Maisie Hill - Perimenopause Power: Navigating your hormones on the journey to menopause

To every single one of you who read Period Power and sent me a message or left a comment asking me What happens next? this book is for you and thanks to you.

And to my ovaries, for doing an outstanding job.

Contents

How to use this book

My clients come to me wanting help. They want strategies that will make a difference to their symptoms and their lives, and I assume that its the same for you. So, if youve got a particular symptom thats bothering you, such as hot flushes or changes to your mental health, you can head straight to the relevant chapter(s). Get the information you need as soon as possible.

What also helps my clients is understanding why theyre having their particular experience because knowledge alone can have a profound effect. Seeing my clients faces as it all starts to make sense to them always brings a smile to mine, which is why Ive explained the science behind perimenopause and postmenopause in this book. But I appreciate that scientific language can be confusing thats why theres a glossary at the back (see ) that you can refer to, if and when you need it.

This is a book that you can come back to as you journey through perimenopause and enter your postmenopausal years. Some of it will apply now, some will become more relevant later on, but, ultimately, having an overall sense of the menopause transition will help you to be prepared and to have a positive experience, which is what I want for all of us.

Language and Inclusivity

Perimenopause is a process that happens to those born with female reproductive organs, but I appreciate that not everyone who reads this book will be female some of you will be non-binary or trans. Its with this consideration in mind that Ive tried to be inclusive in my choice of language, referring to women either because thats the language used in the research papers I reference, or to make a point about patriarchy.

You might wonder what a 40-year-old is doing writing a book about menopause. I mean, thats something that happens in your fifties, right? Not quite.

Whilst the average age of menopause is 51, menopause itself only lasts for one day, because it simply marks the one-year anniversary of your last period. Perimenopause, on the other hand, refers to the period of time in which youll have cycles, but start to experience menopausal symptoms. When most of us are talking about menopause, what we actually mean is perimenopause. Perimenopause is most likely to start in your forties, but for some it will begin in your thirties. It can last as little as two years or as long as 12, and if more of us were aware of the subtleties of this transition, wed recognise the hallmark signs of our hormones shifting far sooner and actually be able to do something about it.

To begin with you might notice that your periods roll around quicker than they used to and that you need to up your game in order to manage blood loss. Symptoms such as night sweats, insomnia, headaches, migraines and breast tenderness may appear in the days surrounding the start of your period. These are the early signs that your hormonal landscape is shifting and that youre entering your perimenopausal years. With time, those signs will become increasingly prevalent, and in the later stage of perimenopause, your periods will become less frequent and other symptoms, such as vaginal dryness, joint pain and bladder changes, will become more likely.

You may be someone who glides through perimenopause without any significant issues. You might hurtle into it unexpectedly and feel rocked to your core. You might be comfortable managing your experience without help. You might want to do things naturally and feel confident that you can. You could be up for taking hormone replacement therapy (HRT) and whatever else modern medicine has to offer. You could also find that somewhere along the line your thoughts and feelings about how youll manage the change, change. What works well for you at first may not do the same further down the line, and one form of treatment might work wonders for your best mate, but not for you.

Whilst were on the subject, just as there are no prizes handed out for birthing a child without pain relief, there is no prize for going through the menopause transition without using HRT. Whatever your thoughts on how best to navigate the menopause transition are, youll find explanations and strategies that will help you in this book.

Your needs are likely to change throughout this process and its okay to change your mind about how you support your health and wellbeing. I dont want you to judge yourself, or anyone else, for the choices you make. Whatever course of action you decide upon, I want you to feel good about it. My hope is that this book will help you to make decisions about your medical care and your life, because indecision is exhausting. Going back and forth worrying about the right course of action takes up mental space that quite frankly, in this stage of life, you dont have. Not to mention preventing and interrupting your sleep, which you could certainly do without.

By the end of this book, youll have a chunky toolkit of tips and techniques that you can use to improve your experience of perimenopause as well as your postmenopausal years. To begin with, the decisions you make are likely to be about managing your symptoms, but as youll discover, the decisions you make now will impact the decades that follow. Perimenopause is often described as a window of opportunity and thats what Id like you to consider it as.

Perimenopausal symptoms include (but certainly arent limited to):

More frequent or further-apart periods (or a thoroughly unpredictable combination of the two)

Changes to menstrual flow heavier, longer, shorter, lighter

Increased PMS

ALL THE RAGE, ALL THE TIME

Sleep disturbances

Fatigue

Breast tenderness

Headaches and migraines

Brain fog

Poor memory

Bloating

Hot flushes

Night sweats

Dry mouth

Joint and muscle pain

Mood changes such as anxiety and depression

Panic attacks

Vaginal dryness

Pain during penetrative sex

Reduced sexual desire

Increased sexual desire (yes, really)

Bladder changes leakage, urgency, needing to pee in the night

Skin changes acne, dry skin, oily skin, loss of plumpness and elasticity

Itchy skin

Hair loss, or thinning

Diarrhoea or constipation, or both.

Perimenopause is more than just physical symptoms, though. In the Autumn phase of life, we are confronted with thoughts and feelings that may have been supressed for years; creative and sexual desires that suddenly emerge or disappear; a greater need for self-expression; and a deep longing to walk away from life as we know it. And then theres going about your daily life feeling like a tinderbox thats ready to ignite, thanks to the irritability, impatience and red-hot rage that course through your body. Perimenopause is a baptism of fire that forces you to face yourself, your history and your future. There is an intensity to perimenopause that we are rarely prepared for, but desperately need to be, because rather than it be something that happens to us, we can have a sense of agency over our experience and find our power.

The Current State of Affairs

In the last three years theres been a 37 per cent increase in online searching for information about the menopause and its hardly surprising given that, according to independent Nuffield Health group, 13 million women in the UK are currently perimenopausal or postmenopausal, and, because of the increase in population size that came from the first- and second-wave baby boomers, its estimated that more than 50 million women and those assigned female at birth in the US have now reached the average age of menopause. By 2050, this figure is expected to quadruple. Yet the sheer volume and range of symptoms and needs of those who are peri- and postmenopausal is not reflected in the research, public health education and spending. If the tables were turned and men were the ones who were wide awake drenched in sweat at 1am, if their cognitive function changed and their penises shrivelled up, how much money do you reckon would be coughed up to help them? There certainly wouldnt be a worldwide shortage of HRT, as there currently is. After menopause we still have a third of our lives left and the impact of the hormone shifts during the menopause transition echoes throughout those decades, but there simply isnt enough research being done to reflect this fact.