Is this perimenopause? The symptoms nobody connects to hormones

You are forty-two and it feels as though your body is falling apart one piece at a time.

In January it was a shoulder that stopped moving properly overnight. In spring came the insomnia. In summer, over coffee, you could not retrieve a word you have used for twenty years. And somewhere along the way a particular anxiety settled in, the kind that arrives at quarter past four in the morning for no reason at all.

You have been to an orthopaedist, a GP and perhaps a cardiologist. Each found something small or found nothing. And none of them asked the one question that would have tied it all together.

Perimenopause is not menopause

This is the first stumbling block. Say menopause and most people picture hot flushes, a woman of fifty-five and the end of something.

But menopause is a single day. It is the date of your last period, and it can only be identified in hindsight, after twelve months without bleeding. Everything interesting happens before it, and that stretch is called perimenopause. It lasts four to eight years on average and often begins soon after forty, in some women earlier.

Which means a woman with a reasonably regular cycle and five years still to go can already have the full programme of symptoms. And nobody, herself included, makes the connection, because after all she is still menstruating.

It does not start with hot flushes

For a large share of women, hot flushes are the second or third thing to arrive. The first tends to look like an entirely different problem.

• Sleep. You fall asleep fine, then wake between two and four and cannot get back.
• Anxiety and irritability. You react in ways you do not recognise in yourself.
• Heart palpitations. Often at night, often alongside the waking.
• Joints and tendons. Morning stiffness, aching hands, and in some women a frozen shoulder, which shows up strikingly often at this age.
• Brain fog. Words going missing, poorer concentration, the sense of cotton wool in your head.
• Your cycle. Not necessarily further apart. Often shorter, heavier and unpredictable.
• Small things nobody thinks of. Dry eyes, ringing in the ears, skin changes, different migraines, more frequent urinary trouble.

None of these on its own means perimenopause. Three or four of them at once in a woman over forty are worth a question.

Why nobody connects it

Because nobody was properly taught it. For a long time peri/menopause was covered in a handful of hours of medical training, and many practices still have neither the time nor the tools for it.

And there is one more trap: blood tests. They look like the logical answer, but in perimenopause hormones swing from one day to the next. A single sample can come back entirely normal and disprove nothing. In this phase the picture rests on the story, not the paperwork.

What to do

The most useful thing you can do today is start writing it down. Date, symptom, intensity. Three months of records are worth a hundred times more to a doctor than the sentence that you have not been feeling well lately.

And then find someone who understands it. That is unfortunately not a given and it takes some looking.

Perimenopause is not an illness to be cured. It is a transition that can be described, and in most cases made considerably easier.

This is information, not a diagnosis. If you recognise yourself in it, it is worth raising with a doctor.

See the programme of upcoming seminars, where we take each of these topics apart in depth. Seminars are held in Czech.