6 Questions on Peri- and Menopause Answered by an Expert

“Paying someone to test your spit is a waste of money”

I entered perimenopause a couple of years ago and, as a health writer for magazines, I’ve had the chance to interview some amazing experts.

I had questions (I knew my readers did too!) and it’s not always easy to get answers.

Recently, I spoke to Dr Linda Dear, a GP and menopause specialist, to clear some of them up.

1. Doesn’t menopause happen after 50?

Menopause is a transition you often don’t realise you’re in until it’s over.

You’re officially postmenopausal when your periods have stopped for a year.

51 is the average age that happens, but it’s actually completely normal to hit menopause any time between 45 and 58.

So if your doctor says you’re too young at 47, get a second opinion!

Five per cent of women will go through menopause between 40 and 45. And for 1–2 per cent of women, it will happen even younger, called premature menopause or primary ovarian insufficiency (POI).

But there’s another stage too where your hormones are all over the place.

Perimenopause, which varies in symptoms from mild to severe, can happen for 2–10 years before the estrogen drop of menopause even starts.

“Perimenopause is the life phase no one tells you about,” says Linda.

It often starts in your 40s or even 30s and typically lasts around four years.

2. I forget everything. Am I getting dementia?

“A lot of women will think they’ve got dementia,” says Linda.

She says there has been research from the team who designed Balance, a menopause app, to show how much money and time is wasted on unnecessary tests and specialist appointments for dementia, long COVID, new allergies, vertigo etc. when the cause of many of these symptoms is hormonal.

“While you’re waiting the six months to see the specialist, you can try HRT and if it’s not hormonal, HRT won’t fix it,” she suggests.

“There can be a lot of psychological symptoms with menopause,” says Linda. Many women experience stress, concentration problems, fatigue, brain fog, negative thinking, anxiety, low mood or irritated, angry thinking during peri- and menopause.

“There can be a lot of psychological symptoms with menopause.”

All of these can be understandably concerning, but if it is hormone-related HRT can help very quickly.

3. Do I need antidepressants for my low mood?

Antidepressants may seem like the obvious first treatment option if your mood is low, but Dr Linda says if she suspects peri- or menopause are the cause, she often tries HRT first.

Unlike many doctors, if a woman comes to Linda and tells her they’d like to try HRT for their mood she generally says yes, if it makes sense for their situation.

“Because if I give you HRT and this is not a hormone problem, HRT won’t help. It actually sometimes helps figure out if hormones are the problem.”

“I’m not saying we should use HRT as a diagnostic tool or test for perimenopause,” she says, “the problem is there is no test for perimenopause because it is a state of fluctuation, a state of change.”

Antidepressants won’t always be helpful for depression if hormonal fluctuations are behind it and can leave women suffering longer than they need to be.

4. Can I get a test for perimenopause?

“There is no test for perimenopause. Any blood, saliva or urine test is just a snapshot in time,” explains Linda. “By the time you get the result, that woman’s blood, spit, and urine stream is saying something completely different.”

Especially during perimenopause, your hormones will fluctuate throughout the month. Testing is more about ruling out other things, especially if the woman is younger than expected.

It becomes ‘diagnosis by exclusion’ for doctors because they don’t want to miss something else that could be causing your symptoms. Symptoms are more important than tests, but they can be vague and mimic other things.

Numbers don’t always show what’s happening

“The blood tests that are helpful aren’t hormone ones, they’re everything else but hormones,” says Linda.

With early menopause it can be worth FSH testing more than once a few months apart. For example, Linda explains that two very high FSH levels, say over 100, suggests menopause, but numbers alone are often not clear enough for a diagnosis.

You can actually diagnose POI without FSH tests sometimes. It’s about looking at the whole picture.

“There’s not this nice neat little diagnostic system,” she says. “People don’t realise that it’s the same with lots of actual diseases as well. People assume we have all these neat boxes to diagnose everything and the human body isn’t that convenient, especially women’s bodies.”

5. Are there non-medical alternatives that help?

Menopause is holistic, says Linda: it affects your whole body, so it’s important to look at treatment in a holistic way too.

“From your brain to your vagina and about lifestyle as well,” she says.

Linda suggests looking at your diet, for example, switching to a Mediterranean diet. Aim for less processed foods and sugar, and more whole foods.

A healthy diet and lifestyle can reduce your hot flushes, night sweats etc. Good sleep, rest and managing stress, and moderate exercise all help reduce symptoms.

6. Will supplements actually help reduce my symptoms?

“I don’t have a problem with supplements at all. I think they’re probably worth a try,” says Linda.

But she warns against going with supplement companies who make you pay for a test, or insist you send your bodily fluids away to be tested, before you can use their products. She sees it as unethical.

“They’re just making money out of vulnerable people,” she says. You can try HRT without a test often, so why do you need a test for a supplement?

“Spend money on supplements, fine,” says Linda. “Because you’re going to eat something and try it, but paying someone to look at your urine or spit is really a waste of a woman’s hard-earned money.”

Some of the supplements she says might be worth a try are:

• Magnesium for sleep, mood, anxiety, and muscle cramps.
• Melatonin sometimes falls into the drug category, but could be seen as a supplement for sleep problems.
• Omega 3 (from food is best).
• Also prebiotics (the kinds of foods your healthy gut bacteria like, such as garlic, onions and bananas) and probiotics.

Gut health is especially important in peri- and menopause, says Linda. You can get probiotics in food, such as kombucha and live yoghurt etc. or in supplements. “Look for bottles in the fridge and as many long Latin-sounding words as possible.”

Black Cohosh and Ashwagandha can also help, mainly with hot flushes.

If nothing has improved by three months stop buying it, says Linda.

“Supplements can be great. There’s often a unique mixture that works for each woman.”

Not necessarily what they claim to be

Linda also wants us to remember, supplements don’t always do what they claim to do and can have side effects too.

“Supplements can say anything they want on the bottles: they are not regulated, and they don’t have to advertise any of the side effects reported to them,” Linda explains. “Just remember that not everything that’s written on them has to be true.”

Kelly Eden has been telling and selling stories for over 15 years and teaching others to do the same. Get free resources here.

Dr Linda Dear runs the MenoDoc website and is conducting a large menopause survey. Australian women and New Zealand women can take part at this stage.

Originally published on Mamamia