“Today is a good day,” says Sue H. as the espresso drips out of the coffee machine. «Yesterday was difficult. I had a bad headache again and couldn’t think so quickly.”
Sue is actually a humanitarian and likes to be in company. But the headaches regularly thwart her plans. Just like the brain fog that keeps coming back. A pressure on her forehead and eyes, she explains as she sits down at the dining table with her coffee: “It then feels like the flu. I see everything as if through a curtain.”
It started after the second pregnancy
This brain fog and headache are two of many complaints that crept into Sue H.’s life after her second pregnancy. She was 36 at the time.
Legend: In the transition phase to menopause, various symptoms can occur, including sleep disorders. Colourbox
“It’s the hormones!”
For a long time, Sue H. thought it was the stress: the small children, the job as a high school teacher. She also thought about menopause, but quickly got over it. Her menstruation was still regular, she says – but different: “I suddenly had extremely heavy menstruation, accompanied by severe abdominal pain. And I suddenly felt ovulation very clearly.”
The family doctor did a complete blood count twice and a CT scan of the head – everything was normal. Four years after the first complaints – shortly before the lockdown – everything became too much: Sue H. was on the verge of burnout and took sick leave. Then she came across an article about menopause and realized: “It’s the hormones!”
Menopausal symptoms before 40?
“Sue is not an isolated case,” says Susanna Weidlinger, senior physician in the menopause center at the Inselspital Bern. “Many of these women come to me.” And by that she means women between premenopause and perimenopause, i.e. in the transition phase to menopause.
Explanation of terms: premenopause, perimenopause and menopause
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Die Premenopause refers to the woman’s fertile years since her first menstruation. At the end of premenopause – from your mid-30s – the first of the two sex hormones begins to decline: progesterone.
Die Perimenopause is another name for menopause. It begins on average at the age of 45 with the decreasing concentration of the other sex hormone estrogen.
Die Menopause is a woman’s very last menstrual period. This means that this period only lasts a few days. The average Swiss woman goes through menopause at age 52. After that, she no longer produces sex hormones more.
In addition to headaches and sleep disorders, bloating, joint pain, breast tenderness, spotting, discouragement, aggressiveness or mood swings can also occur during this transition phase. These are all symptoms that can worsen later during perimenopause, i.e. menopause.
Progesterone begins to decline in your mid-30s
The cause of these symptoms: From the mid-30s onwards, the hormone progesterone begins to decline. Progesterone ensures that the uterine lining becomes soft and a fertilized egg can implant better.
For a long time, progesterone was only considered a pregnancy or menstrual hormone. “We now know that progesterone also has an anxiety-relieving, relaxing, pain-relieving and sleep-promoting effect,” explains the gynecologist, who specializes in hormones.
Susanna Weidlinger
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Legend: Inselspital Bern
Susanna Weidlinger is a senior physician in the Menopause Center at the Inselspital Bern and President of the Swiss Society for Gynecological Endocrinology, Contraception and Menopause (SGEM).
So when progesterone begins to decline in your mid-30s, an imbalance arises between the two sex hormones, which act as antagonists. In technical language there is talk of a relative progesterone deficiency and a simultaneous estrogen dominance.
Menopause at different times
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There are other reasons why menopausal symptoms may start earlier.
The average Swiss woman reaches menopause at 52. However, 10 percent of women have their menopause between the ages of 40 and 45. That’s what it’s called early menopause.
One percent of women experience menopause before the age of 40. This will be as premature menopause designated. Both conditions require diagnosis and treatment.
There is no official name for the period just before menopause. Some use “In Between”. Others use the term “premenopause”. For others, like Susanna Weidlinger, this represents the fertile years since the first menstruation.
What the “In Between” women have in common
The “In Between” women have one thing in common: they all still menstruate regularly. But like Sue H., this period changes: it can become stronger or weaker or shorter or longer than before.
Susanna Weidlinger cannot say how many women feel this “in between” phase as strongly as Sue H. does. There are no numbers on this. And she is not aware of any research specifically on this transition phase.
What kind of therapies are there?
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Susanna Weidlinger says the most effective are individual hormone replacement therapy and a healthy lifestyle. But herbal remedies could also help, such as black cohosh. Or cognitive behavioral therapy. This helps to be able to deal with the symptoms better mentally.
After examinations by her family doctor revealed no abnormalities, Sue H. made an appointment with her gynecologist. “He said I was too young to have menopausal symptoms when I told him about my suspicions. These symptoms are normal for late-term births, he said, and I have to come to terms with them.
Many doctors are not aware of this transition phase. The patients are sent to sleep laboratories, to rheumatologists, psychiatrists or for dementia evaluation.
Only after three attempts and a husband who came to an appointment and described his wife’s symptoms from his perspective did the gynecologist give in and prescribe hormone replacement therapy.
“I often hear that from my patients,” explains gynecologist Susanna Weidlinger. “Many doctors are not aware of this transition phase. You send the patients to sleep laboratories, to rheumatologists, psychiatrists or for dementia evaluation, but don’t think about menopause.”
Difficult diagnosis
How can that be? Susanna Weidlinger has three possible explanations. Firstly, the diagnosis of this transition phase is actually difficult to make. Because women still menstruate regularly. And the imbalance between estrogen and progesterone can hardly be detected in the blood.
Legend: Pressure on the forehead and eyes: Headaches and brain fog are symptoms between premenopause and perimenopause that can worsen later. iStock/Tunatura
This point also includes the fact that many women suffer from multiple stresses in this phase of life. You are starting out in your job, have small or pubescent children or those who are just moving out. Maybe the parents get sick and the man has a midlife crisis. “Not all problems can be traced back to the menopause,” says Susanna Weidlinger, “but some of them can.”
Overcrowded menopause centers
Secondly, consultations are poorly compensated. “A maximum of twenty minutes can be billed for a normal medical consultation. This includes the pre- and post-processing, the greeting and the farewell. There is hardly any time left for a detailed discussion about what would be needed for the diagnosis.
For a long time, menopause was neglected in medical studies. Fortunately, that has now changed.
There are special menopause centers like the one at the Inselspital Bern, where Susanna Weidlinger works. There are 60 minutes available for an initial consultation. But: “We currently have a waiting period of twelve months for initial consultations.”
Susanna Weidlinger suspects there is a third reason why many female doctors do not have this transition phase on their radar: “For a long time, menopause was neglected in medical studies. Fortunately, that has now changed.”
Role models are missing
It took many years before Sue H. was prescribed therapy for her early menopausal symptoms. “I would have been so happy if I had checked immediately what was wrong with me,” says the now 44-year-old. “I would have been spared a lot.”
She emphasizes that she was missing role models – women who openly talk about their menopause-related problems. “I hope that in a few years my daughter will experience things differently and know what could happen to her.”
