Learning About Perimenopause
- ‘The X-Files’ actress Gillian Anderson felt as if she was “losing” her mind amid perimenopause, the hormonal transition prior to menopause, and hopes her story will inspire others to understand the symptoms that come along with the body transition.
- According to the North American Menopause Society (NAMS), “the gradual transition between the reproductive years and menopause (the cessation of menstrual periods) is called perimenopause (literally meaning around menopause”).
- “It is generally a transition that is many years long and can be associated with shorter menstrual intervals, irregular menses, night sweats, and other symptoms. In some women, these symptoms are troublesome enough to need medical intervention.”
- As women age and their bodies go through changes, it’s important to understand the cancer risks that may arise and the critical screenings that need to be done. Know Your Screening Tests: Pap smears, annual mammograms, and colonoscopies are all key for women as they enter menopause and cancer risk increases.
- Anxiety symptoms include feelings of irritability, fatigue, and nervousness. People struggling with anxiety also have trouble sleeping, difficulty concentrating, and rapid heart rate which leads to hyperventilation. Therapy and medication are the two most recommended forms of treatment for individuals with anxiety, and treatments vary depending on the type of anxiety an individual has.
Speaking in an earlier interview with Lenny Letter, prior to releasing her book “We: Manifesto for Women Everywhere,” the 55-year-old mom of two opened up about how perimenopause affected her brain.
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Anderson looked back on her struggle to understand what was going on with her body and how she sought help from various types of doctors, all with different opinions.
“I was used to being able to balance a lot of things, and all of a sudden I felt like I could handle nothing. I felt completely overwhelmed,” she said.
“When I talked to the menopause specialist, she said that she often gets phone calls from female CEOs screaming down the phone, ‘I need help now! I am losing my mind!’ And that’s completely right. I felt like somebody else had taken over my brain.'”
Anderson complained about there not being enough clear information about perimenopause and it’s effect on mental health, like “anxiety, depression, mood swings, hot flashes, night sweats, and fatigue.”
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She continued, “How wonderful would it be if we could get to a place where we are able to have these conversations openly and without shame.
“Admit, freely, that this is what’s going on. So we don’t feel like we’re going mad or insane or alone in any of the symptoms we are having.”
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Anderson then referred to how Angelina Jolie, an Academy Award-winning actress and mother of six, previously had her breasts and ovaries removed after learning she had the BRCA1 gene, which greatly increases her risk of developing breast and ovarian cancer. She decided to undergo surgery after her mom Marcheline Bertrand passed away in 2007 after battling breast and ovarian cancers.
She explained, “When Angelina Jolie made the very, very courageous decision to have both her breasts and her ovaries removed because of genetically being at risk for breast and ovarian cancer, many of the comments (aside from admiration for her decision to go public with a very private matter) were around the concern that it might throw her into early menopause.”
“Then she became vocal about being in menopause and pushed back against the narrative that aging is bad. It’s a step that more of us in the public eye need to take in order to shake the shame around it,” Anderson concluded.
“Perimenopause and menopause should be treated as the rites of passage that they are. If not celebrated, then at least accepted and acknowledged and honored.”
Understanding Perimenopause
According to the North American Menopause Society (NAMS), “the gradual transition between the reproductive years and menopause (the cessation of menstrual periods) is called perimenopause (literally meaning around menopause”).
“It is generally a transition that is many years long and can be associated with shorter menstrual intervals, irregular menses, night sweats, and other symptoms. In some women, these symptoms are troublesome enough to need medical intervention.”
Meanwhile, when menopause (whether natural or induced) occurs when a woman is 40 years old or younger, it’s dubbed as premature menopause.
“This occurs in about 1% of women in the United States,” the NAMS explains. “Premature menopause that is not induced can be genetic, metabolic, autoimmune, or the result of other poorly understood conditions. Premature menopause should be evaluated thoroughly.”
The Difference Between Menopause and Early Menopause
Menopause is described by the National Institute on Aging, as “a point in time 12 months after a woman’s last period.” Additionally, “The years leading up to that point, when women may have changes in their monthly cycles, hot flashes, or other symptoms, are called the menopausal transition or perimenopause.”
