Hello Perimenopause

Hello Perimenopause

I haven’t ‘reached’ perimenopause so much as it’s hunted me down and attacked me. That’s how it feels, anyway. At some point over the last year my body decided that it was time to enter this mysterious phase, and I’ve been suffering various symptoms ever since.

How It Started: 2022

2022 started as many years have done recently, with excess weight from Christmas and New Year which I was determined to get rid of and get back to feeling lean and fit through a course of healthy food and daily exercise. I tried to keep up with my daily hill walks, supplemented with exercise bike and treadmill workouts, but it was just so difficult. I mean it’s always difficult – it’s exercise, it doesn’t work if it’s easy – but something just felt off. It was me, I was the problem, it’s me.

By spring I was thoroughly fed up with the way my body wouldn’t work anything like it had done in previous years. I just didn’t have the energy, no matter what vitamins and supplements I took, no matter how healthy the food in my diet. I was unusually hot all the time, with flashes of intense heat when I felt like I was literally melting. My anxiety levels were through the roof too, and I was barely sleeping – the insomnia was crippling. It was time to go to the doctor.

Asking For Help

Eventually, after the usual struggle of getting a GP appointment (a problem plaguing the UK right now; I won’t get into the politics of it), I managed to sit down with a doctor and hand over the list of symptoms I’d noticed since the start of the year and noted down. Somewhat shamefully, but hopefully understandably, I’d even taken my husband with me in case I was unlucky enough to be seen by a doctor who just wouldn’t believe me at all – perhaps even writing me off as a hysterical middle-aged woman (another perimenopause symptom? Probably).

The doctor considered what I had to say, even though I was struggling to get most of it out through emotional sobs. I was that much of a wreck that dwelling on just how different I felt compared to previous years was incredibly upsetting. She said I was young to be entering perimeno (I’m 42), and that in any case she wasn’t able to give a diagnosis of perimenopause without a blood test to confirm my hormone levels had dipped. I explained that I started my periods quite young, when I was 10 years old – she just nodded doubtfully.

By the way, I’ve since found out that you do not need a blood test in order to be diagnosed as in perimenopause, and unless the blood is taken within a narrow window during the month they are pretty useless at determining whether you’re in this phase anyway.

Unaware of all this and trusting the doctor at this point, I duly went back to the surgery the next day for my appointment with the nurse who would take my blood and send it to be checked. This was just before my husband and I headed off for our first anniversary weekend, in August. I had been having hot flushes, crying every day (sometimes multiple times), feeling deeply and worryingly depressed for no apparent reason, my periods were all over the place and I had no energy or motivation. The terrible anxiety-induced insomnia continued, which only served to exacerbate the other symptoms through the day. My libido had fallen through the floor and I had other signs of hormonal changes/perimenopause such as an overly dry vagina – a problem I’d never before experienced in my life. YES vaginal moisturiser is fantastic for combatting intimate dryness but I needed to treat the cause of it, not just the symptoms.

Symptoms

From my ‘symptoms list’ note I took to the doctor:

• Total lack of energy
• No motivation
• Erratic moods – somewhat positive, then total crash – crying every day
• Times of numbness, or sadness, or severe depression
• Hormonal hunger, leading to weight gain
• Irregular periods
• Loss of libido, dry vagina
• General growing aches and pains, plus dizzy spells
• Regular insomnia, requiring sleeping tablets often
• Can’t see the point in anything anymore, or look forward to anything, or enjoy anything properly
• Terrible headaches, migraines even sometimes

Being Dismissed

Thinking I’d hear back from the surgery soon about my results, I was surprised to have to chase them up some weeks later. Yes, weeks. I was told in no uncertain terms by the receptionist that my blood results were ‘all normal, so no further action’ before she promptly hung up on me. This was obviously very upsetting, but after reading many women’s horror stories surrounding being believed about perimenopause, not being trusted about their own bodies and the struggle to get diagnosed and treated, it wasn’t all that surprising.

I struggled on, thinking that perhaps it was all just a case of ‘the blues’, that the hot flushes were just a sign of getting older, as well as the hot summer weather, and that my periods were just irregular due to age as well… but isn’t that part of what perimenopause is? As a woman gets older, hits middle-age and approaches the usual menopause time, there has to be a number of years beforehand where she is in the perimenopause stage… I kept coming back to perimeno as the only possible cause of my plentiful symptoms.

