Perimenopause - part 1

In this episode, we’ll learn about the first stage of the menopause journey – perimenopause. You'll hear from endocrinologist, senior lecturer and president-elect of the Australasian Menopause Society, Dr Christina Jang who takes us through what perimenopause is, the varying physical or mental health symptoms that may be experienced and how difficult it can often be to get a diagnosis. Dr Jang will be with us for the whole season sharing her expert knowledge and advice.

You'll also hear from Nicole, who shares what her early perimenopause symptoms were like and her experience with getting a diagnosis.

What is perimenopause? What are the symptoms? What age can you go into perimenopause? Listen to find out!

If you'd like to learn more about menopause, we have a whole season lined up. Make sure you listen to our next episode, where we explore how diet and lifestyle changes can help relieve symptoms. We’ll also discuss how hormonal changes can affect mental health and wellbeing.

Feel free to leave us a review too—we'd love to hear your thoughts.

Featured in this episode

Katie May

Our host Katie is a single mum in her late 30s. She is a communications expert with 17 years’ experience and is passionate about health and wellbeing. She is currently studying Italian just for fun and absolutely adores her pet greyhound, Piper.

Dr Christina Jang

Dr Jang is a Brisbane-based endocrinologist treating all endocrine conditions, with a special interest in female reproductive endocrinology, including menopause. She is a staff specialist in endocrinology at the Royal Brisbane and Women's Hospital (RBWH). She is a senior lecturer at the University of Queensland and president-elect of the Australasian Menopause Society (AMS).

For her, endocrinology is an area of medicine which presents opportunities to deliver far-reaching benefits to her patients.

Nicole

Nicole is married mum of two in her late 40s. She’s a former registered nurse, currently working in state government communications. She loves reading historical fiction, listening to true crime podcasts and strength-training at the gym. She is right in the middle of perimenopause and is passionate about sharing her experiences in hope that it helps others in the same stage of life.

Episode resources

Australasian Menopause Society (AMS)

The AMS is a not-for-profit member-based society aiming to improve the quality of life for women during and after the menopause. The AMS helps women and their health professionals better understand the transition through this stage of life by providing accurate, evidence-based information about premature menopause, perimenopause, menopausal hormone therapy (MHT) and alternatives, osteoporosis and how to locate a doctor interested in women's health. Find out more from AMS.

Jean Hailes for Women's Health

Jean Hailes for Women's Health is a national not-for-profit organisation dedicated to improving women's health across Australia through every life stage. They work in public health, research, clinical services and policy. Their website has practical and easy-to-understand information for women and for health professionals. Visit Jean Hailes for Women's Health for more information.

Lifeline

Lifeline provides free, 24-hour telephone crisis support service in Australia. Counsellors are available to provide mental health support and emotional assistance, not only via telephone but face-to-face and online. Visit Lifeline or call 13 11 14.

Beyond Blue

Beyond Blue is an Australian mental health and wellbeing support organisation. They offer free, qualified mental health support via chat or phone. Visit Beyond Blue or call 1300 22 4636.

Transcript

Episode 1: Perimenopause | Entering perimenopause and how to prepare

Vox pop:

Welcome to perimenopause. Welcome to the third stage of the female body.

Katie:

Hello and welcome to season two of It Can't Hurt to Ask, a podcast by Queensland Health. I'm Katie and I'll be your host for this season where we'll be discussing something that almost 50% of the population will experience, and that's menopause.

A quick note on terminology. Throughout this podcast, we'll be using the terms women and girls. We use these terms inclusively to mean all people who identify as a woman or girl and recognise that people who do not identify as a woman or girl may still be affected by women's health issues.

Before we get started, we'd like to acknowledge the Traditional Custodians of the land on which we record this podcast. For us it's Meanjin, land of the Yuggera and Turrbal peoples.

In this series, we're going to take a deep dive into the different stages of menopause, ranging from pre-menopause right through to post-menopause.

We'll be joined by leading expert, Brisbane-based endocrinologist and President-elect of the Australasian Menopause Society, Dr Christina Jang. Christina and I will be chatting through what you can expect during the various stages of menopause and how it can affect your mind and body.

Every woman, besides those who have had their ovaries removed before puberty, will experience menopause. That's why it's so important that we come together and have a space where we can all learn more about menopause together.

We'll talk about treatment options, how to manage symptoms, and hear from real people who are currently going through menopause. And of course, we'll provide you with resources and information on where you can seek help.

