As midlife specialist Jo Ibbott takes over the menopause column, she unpacks the confusion around this significant life event 

As I go into workplaces and talk to people about menopause men are often surprised that women have no idea what is going on for them! The trouble is, we have been left woefully in the dark about this significant life stage. At school we were taught about periods and pregnancy but menopause was never mentioned. Our mothers didn’t talk about it, or, if they did, they told us they ‘sailed’ through it. Menopause isn’t part of the curriculum at medical school so many doctors don’t receive the training they need either. There’s a huge understanding gap, one major result of which is one in ten women leave the workforce due to symptoms and the consequent impact on their emotional, psychological and financial wellbeing. Workplaces are suffering too, as they are losing skilled, talented, experienced women and having to re-recruit and replace, all of which is costly. 

Feeling confused

Tasha enjoyed her job and felt fulfilled in her career. She knew she was good at it and she felt confident and capable within it. 

Until one day she didn’t.

Tasha started to feel overwhelmed: her anxiety was rising, she felt her brain wasn’t functioning in the way it once had, her self-confidence began to wane and she just wasn’t coping.

She had no idea what was going on. She thought that perhaps this was just how things were going to be as she was getting older (she was 43). These symptoms impacted her choice of job; where once she’d be project managing, she was now taking on administrative roles with less responsibility. Where once she was employed full-time on a permanent contract, she was now opting for part-time, shorter contracts because she just didn’t have the energy or capacity for anything else. 

Tasha didn’t understand what was going on. She was confused, low, struggling emotionally, wondering why this was happening and what she could do about it. Enter perimenopause! Tasha was suffering from something I call symptom creep. This is the often undermining, gradual impact of hormonal decline that accompanies mid-life for every woman. It also impacts one in a hundred younger women (under 40 years of age) who suffer premature ovarian insufficiency (POI) which is when a women’s ovaries stop working normally before the age of 40. 

What was going on? 

Tasha’s symptoms can be explained by looking at what perimenopause and menopause are and why they happen.

Perimenopause refers to the years leading up to menopause. Menopause is just one day –twelve months after the day of a woman’s last period. Following that, a woman is considered to be post-menopausal, which isn’t without its challenges! It’s perimenopause, though, that can cause all the trouble and deserves our attention and understanding. 

Perimenopause begins when our ovaries start to run out of eggs, as the levels of associated hormones, oestrogen and progesterone, begin to fluctuate and decline. Women have hormone receptors all over our bodies, which is why we can be affected by physical, cognitive and psychological symptoms associated with the fluctuations and decline. Effectively, all the systems in our bodies that have relied on these hormones start to feel their absence; it’s a significant health event. 

The average age for a woman to start going through perimenopause is 45–55 in the UK. Black and Asian women may well begin a few years earlier and reach menopause earlier. 

All the systems in our bodies that have relied on these hormones start to feel their absence

Not everyone will be affected by this decline in hormones; approximately one in four women have no symptoms at all. Some have symptoms for a few months, others for years. The average time span for menopause symptoms is between four and eight years. 

This experience is unique for every woman. Tasha’s experience is different to mine, which will be different to yours. This is what can make it confusing and overwhelming. 

Having said that, Tasha’s experience of self-confidence declining, feeling she’s falling off a career cliff, questioning her capability, struggling to hold it together emotionally is all too common. 

When I met Tasha, she said to me that perhaps if there had been a poster on the back of the toilet door at work explaining the symptoms of perimenopause she might have realised it was perimenopause and not her, and might not have left her job. Tasha now has the right support from her GP and an understanding of the things she needs to be doing to keep healthy and well in the face of this hormonal decline. 

It wasn’t her; it was perimenopause.

The need for education

The pain and struggle for many women is real. The impact on mental health and wellbeing is real. The lack of education and understanding about perimenopause only serves to perpetuate misunderstanding and taboo, so workplaces, churches and communities need to start getting positively curious about it. 

Perimenopause can feel like a thief, stealing our confidence and sense of self. This is not God’s best for women. Jesus promised life in all its fullness (John 10:10). Perimenopause doesn’t have to mean loss and destruction of what has gone before. With better understanding and the right help and support it can bring freedom and opportunity, leading us into a life where we are more awake to ourselves, our purpose and our faith. 

It’s not you, it’s perimenopause. Don’t suffer in silence; don’t be undermined.