The average age women go through the menopausal transition, which usually lasts approximately seven to 14 years, ranges between ages 45 and 55.
“The duration can depend on lifestyle factors such as smoking, age it begins, and race and ethnicity,” the institute explains. “The menopausal transition affects each woman uniquely and in various ways. The body begins to use energy differently, fat cells change, and women may gain weight more easily. You may experience changes in your bone or heart health, your body shape and composition, or your physical function.”
As for early menopause, the National Cancer Institute says it’s a condition which causes the ovaries to stop working and menstrual periods to stop before a woman turns 40. It’s a transition that can lead to fertility issues and symptoms of menopause.
Additionally, early menopause is split up into two types, primary and secondary. According to the National Cancer Institute, “There are two types of early menopause, primary and secondary. Primary early menopause means that the ovaries do not function normally. This may be because they have been removed by surgery, or it may be caused by some cancer treatments and certain diseases or genetic conditions.
“In secondary early menopause, the ovaries are normal but there is a problem getting hormone signals to them from the brain. This is usually caused by diseases of the pituitary gland or hypothalamus. Some women with early menopause sometimes have menstrual periods and may be able to have children. Also called ovarian failure, ovarian insufficiency, and premature menopause.”
Early Menopause Affects Cancer Risk
Luckily, a woman’s risk for breast cancer is reduced if she went through early menopause.
In an earlier interview with The University of Texas MD Anderson Cancer Center, Dr. Therese Bevers, M.D., medical director of MD Anderson’s Cancer Prevention Center, offered some insight into the link between menopause and how it affects a woman’s cancer risk.
Dr. Bevers told Survivor Net that menopause doesn’t cause cancer, however, as women get older, their risk of developing cancer rises.
“Starting menopause after age 55 increases a woman’s risk of breast cancer and endometrial cancer. That’s probably because she’s been exposed to more estrogen,” Dr. Bevers explained. “During a woman’s menstrual cycle, estrogen stimulates the uterus and breast tissue. So the more menstrual periods a woman has, the longer these tissues are exposed to estrogen.”
She noted that women who begin the menopausal transition at a later age “also may have an increased risk of ovarian cancer, possibly because they have had more ovulations.”
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Dr. Bevers also suggested women try safer alternatives when coping with menopausal symptoms, instead of first trying hormonal therapy, as it’s been associated with an increased risk of certain cancers.
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She advises women to make “small lifestyle changes,” to reduce symptoms, like avoiding coffee before showering can make a big difference.
Other safe and health ways to manage symptoms, according to Dr. Bevers, include:
- Exercising regularly
- Reducing stress
- Getting enough sleep
- Avoiding hot flash triggers like coffee, tea and alcohol
- Quitting smoking
“The same ways you reduce your cancer risk before menopause: exercise, eat a healthy diet, don’t smoke and avoid secondhand smoke, and maintain a healthy body weight,” Dr. Bevers added. “Research shows that gaining weight after menopause increases a woman’s risk of breast cancer, but losing weight after menopause can actually reduce your risk.”
Your risk for breast cancer comes from a variety of potential places. Some of these are risk factors you simply can’t change. Others you can impact by modifying your behaviors and that’s good news for people who want to take an active role in their personal risk reduction.
“Common causes include genetic predispositions, such as BRCA mutations or other mutations that cause breast cancer,” Dr. Sarah Cate, assistant professor of surgery Icahn School of Medicine at Mount Sinai, told SurvivorNet in an earlier interview. “Other causes are family history, obesity, radiation to the chest like is used in Hodgkin’s lymphoma, alcohol use, never having children, and certain types of abnormal breast biopsies.”
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These are factors we can’t control, but “what we can control are factors like diet and exercise, as well as alcohol,” Dr. Cate explains.
How To Manage Anxiety During High-Stress Times
Battling a mental health issue, symptoms associated with perimenopause, cancer, or learning to move forward after treatment can be an extremely stressful time for so many people. How can you manage your anxiety while dealing with so many other things?