Today's episode is all about perimenopause. To help us understand it better, we're joined by Brisbane-based endocrinologist and President-elect of the Australasian Menopause Society, Dr Christina Jang. Thanks for joining us, Christina.

Dr Jang: Hi, nice to be here. Thanks for having me.

Katie: So, Christina, what made you get into this field of menopause?

Dr Jang: Well, my background is as an endocrinologist, so our interest is in hormones. I did a bit of work in the menopause field when I trained in Melbourne. So, and I guess my practice is actually co-located with a group of obstetricians and gynaecologists.

So, the reproductive endocrinology side of things has always appealed to me, female reproductive endocrinology and having the background in menopause, it seemed a good jump into it. Yeah. I really enjoyed it.

Katie: I'm sure the patients appreciate your expertise as well.

Dr Jang: Thank you.

Katie: And congratulations on President-elect of the Menopause Society.

Dr Jang: Thank you.

Katie: So, let's start with the very basics. What is perimenopause?

Dr Jang: So, the perimenopause is the phase in a woman's life which occurs just before her last period or the menopause. It usually starts in a woman's 40s.

The hallmark symptom of the perimenopause is a change in the menstrual cycle due to fluctuating hormone levels. Periods can become very erratic and commonly they're very heavy.

The diagnosis of the perimenopause is based on a combination of factors including age, symptoms, but usually it's a change in menstrual cycle patterns. Blood tests might be used to check hormone levels, but they're usually unnecessary. And we would generally consider a woman's presentation and symptoms to make a diagnosis.

Katie: Okay, so for someone like me who started menstruating quite young, about 10, can I expect to enter perimenopause earlier than other people perhaps?

Dr Jang: The age of menopause is about 50 to 51. And that hasn't changed for forever really, for a long time. The age at which a woman first gets her period, we call that the menarche, doesn't seem to correlate.

Katie: Okay, that's good to know. And what about genetics in terms of if my mother got it at a certain age, I will too?

Dr Jang: I think there is some evidence that is the case. There can be some genetic factors involved. So that's been described in literature, and I've certainly seen that in my own practice. But there's also environmental factors as well.

So, we know that women who are smokers tend to have an early menopause. And there's some reports that women, for example, with type two diabetes, also tend to undergo an early menopause.

Katie: So, when you're talking about the hormones fluctuating and those things happening in the body, what does that look like, what sort of symptoms are present?

Dr Jang: So, when the hormones fluctuate, we're really referring to oestrogen. So, oestrogen levels can be very high and at which time that can lead to very heavy periods, breast tenderness, and when they drop, when the oestrogen levels drop, that can cause headaches or migraines. And when the oestrogen levels are low, that's when you get what we call vasomotor symptoms like the hot flushes, the sweats, and that's when you can and other symptoms such as joint aches and pains, sleep disturbance as well.

Katie: I've heard of some women also reporting sort of more emotional or mental health symptoms of the perimenopause or the menopause. Can you talk us through what some of those symptoms look like?

Dr Jang: Yeah, that's definitely the case. So many women report exacerbation of mental health symptoms and that seems to be more likely in women who have had a pre-existing history of mental health issues or for example hormone related type mental health issues for example PMS or premenstrual dysphoric disorder or PMDD. So those women can be at risk of having exacerbation of their anxiety or depression around the time of the menopause.

Katie: Okay, so for someone like me who has anxiety and I'm on medication for that and endometriosis, which has the hallmarks of fluctuating periods and heaviness and things like that, how will I know perhaps that I'm entering this stage? Would I just notice symptoms worsening perhaps?

Dr Jang: You may do. Yeah, you may do. So, for many women, in fact, I saw someone yesterday and she's been really well controlled. She's got a long history of anxiety and depression. and she's been going along really well for the last 10-15 years.

And then she got to the perimenopause and all her medications were going along quite well, she was taking them, but then she just started noticing the anxiety and the mood changes. And so, she talked to her doctor about it and the question was raised whether it could be due to the perimenopause and we're exploring that.

So, I think if you notice a change in your mental health, it's really good to talk to your doctor about it and whether it could be related to a change in the hormones associated with the menopause.

Katie: Yeah. Yeah, right. I'm only 37, so I haven't entered this phase yet, but it's good to know, and I think some of our listeners who might be in the same stage of life as me will appreciate knowing what we, I was about to say, could look forward to, but that doesn't sound very pleasant.

Dr Jang: Yeah, I was asked recently, how do we sell menopause? Doesn't seem like there's a lot of... good to it, but I don't think we really need to sell it, it's going to happen anyway.

Katie: Exactly.

