It’s ‘just perimenopause’. It’s a refrain I’m hearing more and more from friends and patients – and it worries me. Many might argue that more women talking about perimenopause is a good thing. Our understanding of this premenopausal condition – in which levels of female sex hormones begin to fluctuate, causing menstruation to become irregular – has advanced by leaps and bounds in recent decades.
With that greater understanding has come greater awareness – and better treatment – for those experiencing uncomfortable symptoms of perimenopause. There’s a dangerous downside, though: As research on perimenopause has grown, so has the list of possible symptoms.
At the same time, perimenopause has become a big talking point on social media. Self-proclaimed perimenopause “experts” have made entire careers TikTok videos and Instagram posts about the symptoms and treatments.
I’m starting to worry that we’re getting to a point where our obsession with perimenopause means other medical conditions are being missed. These can be psychological problems, such as depression or fear – but they can also be life-threatening.
Take some of the women who recently told me about alleged problems with perimenopause. One reported new vaginal bleeding, another reported pain during urination and one had sudden weight loss.
All of these symptoms can be due to perimenopause, but they can all be signs of it cancer at. Crucially, none of these women had been tested for the deadly disease – or anything else. Instead, they received hormone replacement therapy [HRT].
I fear there are countless women who are wrongly told they are having perimenopause – meaning they are not being treated for the true cause.
So how can you know if your symptoms are related to perimenopause? First, it is important to explain what happens in the body during perimenopause. The condition occurs when the levels of female sex hormones estrogen and progesterone begin to fluctuate. This usually happens when women are in their mid to late 40s.
I fear there are countless women who are wrongly told they are having perimenopause – meaning they are not being treated for the true cause, writes Dr Ellie.
Perimenopause and menopause are often used interchangeably, but they are not the same. Menopause is when sex hormone levels permanently drop and menstruation stops. Although many still experience symptoms after menopause, the most uncomfortable and distressing problems often occur during perimenopause, when sex hormones are at their most erratic.
The most common of these are hot flashes, sleep problems, mood swings and vaginal dryness.
But the list of symptoms of perimenopause has grown. For my recent book, The Little Book of HRT, I added an astonishing 45.
The problem is that doctors assume that every middle-aged woman who develops vague symptoms is experiencing perimenopause. There are so many other explanations. Mental health issues such as sleep problems or brain fog can be due to mental health issues.
Many stressful events happen around this age, such as children leaving home, parents dying or divorcing. The best treatment may not be HRT, but antidepressants.
Urinary problems – such as incontinence and pain during urination – are also considered common symptoms of perimenopause. But these problems are often caused by a urinary tract infection.
I have also seen women with rheumatoid arthritis who have gone untreated for far too long because they were initially told their pain was due to perimenopause.
Most troubling is when women are told that their heavy menstrual bleeding is due to perimenopause and do not undergo further testing.
It’s true that this is one of the most common symptoms of perimenopause, but it can also be a sign of uterine or ovarian cancer and any delay in diagnosis can be fatal.
The only way to know if heavy bleeding is due to cancer is to test for it. The answer is not to give HRT and hope for the best.
When doctors assume that every symptom affecting a woman in her 40s is due to perimenopause, real problems are overlooked – and people get the wrong treatment.
Recurring referrals from general practitioners cause patients to wait too long
I was shocked to read that a quarter of patient referrals to hospital are now rejected and sent back to GPs.
Many of these so-called ‘bounce-backs’ occur – according to the healthcare magazine Pulse – because hospital doctors seek ‘advice and guidance’ from general practitioners before accepting the referral.
Essentially, this means they have questions about the referrals.
However, some GPs say this is leading to long delays for patients who need urgent treatment.
I happen to agree. Often these referrals are for tests for life-threatening conditions, such as heart disease and cancer.
The NHS is already taking too long to diagnose these conditions – we can’t afford to keep patients waiting any longer.
Has your hospital recently refused a referral? Has it affected your health? Write and let me know.
Your questions answered…
I am a fit 65 year old man and I am starting to experience fainting spells. These occur every few weeks and come out of nowhere. What could be the problem?
Dr. Ellie answers: Anyone who faints regularly should see their doctor immediately.
Fainting can be a sign of serious heart disease. The most common heart problem related to this problem is atrial fibrillation – a heart rhythm disorder.
Crucially, there is a particular form called paroxysmal atrial fibrillation, where the heart rhythm is disrupted only occasionally, such as once or twice a month.
When this happens, it can cause fainting. However, the condition can be difficult to diagnose because a standard heart rhythm test may miss these episodes.
For this reason, patients with these symptoms should wear a 72-hour monitor that can detect volatile rhythm changes. This would be applied by a cardiologist in the hospital. Another cause of fainting is low blood pressure, where the heart does not push blood through the body hard enough.
This can cause dizziness, blurred vision, fatigue and fainting. Low blood pressure is often caused by dehydration, certain medications and even getting up too quickly. A GP must be able to carry out a check.
Heart problems are not the only cause of fainting. Two vitamin deficiencies – iron and B12 – are linked to fainting. An iron deficiency is often caused by a lack of red meat, beans, lentils or dark green vegetables. In women it can be caused by heavy periods.
Meanwhile, a B12 deficiency is often due to a vegan or vegetarian diet. This is because the vitamin is only found in animal products.
But before exploring these possibilities, it is crucial that heart problems are ruled out.
