Why did no one warn me about perimenopausal periods? Seriously. When I was 11, a district nurse came in to school and gave all the girls a frank and detailed talk about menstruation. Basically, it was a heads up about what we were about to go through.
Nobody sat me down and told me about perimenopause! At no point did someone say: “You’re about to go through a second puberty”. I didn’t get a PowerPoint or so much as a leaflet on the subject. I have dealt with my monthly periods for the last 31 years, but I was completely unprepared for this.
I had assumed that when the time came my periods would just graciously bow out. That somewhere around 50, they would quietly wind themselves up and then exit my life in a calm and orderly manner. After all, they arrived in a fairly straightforward way.
I have scoured the NHS online and the only information there tells me that during perimenopause my periods may become “irregular”. Well, I am not dealing with “irregular” periods. I need information on “periods like the Battle of the Somme during perimenopause”, but there is very little information to be had.
I have always had bad PMS, but after years of surfing the hormonal tides each month, I thought I had a handle on it. It sucks but I can deal with it. Abdominal cramps, acne, nausea, headaches, and morphing into a swamp beast for a few days each month was just par for the course. But something started to happen when I was in my late thirties. It was like the wheels were coming off my womb. The bleeding got much heavier, and the symptoms of PMS increased significantly. It got so bad that at one point I had to take iron supplements because I was becoming anemic each month.
At 39, the perimenopause seemed like a million miles away and I was at a loss as to why my reproductive system had suddenly chosen violence. I didn’t have any other symptoms of perimenopause, and my cycles were regular, it’s just that they had become apocalyptic events.
I spoke to Dr Louise Newson, a physician and hormones specialist, about worsening PMS as we get older and asked if this is something she sees a lot in her menopause clinics. “We see this a lot,” Dr Newson told me. “Lots of people have symptoms of PMS, or premenstrual dysphoric disorder (PMDD) in perimenopause. It’s caused by a change in hormone levels. If women are sensitive to changing hormones levels, then as those hormones reduce in perimenopause, they just get worse and experience more symptoms.”
I can’t understand why this information isn’t more widely available. I wish I had known this three years ago when I started struggling.
It wasn’t until I mentioned it to my mum, and she told me that she had gone through an early perimenopause, that things started to make more sense. My poor mum had such severe symptoms that she wound up getting a full hysterectomy in her mid-40s.
Her periods became so heavy and debilitating that she had to take time off work each month, though she wasn’t told that this was the menopause. She was just told “these things happen”. “Things”, that as it turns out, stopped with a hysterectomy and HRT. Funny that.
I asked Dr Newson if a hysterectomy, which is the removal of the womb, is still a treatment that would be offered for worsening PMS. “It is,” she told me. “But I don’t think it should be done. People think if the hormones are causing the problems, then let’s get rid of them. But actually, if you get rid of the hormones then you just don’t have any hormones in the body and that can make people feel worse, and then you’ve got health risks of not having any hormones.”
My grandmother had also gone through these perimenopause symptoms in her late thirties. It was the 1960s then and she wasn’t offered any kind of treatment. She was told to go away and have another baby.
Now I am 42 and being held hostage by my uterus each month, a tiny terrorist that has hijacked my body and refuses to enter in to any kind of meaningful negotiations. PMS used to last a few days, but now it’s a week with another week leading in. Headaches that were once an irritating, humming pain behind one eye are now so bad they can put me in bed for days, throwing back painkillers like they are Bombay Mix.
Every joint in me aches, my limbs are so heavy I feel like I am stuck to the floor, and the rage, oh my god, the rage. I can run the hormonal gantlet from murderous fury to wretchedly depressed in the time it takes me to get more chocolate from the kitchen. I bleed so much that I half expect the Red Cross to chopper into my living room and declare me a humanitarian disaster zone. And then, suddenly, as if by magic, it all clears and I feel normal again, at least for a few weeks anyway.
I was fairly sure this was the work of Satan, but it is actually caused by a drop in the hormones progesterone, oestrogen, and testosterone. As women age, we make less of all of these, and it is this imbalance that can cause the characteristic symptoms of perimenopause and menopause, i.e. hot flushes, sleep disturbances, mood swings, and vaginal dryness. As it turns out, a drop in hormones can also turn you into the girl from The Ring for two weeks a month.
According to the research, only about 10 per cent of people will actually seek medical help for symptoms of perimenopause, and you can bet your bottom dollar that I am one of them. I went to the GP for the first time after I had learned my mum had been through something similar when she was my age. I was told I was too young to be experiencing perimenopause. Surely the only time a woman doesn’t want to hear those words is when she’s trying to convince a doctor that she is struggling with a hormonal imbalance. They also explained that they can’t prescribe HRT to help with PMS.
I was given the combined contraceptive pill, which is often prescribed to women to combat PMS as well as the symptoms of perimenopause. The combined pill contains synthetic oestrogen and progesterone in such high levels that the body stops producing its own. It can help to regulate hormonal fluctuations by maintaining a steady and constant supply.
The pill has stopped me bleeding out each month, but it hasn’t stopped the PMS symptoms that went with it. The mood swings, the debilitating headaches, and awful fatigue are all still out in force and getting worse.
I asked Dr Newson why this treatment might not be working. She explained: “Synthetic hormones don’t work in the same way. Your body can react differently to them.” When I asked what treatment she would recommend for someone in my position, she said she would prescribe HRT. “You need to treat the underlying cause,” she explained. But I can’t seem to access this on the NHS.
I keep going back to the GP, but because I’m 42 and not experiencing any of the usual symptoms of perimenopause beyond terrible PMS, they won’t prescribe HRT. I have been offered the Merina Coil, but this too uses synthetic progesterone. I feel I am at the end of my hormonal rope. Do I really have to wait until I’m older or for this to get even worse before I can access HRT on the NHS? Because I’m under 45, I need to be diagnosed with “early menopause” in order to access HRT. But this won’t happen because my periods are regular and the only symptom I have is dreadful PMS.
I am far from on my own. Last year, researchers from UCLA conducted a study of women aged 40-55, and found that “almost all of the women spoke of having unpredictable periods that accompanied the perimenopause – including changes in cycle length, period duration and the amount of blood flow.”
The research also noted that “many women stated that their PMS symptoms were more intense and lasted much longer than before. This ranged from having anxiety that they had not experienced before, to uncontrollable mood swings, to generally longer periods of PMS.” Yes! This is me! Why isn’t this information plastered across the NHS website? Why did I have to dig it out of a scientific journal?
The UCLA team concluded that there is a clear need for “comprehensive menstrual education in schools involving both genders to enable informed decision-making and improved training for healthcare professionals are recommended”. All I can say is amen to that, and I hope this article can contribute something to raising awareness.
However, my being aware of perimenopausal PMS has done very little to my being able to access HRT on the NHS. I am still “too young” and should give the coil a try first. As much as it pains me, I fear I am going to have to go private to get the help I need.
I simply cannot continue like this.