Dr Jang: So, it's about being prepared for it.

Katie: Absolutely. That's what I mean. And I just want to acknowledge, you know, thinking about those symptoms that you talked about, the women who are or have been through it, I just wanted to acknowledge them and say how difficult that must have been for them. Yeah. And the people around them as well.

We know the symptoms of menopause can be quite broad, which unfortunately means they can also be mistaken for other conditions. Nic from Ipswich knows this all too well. So, let's hear from Nicole, who shares her experience with perimenopause. And for her, the initial symptoms were actually quite concerning.

Nicole: So, I remember driving my car one day, I was just going to an appointment and suddenly I had to pull over really quite quickly because I just got really dizzy and just had this overwhelming feeling of, yeah, like anxiety and panic. Like I really felt like I was going to run off the road and crash the car. So, I had to pull over and have a few deep breaths.

And I was really shaky, felt terrible.

And I sort of wondered at the time whether it was a panic attack. And I thought, well, I don't, I'm not stressed, so I don't know why I'd be having a panic attack.

A few days later, I actually woke up feeling dizzy and having vertigo. And I got up and made my way to the kitchen and grabbed a glass of water, went back to bed and then my heart was racing. And I actually felt I really felt like I was going to have a heart attack or something. It was just a really awful feeling.

And I remember my son coming into me. He was about 11 or 12 at the time. And he's like, ‘You all right, Mum?’ And I couldn't really speak to him, and I was grabbing my phone thinking that I was going to have to call the ambulance and I think I frightened him a bit but he sat with me and he just spoke to me and patted my leg and then I calmed down. So, I don't know whether that was again a panic attack, vertigo, a bit of both.

I had a couple more of those episodes in the weeks after that and so I ended up going to the doctors and had a lot of tests, had scans, they thought it was something wrong with my ears, my inner ears. During that time, no one mentioned perimenopause or anything hormonal.

Katie: It wasn't until much later that Nic was told her symptoms of vertigo and panic attacks were all likely at the start of perimenopause. She was 43 when the symptoms occurred and was 47 when she was advised they related to perimenopause.

Thank you to Nicole for sharing her story. We're going to hear a little more from her later. And we're actually also going to hear from other women and some of their loved ones about their experiences with menopause, as well as the different stages of menopause.

So, Nicole had a bit of trouble finding the information and it seemed like no one really mentioned menopause or perimenopause. What's the awareness like generally in the clinical community of menopause and what makes it so difficult to diagnose?

Dr Jang: Nicole obviously had a really tough time. I feel really bad for her listening to her story and some of her symptoms must have been absolutely terrifying. She's obviously had symptoms which are unique to her and other women have symptoms which are unique to them. And it's really difficult to tease out sometimes whether that is menopause or not.

So, it is a really difficult diagnosis to make. We usually say the perimenopause or menopause is associated with irregular menstrual cycles, but obviously other symptoms may be present as well.

Coming back to the issue of the awareness, I agree many clinicians, health care professionals hasn't been great. There's been a lot of dialogue around that more in recent times. There's been a Senate inquiry looking at that very issue. So, we welcome that discussion. I think it's great. And hopefully as more education evolves and more doctors become aware of it, hopefully there will be less people like Nicole experiencing stories like that.

Katie: Yeah, at least getting their diagnosis a lot quicker.

By the time Nicole received her diagnosis, she was onto her sixth GP. Let's hear more about what happened before she got that diagnosis.

Nicole: Not long after I turned 44, I saw a gynaecologist and he just sort of said, ‘Oh, we'll do some scans.’ So, I had an ultrasound which showed there was a fibroid in my uterus, quite a large one. But he said, ‘It's not big enough to really do anything much about, but what we'll do is we'll put a Mirena in and usually the hormones in the Mirena IUD will settle the fibroids down and you should have no problems.’ Again, menopause, perimenopause was never mentioned.

Probably not long after my 45th birthday, heavy bleeding, even though I had the Mirena in and the bleeding had stopped for about six months or so, this heavy bleeding started and it was shocking to me. It was kind of frightening.

Went to my GP who said, ‘Okay, we'll send you to a gynaecologist again.’ So, I went to a different one. And had more scans and the fibroid hadn't reduced in size. In fact, it had increased and it had made my uterus misshapen. And he just basically said to me, ‘I think it's time for a hysterectomy.’

He left my ovaries in, so I had a hysterectomy when I was 45. And yeah, he left my ovaries in because he said, ‘Well, you'll eventually naturally go into menopause.’ But that's all he said. There was no information after that, nothing further.

