Understanding Perimenopause and Menopause
Approximately 30% of women endure intense symptoms during perimenopause, a transitional phase often occurring in their 40s, marked by fluctuating hormones and irregular menstrual cycles. This stage leads into menopause, which typically happens around the age of 51 when menstruation ceases altogether.
Experiencing the Struggles
Em Rusciano, a comedian and presenter currently aged 45, began feeling a loss of control over her body while in her late 30s. As a mother of three, she described her mind as feeling “like pea soup,” suffered from aching joints, experienced heightened emotions, and faced exhaustion coupled with insomnia. “It was undeniably brutal,” she confessed.
“I felt adrift, losing essential parts of myself like my sharpness, confidence, and multitasking abilities,” Em reflected. “Every aspect of my life was affected—work, relationships, family, and most notably, my sense of identity.”
Seeking Answers
For a significant time, Rusciano felt isolated in her struggles, convinced she was failing at life. Over a year ago, she consulted her doctor, who discovered her hormone and follicle-stimulating hormone (FSH) levels were erratic. An endocrinologist later confirmed she was in early menopause—defined as occurring between the ages of 40 and 45—and had low bone density.
“Once I understood that my experiences were biological rather than a personal failing, I was able to reframe my situation and focus on recovery,” she shared, leading her to start Menopausal Hormone Treatment (MHT).
A New Approach
“MHT isn’t suitable for everyone, but for me, it has been transformative. I’ve revamped my lifestyle—lifting weights, prioritizing health, and crucially, putting myself first,” she continued.
Medical experts, like Professor Susan Davis, advocate for treatment options for women experiencing moderate to severe menopausal symptoms, particularly to avert osteoporosis and in cases of early menopause.
MHT: Not a Cure-All
While MHT is a significant option for those dealing with disruptive symptoms, Dr. Khan warns against viewing it as a miraculous solution. According to Dr. Claire Haver, a prominent obstetrician and social media figure, MHT can alleviate symptoms and potentially prevent cardiovascular issues and dementia.
However, Davis counters this view, stating that current evidence does not support the use of transdermal estrogen for heart disease or dementia prevention and expresses concern over the safety of using postmenopausal doses for perimenopausal women.
“Understanding that perimenopausal women still produce considerable amounts of estrogen and progesterone is vital. We need tailored treatments instead of defaulting to standard MHT,” Davis explained.
In contrast, she remains skeptical about the effectiveness of supplements, noting that they often don’t even survive gastric acid if one isn’t deficient.
Challenges Beyond Hormones
As conversations around menopause become more mainstream, there’s a growing tendency to attribute various mental health issues directly to these transitions. A report by McKinsey revealed women outspend on menopause and pregnancy-related products compared to other health products, as the global menopause market is projected to grow significantly by 2030.
Despite claims of increasing anxiety and depression during perimenopause, a new study from Davis, set to publish soon, shows that depressive symptoms often decrease with age. For instance, only 14% of women in their 40s show moderate to severe depressive symptoms, with a slight increase to 17% for those in perimenopause.
Explaining this complicated landscape, Khan remarked that many women seek help because of overwhelming pressures in their lives, turning to hormone optimization as a solution.
The Role of Lifestyle
Stress and reliance on substances like alcohol—one in five middle-aged Australian women reportedly binge-drink to cope—can aggravate sleep disturbances, anxiety, and symptoms associated with hormonal changes.
Davis emphasizes that while menopause is significant, attributing every issue to it can diminish the focus on broader stressors affecting women’s lives.
Embracing Change
So, what are the best strategies for navigating this inevitable transition? MHT can be life-altering for women facing menopausal symptoms or low bone density, as highlighted by Rusciano’s experience. For women in perimenopause, regulating their cycles and administering low doses of estrogen or vaginal estrogen may provide relief.
“I advocate MHT for menopausal women, as well as perimenopausal treatments, acknowledging the individual’s entire situation,” emphasized Davis.
The Path to Wellbeing
Khan asserts that true wellness goes beyond hormone treatment, requiring attention to nutrition, exercise, stress management, sleep practices, and social connections.
Importantly, women must be reminded that after menopause, “things generally stabilize.” The portrayal of post-menopausal life as solely miserable is a myth; many women find enhanced life satisfaction and even experience a revitalized sex life in their 50s.
Rusciano describes her journey as one of growth: “This transition represents evolution rather than loss. For too long, we have perceived menopause as the end, but it can mark the beginning of a clearer, more empowered version of ourselves.”
Em Rusciano, Dr. Fatima Khan, and Professor Susan Davis will participate in an event at the Sydney Opera House on March 9, addressing topics related to menopause and women’s health.
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