimenopause, and how to advocate for yourself as you're going through it.See pcm.adswizz.com for information about our collection and use of personal data for sponsorship and to manage your podcast sponsorship preferences.NPR Privacy Policy

You're listening to Shortwave from NPR. Hey, everybody, Emily Kwong here. This episode, we're talking about a special time in a person's life. When their body goes through a lot of hormonal changes. And no, we are not talking about puberty. We're talking about life on the other side of the reproductive rainbow. We're talking about menopause and perimenopause specifically. When I was nine, I got the talk all about what's going to happen to my body when puberty kicks in.

But no one gives you the talk for perimenopause. No one sits you down in your 30s and is like, hey, this is going to happen. It's going to go like this. This is what you're going to feel. It's totally fine. Here's some resources. Here's some ice cream. Nobody does that.

And that's a huge, huge problem. Yeah. And our message to listeners is that this chapter of life is navigable. Exactly. And we have health correspondent, Ritu, Chatterjee. here to help. Hi, Emily. Hi. So perimenopause is experienced by a lot of people. And Ritu, there's a lot of silence around it. Yeah. And nobody even going through it really talks about it or they might talk to each other in hush tones. One generation never really tells the next

generation, hey, this is what you have to expect. And that's the problem. And it's like we're rediscovering our uteruses every generation again, and again, and again. Exactly, exactly. So So anyway, technically, menopause is when someone's gone through a whole calendar year where they haven't menstruated. But perimenopause is essentially this transition to menopause when one's body is preparing to end the reproductive stage of life. And this can last for years. It can be anywhere between one to ten years, usually four years on average. Wow. And it can start as early as your 30s in some cases, though usually it happens in your 4.4.

40s and 50s. And it can come with a range of physical symptoms. I think hot flashes is the one that we hear about more often. You know, there's irregular periods, which is often the first symptom. But the other thing that gets talked about even less, and like really few people know about this, even doctors, is that perimenopause brings with it a heightened risk of mental health problems. It comes not just with physical changes. It comes with emotional changes. mood changes as well.

So today on the show, we are going to get real about reproductive transitions. We're going to talk about perimenopause, what goes on in the body and the mind during this major life change and how to navigate it. Today, I am joined by NPR health correspondent and reproductive fairy godmother, through Chatterjee, for some real talk about perimenopause. We're going to talk about how the physical symptoms can come with a host of emotional and mental health symptoms too, which some people don't realize, right? Exactly.

But before I say more, I just want to say that I think I love my new title, Reproductive Fairy Godmother. But anyway, getting back to business, yes. So I wasn't sure how it would go. Yeah, the physical symptoms can come with a host of emotional mental health symptoms, absolutely. So take, for example, a woman I spoke with Terry Hines. Now, about a decade ago when Terry was in her mid-40s, her period started to change. It increased in frequency, it increased in intensity, and it increased in duration. Now, she had some of the classic symptoms of perimenopause, like hot flashes.

And she also started gaining weight, which many women do during this time. But there were notable changes to her mental health, too. I just did not have the energy to do the things that I wanted to do. There was such a fog over who I was. what I wanted, where I was going, what I was capable of accomplishing, I just could not find my footing. At the time, Terry lived alone in Philadelphia, where she worked as an assistant principal at a school. And she really struggled to get out of bed and go to work and do the things that she loved to do, like taking her dogs for a morning walk. And she began to withdraw from her friends as well.

Yeah, you know, Ritu, speaking from experience, these all sound. like symptoms of depression, you know, self-isolation, fogginess, low energy. Exactly. And, you know, the thing is that Terry had actually struggled with depression before and had sought treatment for it. And she knew her symptoms. She knew her triggers. And that that was usually a big change in her personal or professional life. But this time, though, she says she was just so focused on all the physical changes going on in her body because of perimenopause, that her emotional struggles, at first they didn't even register in her mind. Oh. So on top of perimenopause, Terry was managing depression, too.

Exactly. And that's not uncommon, especially among individuals who have had previous diagnoses or of clinical depression and anxiety. And there's data suggesting that in the latest stages of perimenopause, as many as 38% of women experience depressive symptoms. I want to put this on the evening news. Like all persons who experience depression should be made aware of this. So they're prepared. I mean, that's a huge number. So do you have a sense of biologically why they're such a spike?

Right. So it's a stage of life when your hormone levels are changing. It's all changing. Your periods are changing. Your hormonal cycles are all sort of, you know, going awry. And that can trigger intense changes in mood. And psychiatrists that I talked to for the story said that if you're experiencing depression or anxiety during perimenopause, it's not that the changes in your hormonal cycles are unusual or, say, dramatically different from somebody else's. But it's more likely that your brain is more sensitive to these changes.