Then I started definitely to get some different symptoms, which were hot flushes, night sweats, insomnia, heart palpitations, which were pretty frightening. I'd get memory loss, brain fog, fatigue, low energy, and then the body aches and the joint aches started as well.

So, I saw a GP about that and she said, oh, because I'd also started putting on a bit of weight, which was unusual for me. And the first GP I saw about this said, ‘You just need to eat better and lose weight.’  So, I felt pretty disheartened about that. A couple of weeks later, I thought, oh, I'll go and see a different GP.

And saw a different GP who kind of didn't give me much information, but looking at my symptoms, agreed that I was probably in perimenopause, did some blood tests, and she just said, ‘Okay, I'll just give you some of these patches with oestrogen, pop them on, and you'll be right.’ Again, not a lot of information was given. So, most of the information I know about perimenopause, I found out on my own.

Katie: Okay, so that was more of Nicole's story. She mentions there some other symptoms as well as that heavy bleeding and that irregular cycle you were talking about before. I have a Mirena for endometriosis, so can one assume, and I know you're not a gynaecologist, but can one assume that would help manage any kind of perimenopause symptoms that relate to the bleeding and that kind of thing?

Dr Jang: The bleeding is the main one that the Mirena will help with. The Mirena contains a hormone called progesterone, it's a type of progestin, and that usually helps to keep the lining of the wound thin. So that's its main role. So that's the main role of the Mirena. So, it's an excellent option for women who are having heavy menstrual periods around the time of the perimenopause.

Katie: And what about some of the other symptoms that Nicole was describing? Are they fairly common as well?

Dr Jang: Yeah, she was very pretty much textbook actually. The hot flushes, the poor sleep, the fatigue as a result, the joint aches and pains, the brain fog, she had a lot of them, poor thing.

Katie: Nicole also mentions there that it was difficult to find information around what might be happening to her or about perimenopause. Is that common, like in the patients that you see, the women you see, do they have lots of questions?

Dr Jang: Yes, it's very common. It's good that they have the questions. It's a bit disheartening, I guess, to hear her story that she had difficulty.

Look, I think it's really hard for GPs. It's really hard. This is a complex problem. Every woman is different. And the symptoms aren't always textbook. So, GPs have a confined time that they are supposed to see patients in. Unfortunately, having a long explanation, it's not conducive to that. So, it's not an uncommon problem. So yeah, it's a hard one.

Katie: Yeah, and hopefully that's why podcasts like this can help get the word out there and the awareness that about, you know, perimenopause and the different stages of life to help us be more informed and help us make informed choices when it comes to our medical care.

Dr Jang: It is good that we have the internet now. I mean, like we didn't have it so many years ago, but the internet is so rich with information that women can go find their own, look up their own resources.

I'm going to give a plug for the Australasian Menopause Society. It's got information sheets in it for consumers, and it's also got a lot of good information sheets for health care professionals as well so that they can upskill, and we really encourage that.

Katie: Thanks for that, Christina. We'll take a deeper dive into support options in episode six of the series, so stay tuned.

So, it's clear everyone's journey is different and there are some common symptoms there. So, if someone thinks they might be experiencing perimenopause, how should they prepare for an appointment with their specialist or doctor or healthcare professional in terms of advocating for what they think it might be?

Dr Jang: Well, I think one way would potentially be just to track your menstrual cycles. See whether there has been a change in cycle length, whether it's different to normal, and take that to the doctor, have a chat.

If there are other symptoms, like some of the symptoms that I'd mentioned earlier, it's worthwhile having a chat to the doctor and just asking them, is it possible? Is it possible that it could be menopause or perimenopause? And hopefully they'll make an assessment based on the individual or the individual women's history, background of presentation and her age.

Katie: Before we wrap up, did you know we have a whole season lined up about menopause? In fact, we have 6 episodes, so make sure you subscribe and leave us a review, we'd love to hear your thoughts.

As we close this episode today, Christina, is there anything else or another message you'd like the listeners to remember?

Dr Jang: Look, I think we've covered most of it. It's about understanding the symptoms, being prepared for it, asking questions, look on the internet, look on reputable websites.

And talk to your doctor.

Katie: That's great. Thank you. And folks, Christina is going to be with us for the entire season, which is dedicated entirely to menopause, which is very exciting.

In our next episode, we'll be discussing how to manage perimenopause symptoms and how it might affect your mental health. Thanks for joining us today, Christina.

Dr Jang: Thank you.

Katie: Until next time, folks.

[End]