Reaching Out For Help, Again

The last straw came at the start of October, when, despite showering at least once and sometimes twice daily (ugh, hot flushes, plus I was trying to exercise when I could) I was struck with a fungal skin infection. It affected all my creases and folds and made me feel absolutely hideous, as well as it being painful and itchy and weepy and stinky. On top of everything else, I just wanted to hide away, curl up and die. And some days, I meant that literally. Hurting myself was regularly crossing my mind, and I’d thought self-harm had been long since relegated to my distant past. This wasn’t like me at all, none of it was. I felt like a different person, trapped in a horrible, misbehaving body which could turn on me any day with its infections and random periods and more.

I made another appointment to see the doctor. A different one, this time.

By this point it was early November and I’d started with my symptoms in January/February time. I’d suffered all year. Despite reaching out for help and treatment in spring/summer, I had not been trusted to know my own body, my lived experience wasn’t acknowledged and I had received nothing but a snippy dismissal.

Being Prescribed HRT (Finally)

Happily, and I will never take for granted how lucky I was in this regard, this different doctor believed me at once. I broke down in tears once again as I explained what I had been suffering with all year -and now this fungal skin infection on top, which was undoubtedly caused by my changing hormone levels. No blood test was necessary, I just ticked boxes on a paper form she handed to me, had my weight and blood pressure checked and she prescribed me a beginner course of HRT (hormone replacement therapy) then and there. I could have cried with relief… Actually, I did. A lot.

I’d been prescribed Evorel 25 patches (oestrogen) and Ultrogestan 100mg tablets (progesterone) to take alongside wearing the patches. I was told that the progesterone is required in order to minimise increased risks of womb/ovarian cancer. I was offered the Mirena IUD (contraceptive coil) which would negate the need to take the progesterone tablets, and act as the required contraception – HRT offers no contraceptive benefits so you need to make sure you’re still protected when having sex. However, I didn’t want to have the contraceptive coil fitted, and in any case I already have the Nexplanon contraceptive implant in my arm. There are no contra-indications from still having the contraceptive implant and taking the HRT.

I was warned that it would be some time, weeks possibly months, before I saw any improvement from the HRT. I understood that, having done plenty of my own research over the past year and watching helpful relevant TV programmes such as the two-part Davina McCall menopause documentary (absolutely brilliant, strongly recommended).

My fungal skin infection thankfully cleared up in time, although it took several weeks and several cans of Daktarin along with the HRT. (Daktarin spray is bloody amazing by the way; if you’re ever in a similar position with a fungal skin infection, or athlete’s foot, this is the one to get. And I tried all sorts of creams and other sprays – none were as instantly calming/effective.)

Just the fact of being believed, as well as being prescribed HRT which I knew I needed, had a positive effect on me. At last someone had believed me, had trusted that I knew my own body and didn’t write me off as simply overly-emotional or throw anti-depressants and Valium at the problem. The HRT took some weeks to ‘kick in’ chemically, as I’d been warned, but just having them and using them made me feel better in myself. I was on the road back to myself, the me I had been before 2022, a balanced, happy, energetic and motivated me.

How It’s Going: 2023

It’s now March 2023 and I have been back to the doctor again since that life-changing visit last November. Once was to get my cervical smear test done as it was due (all clear, thankfully) and then to get another prescription of HRT. Although I could see improvements from being on HRT, the doctor and I discussed just how improved I felt, in mood and energy and all things, and we agreed that increasing the dosage would be beneficial.

My original prescription was for:

Evorel 25 patches (oestrogen) – these patches contain 1.6mg estradiol (oestrogen) in total, with 25mcg released through the skin daily. The patches need to be replaced twice weekly, three days apart, and I change mine on Wednesday and Saturdays. I was recommended to wear them on my thighs, and make sure I alternated which leg I put the patch on each time. I can shower with them on and they remain in place with no issues. After removal there is usually some sticky residue which is easily scrubbed off in the shower.

Ultrogestan 100mg tablets (progesterone) – I take one per day for 25 days, then 3 days without taking a tablet, and repeat. I’ve simply added them to my daily vitamins and supplements and set phone reminders to let me know when I don’t take a progesterone tablet for the 3 days in the month cycle.

After my cervical smear test came back clear and the doctor was able to re-prescribe my HRT, and with an increased dosage, I was given the same progresterone tablets but Evorel 50 patches.

