The Menopause Trailer: The right doctor to consult, and all that women should know

'Perimenopause is the annoying sequel of puberty, and the dramatic trailer of menopause,' goes a meme on social media about this difficult transition period women go through. Most people know that menopause happens when a menstruating person doesn't bleed for 12 months. Well, perimenopause is the phase that leads up to it, lasting months or even years.

This Menopause Awareness Month, Dr Namitha Susan Joseph, a reproductive medicine and menopause expert based in Kochi, explains what women should understand about perimenopause, menopause, their symptoms and supportive therapies.

Perimenopause and menopause
Menopause is when a woman has gone without her monthly menstrual period for 12 consecutive months. During this phase, their ovaries stop releasing eggs and also almost stop producing the hormones progesterone and estrogen, which regulate the menstrual cycle, pregnancy and overall health.

Meanwhile, perimenopause is the phase that leads up to the final menstrual period. It can last between 6 months and 10 years. At this stage, our brain is in a confused state due to the fluctuations in estrogen levels in our body. The egg supply in a woman would be quite low, and the quality would be declining at this stage.

In the Western world, the average age of menopause is 52. However, in India, it is around 46. This means that perimenopause can also start much earlier, often in the mid-30s. If a woman has a cyst, tumour or hysterectomy, it can start even earlier.

Can they be detected through blood tests?
Perimenopause can't be detected through blood tests, as hormone levels can fluctuate widely in this period. However, menopause can generally be diagnosed through blood tests, which measure the levels of follicle-stimulating hormone (FSH) to determine the same. A high level of FSH can be an indication of menopause.

Symptoms of perimenopause
It is said that perimenopause has numerous symptoms. However, doctors do a 'diagnosis by exclusion' for perimenopause, which means that they rule out other medical conditions through tests before taking a symptom as the one for perimenopause. Regardless, here are a few symptoms which can indicate perimenopause:
a) Hot flashes
b) Severe mood swings
c) Extreme sadness and anger
d) Short-temperedness with dear and near
e) Not feeling like oneself
f) Crying for no reason
g) Recurrent Urinary Tract Infection
h) Vaginal dryness
i) Itching in the ears
j) Skin dryness
h) Sudden weight gain

The right doctor to consult
Thanks to the confusing symptoms and lack of awareness, people approach a wide range of doctors ranging from psychiatrists to gynaecologists for help when they sense perimenopause symptoms. However, it is always better to approach an expert who specifically specialises in menopause for better results. There are very few menopause experts or clinics in Kerala; however, for proper help, it's better to approach the subject matter experts.

Menopause: Is help available?
Yes. The treatment used to handle the fluctuating hormones of menopause is called Hormone Replacement Therapy (HRT) or menopause hormone therapy. Though the treatment was abruptly stopped in 2002 after a study mistakenly linked it to breast cancer risks, it was re-examined in 2022 and assessed as safe.

Unlike in the past, bioidentical estrogen and progesterone that match the natural hormones are prescribed in modern HRT. They have no side effects. However, a person should always consult a doctor before starting HRT so that the medicines prescribed are tailored to their unique requirements, after assessing their health and medical risks.