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Dr. Marianna Strongin, a clinical psychologist and founder of Strong In Therapy, has been helping the SurvivorNet community by sharing coping mechanisms and a structured way to think about handling these issues.
“The way that I define anxiety is that it’s an internal question that we simply can’t find the answers to,” Dr. Strongin previously toldSurvivorNet.
Dr. Strongin says that one of the main causes of anxiety is uncertainty about life, and a cancer battle can fuel anxiety for individuals because of the lack of uncertainty about the future.
Many people will turn to media platforms for answers, but Dr. Strongin says that individuals often end up with more questions as a result which leads to more anxiety.
The first step for coping during stressful circumstances is understanding one’s anxiety. To do this, Dr. Strongin suggests checking in with oneself everyday to see where the anxiety is manifesting and what questions are causing the anxiety. From there, it’s important to answer those questions and reassure oneself with positivity.
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“The answers are our coping skills,” Dr. Strongin says. “Some people are really good at always giving themselves answers…other people don’t have the coping skills to answer their anxiety and as a result the anxiety increases. … We are all facing the same questions.”
She continues, “Some are facing them much more than others and some are better at answering those questions than others. What’s really important is to pay attention to is what those questions are, what the frequency of those questions are, and how you’re answering them.”
Anxiety In The United States
According to the Anxiety Depression Association of America (ADAA), anxiety disorders are the most common mental illnesses in the United States, affecting nearly 40 million adults 18 years and older. Anxiety can be developed through factors including genetics, personality, brain chemistry, and life circumstances. Despite being highly treatable, only 43.2% of people receive treatment for anxiety disorders.
Anxiety symptoms include feelings of irritability, fatigue, and nervousness. People struggling with anxiety also have trouble sleeping, difficulty concentrating, and rapid heart rate which leads to hyperventilation.
Therapy and medication are the two most recommended forms of treatment for individuals with anxiety, and treatments vary depending on the type of anxiety an individual has.
Mental Health: The Basics
The term mental health refers to both our emotional and psychological well-being. Our mental health can affect how we think, feel, and behave. Certain triggers like stress, traumatic events, or change in your physical health can affect mental health. It’s really important to keep tabs on your mental health and, if necessary, seek treatment. This doesn’t necessarily mean traditional therapy because while it may be really helpful (even life-changing) for some, that doesn’t mean it’s for everyone.
Problems with mood and overall mental well-being can be attributed to several factors. For some people it’s genetic, while others may be experiencing a response to some sort of stressor or past trauma.
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In order to keep your mental health in check, it’s important to be aware of signs which can be subtle that there is something affecting your mind. These signs include:
- A change in eating or sleeping habits
- Losing interest in people or usual activities
- Experiencing little or no energy
- Numb and/or hopeless feelings
- Turning to drinking or drugs more than usual
- Non-typical angry, upset, or on-edge feelings
- Yelling/fighting with loved ones
- Experiencing mood swings
- Intrusive thoughts
- Trouble getting through daily tasks
These symptoms can be wide-ranging and vary a great deal from person to person. Everyone experiences grief differently, for example.
However, if you are feeling unusually sad, on-edge, or like you’re no longer interested in activities you used to love, know that there are many treatment options available and many different healthy ways to help you cope.
Advocating for Yourself
We’re delighted to see Anderson talking about the changes her body is going through, even if it’s normal. However, when something seems off with your body, it’s always important to speak up for yourself and advocate for your health.
The Importance of Listening To Your Body
In a previous interview, Dr. Zuri Murrell, a colorectal surgeon at Cedars-Sinai, told SurvivorNet that people should educate themselves, go into their doctor appointment with a plan, and be pushy if necessary.
“It’s important for you to actually educate yourself and be your own health care advocate. And that’s something that I think is really important. You should lead each doctor’s appointment with a plan.”
Be Pushy, Be Your Own Advocate, Don’t Settle
Contributing: SurvivorNet Staff
Learn more about SurvivorNet's rigorous medical review process.