Evorel 50 patches contain 3.2mg estradiol per patch, which 50mcg released through the skin daily. The patches are slightly bigger, but again, absolutely no problems with wear or changing them twice a week as per my routine with the Evorel 25s.

As well as HRT, I have been taking daily vitamins and supplements in case they help. It seemed that every time I talked to my women friends about my perimenopause issues they had a new supplement to recommend!

Every day I now take:

Centrum A-Z vitamin, Vitamin B (I take this extra vitamin as I have a gluten free diet therefore I need this supplementing), Vitamin D, evening primrose oil, cod liver oil and magnesium. As well as my progesterone tablet of course, unless it’s one of the 3 days per month I’m not supposed to take it.

Although the HRT has had an obvious and striking positive effect on me, I am not back to my pre-2022 self yet and I expect it to take some time. Although HRT is a huge help, it’s not a ‘cure all’ for perimenopause and I still feel various symptoms. However, my mood has been lifted and I’m no longer depressed, dangerously or otherwise, which is a massive relief. I have the motivation to get up every day, and I rarely cry at all now. My libido is slowly coming back, and my dry intimate region is getting back to normal.

How It Makes Me Feel

It is difficult dealing with aging in any case, and for people who go through perimenopause and menopause, the brutal and unrelenting signs that your fertile time is coming to an end can be difficult to adapt to mentally as well as all the physical stuff. I didn’t want any more children, but when you have that choice taken out of your hands, and you are faced with the fact that you’re rapidly approaching a time when children are no longer an option, that’s hard. I recognise my privilege as a woman who was able to, and has had, children – so many people are not able to have children who want them dearly, including close friends of mine. Other people don’t want to have children, therefore choose not to, and that’s obviously brilliant too – it’s their life choice. I can only relay my experiences and feelings, and I found that being suddenly faced with the ‘ability to have children’ door being steadily but firmly closed in my face rather hard to come to terms with.

It’s like choosing to enjoy time on your own in a room, with no desire to leave because it’s a nice room and you have plenty to enjoy and occupy your time in your room – until someone locks the door from the other side. The mood invariably shifts.

How does perimenopause make me feel? Not so good, to be honest. Even though I’m being helped immeasurably by the HRT treatment, which I can’t recommend strongly enough if you’re in the same position (& you’re lucky enough to be able to get to a GP, then be believed and then be prescribed), I still suffer various thoughts and emotions relating to this new phase of my life. It makes me feel unsexy, unfit and old. I’m unsettled, sore and tired – sooo tired, all the time. The fatigue is something else. Of course all of the above leads me to being (even more) grumpy.

I can only exercise on the good days, and when I’m not suffering with hot flushes too badly otherwise I’m worried I’ll trigger the fungal skin infection again. Partly because of all this emotional and hormonal turmoil, and partly because I’ve been comfort eating everything in sight for the past year, I’ve put on plenty of weight which doesn’t seem to want to go anywhere. I don’t drink any alcohol – it has no benefits and just makes all my symptoms worse, so I’ve given it up completely. I’m learning to live with this new me, it’s teaching me patience and humility and what my real priorities are in life.

My prescription is on repeat for the next nine months and I can only hope I improve further as the months go by. It is a slow process and a large part of the patience I’m learning is being directed towards myself.

We Need Education, Support, Treatment & to be BELIEVED

Perimenopause is a woefully and shamefully mysterious phase of a woman’s life, even now in the 21^st century when you’d think education about psychological and physical health issues would be at an all-time, taboo-free high. Even as a sex blogger and educator of many years, I was unprepared for my own perimenopause and devastated by not being trusted or believed when I finally summoned the strength and courage to reach out for support and treatment.

I am currently reading The New Hot by Meg Matthews, and Menopausing by Davina McCall, and will review them both here on the blog in due course. You can get more information about perimenopause, symptoms and treatment on the NHS website in the UK, or at menopause.org.

If you think you might be in the same or similar position, you have all my sympathy. I really hope that you can get the compassionate listening ear, the support and the treatment you need. Getting help and HRT during perimenopause is so often a fight for women, and at a time when we’re so severely drained of energy and motivation. I deeply hope that by sharing my personal experiences in this feature, you now at least feel like you’re not alone in your suffering and struggles.

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