So if you've experienced depression before, you're more sensitive to experiencing it when going through perimenopause. Exactly. Now, the other reason is that paramedopause isn't just a biological change, right? It's also a huge life transition because there are all these changes in your body. And it's a big part of aging, which you're coming to terms with. Your metabolism might be slowing down. You might be emotionally processing these things as well. And any big life transitions can affect people's emotional well-being as well. Right. So what did Terry do when she realized she was going through a depressive episode on top? of perimenopause. So it took her while to recognize the symptoms and seek treatment because she was just so focused on what was changing within her body. And, you know, when she did bring up her physical symptoms to her doctor, her doctor wasn't especially helpful, you know, in terms of offering tips for coping with those symptoms. I think she might have said, yeah, you're about the age when you will begin to have these symptoms. You will begin to be perimenopausal. That sounds like

some vague medical advice. Yeah, and that's what a lot of doctors do. Almost all the women that I talk to, that's what they said that, you know, vast majority of doctors basically said, well, you know, this is bound to happen, you know, just shrug it off. See, that's really surprising to me. Do we have any sense of why doctors are so unprepared for really, really helping their patients through perimenopause? I mean, it affects half the population. It's not like perimenopause is some niche condition, you know? And that's the same question I asked Dr. Hadeen Jaffe. She heads the women's mental health division at Brigham and Women's Hospital in Boston. And she said that even OBGYNs who specialize in women's health don't get a ton of education about perimenopause because

so much of their work is focused on the reproductive phase in women's life. And she advises people to be proactive about seeking help. The first thing she recommends is that they monitor their own symptoms keep track of them and make it a point to bring up those symptoms how often they've had them with their doctor. Just the same they would if they had a rash, they would go in for an extra appointment and that's the first thing they say is I have a rash. And if people suspect that they're experiencing perimenopause, is there any kind of diagnostic tool to determine this is perimenopause 100% something to confirm that it's happening? Unfortunately no. And according to Jaffe, you know, there just isn't a good test to diagnose when you're in perimenopause.

So there's no really one point in time when a hormone test is done that can be as definitive in helping somebody understand what's going on in their body just because if you do the test today versus tomorrow versus next week, you might get a very different readout since it's so variable. So the most telling symptoms, she says, is changing. in your period, changes in frequency and or flow. But in terms of the other symptoms, everybody experiences paramedopause differently. There's night sweats, hot flashes, which some describe like having panic attacks. And there's symptoms that affect your sex life, like vaginal dryness that can make sex painful or a decrease in libido. Keeping track of these changes helps you bring that information to your doctor. To quote my esteemed colleague, Madal in case of I, data is life.

Data is life. And so Joffi says, you know, track your periods. Use an app or a paper calendar or a notebook, whatever works for you. Yeah, I actually use an app to track my period right now. So I could get one for later in life for perimenopause. You know, just to know more clearly, like, what is normal for your body? And so if something starts to change, you can show your doctor. Knowing that information, somebody can say, well, over the last six months,

I only had two periods or I had hot flashes almost every day or my mood was as bad as it gets, you know, a third of the time. Knowledge is power. And, you know, the good news is there are doctors who specialize in perimenopause. And you can find them on the website of the North American Menopause Society. Okay, bookmarking North American Menopause Society for when the time is right. All right. So, Ritu, I appreciate this so much because I think when it came to pay.

perimenopause before this conversation, I drew a blank. Like, I didn't know it was only, I didn't know menopause was one day and perimenopause was all the years leading up to it. And that's why I think the women I talked to and the experts I spoke to, you know, really pointed out that one thing to do to sort of get through this, or even if you're getting to the age where you think you might be approaching perimenopause, what could be really useful is to surround yourself with a community of people who have experienced this. And then just like try to talk openly about it. Like a perimenopause support group? Yeah, paramedopause support group. I can't tell you how many women told me that, you know, that's where they found support. That's where they found information. And that's what kind of made them feel like they weren't alone and in this fog suffering through this and bumbling their way through this. You know, a lot of women told me about online communities that they're part of and even some meetup groups.

And to just in any case talk about health, especially things that don't get talked about. It's not just therapeutic. You know, you just also share information that can be useful. And, you know, we heard from Dr. Heddeon Joffey at Brigham Women's in Boston. And one thing she said that really stayed with me is that paramedopause, you know, it comes with all these risks and symptoms, but it doesn't have to be a time of struggle and suffering. It can be an empowering experience. I want people to have permission.

I want people to feel that they owe it to themselves and the people around them that they aren't suffering. I love this. We're taking perimenopause back, changing the narrative. Ritu, Reproductive Fairy Godmother, thank you so much for bringing us. vital, vital information. Anytime it was my pleasure. Today's episode was produced by Rebecca Ramirez and Emily Vaughn,

edited by Jeff Brumfield and Viet Le, and fact-checked by Arella Zabidi. I'm Emily Kwong, and you're listening to Shortwave from NPR. Activist Aaron Doar tells his flock of pro-gun followers on Facebook that he's tirelessly fighting for their Second Amendment rights. But if that's true, why do so many pro-gun Republicans hate him so much? Aaron Dorr is a scam artist, a liar, and he is doing Iowans, no services, no favors.

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