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PERIMENOPAUSE IS A time of increasingly variable hormone levels and irregular ovulation which can result in a change in our menstrual cycle. This hormonal chaos happens, on average, from the age of 45 onwards. However, it can start earlier, for some women. When ovulation (and estrogen production) cease, we call this “postmenopause”.
From puberty onwards, ageing causes a decline in the number of follicles in our ovaries. These follicles contain the small oocytes (eggs) which we release once per month, with ovulation.
As the number of follicles declines, our brain releases a hormone (FSH) which stimulates the ovaries, to promote ovulation and drive ovarian function. This stimulation is often imperfect and creates an erratic, unstable hormonal environment. Oestrogen, a hormone produced by our follicles, swings up and down, from too much to too little.
It continues until the ovaries no longer respond to the brain’s stimulus. They stop ovulating and with that, lose their estrogen production.
This is a challenging question to answer. Our ovaries are tricky little buggers who like to keep us on our toes.
In early perimenopause, the small fluctuations in hormone production may not produce much in the way of symptoms. Remember that your brain is used to a bumpy hormonal landscape – other than during pregnancy or if you are taking the contraceptive pill, hormones fluctuate up and down throughout a normal menstrual cycle. Women may women experience this as “PMS” (premenstrual syndrome).
Increasing hormone variability and inconsistent ovulation will typically result in a change in the menstrual pattern – your periods change. For some women, this means shorter cycles, such as less time between your periods or bleeding. For others, their periods become less frequent.
A persistent difference in cycle length of more than seven days, in consecutive months, is typical of perimenopause.
If you have stretches of 60+ days without a bleed, that would be typical of “late perimenopause”, reflecting that you are further through the menopausal transition and closer to the time of your final period.
There are no blood tests we can do that help figure out “how far” someone is through this process. This is because the hormones fluctuate so much that they can’t be relied upon. There are no over-the-counter tests which will guide you here so don’t be fooled by marketing.
We diagnose perimenopause by listening to the patient – their clinical symptoms and signs. A new persistent change in the menstrual cycle, as above, is one useful indicator.
Some women describe more dramatic PMS-type symptoms; tender breasts, irritability, mood swings, more frequent migraines, low libido, poor sleep and difficulty with finding words or short-term memory.
For some, they may start to experience night sweats, hot flushes or vulvovaginal symptoms such as dryness or painful sex.
Frustratingly, these symptoms may be present in some months but not others. This can lead some women to feel as though they are “losing their mind” and explains why women may doubt themselves or not look for help at this time.
Of course, other stressors can also contribute to these symptoms because perimenopause often occurs when women are at their busiest with work or family life or just life in general. That can make it hard for us to distinguish what is “life” from a hormonal symptom.
Interestingly, cognitive symptoms (memory etc.), mood and migraines peak through perimenopause, which is before your periods have stopped. In fact, research suggests that most women experience their worst cognitive symptoms before their final period. Most of the symptoms we develop at this time are due to the brain having to learn to function in a new, unstable, hormonal environment – the brain is trying to adapt to this new stage of hormonal life.
Lots. First of all, try to keep a (simple) diary. Have a look at your bleeding cycle and if your symptoms, such as headaches or mood swings, have a pattern – are your symptoms often worse before your period?
Don’t panic, you are not alone. Life, in general, is tough but if you throw a hormonal storm in the mix, it’s harder again.
Everyone experiences the menopausal transition differently, with different symptoms or challenges so it can be a very lonely time. Know that these symptoms are common, that you won’t feel like this forever and there’s lots of help out there.
Certain interventions can help but will depend on what your own individual symptoms are. Reducing caffeine and alcohol, increasing exercise, paying more attention to “sleep hygiene” and a good sleep routine may be helpful. For some women, cognitive behavioural therapy can be useful for anxiety, low mood, low confidence and sleep.
We can also discuss nonhormonal medications (such as SSRI/SNRI medications, often used for depression or anxiety) which can improve mood, sleep and hot flushes. For some, the oral contraceptive pill or the progestogen-only pill (“mini-pill”) may provide symptom control, menstrual regularity and contraception. The intrauterine device (IUD) is also very effective in reducing menstrual bleeding and for birth control.
Hormone Replacement Therapy (HRT) has a role here too as it can reduce the need for so much stimulation from the brain’s pituitary gland, helping some of the hormonal chaos to settle down to a slightly more stable state. Think of it as having a bucket of water in the car – in our 20s and 30s, the car is on an even road and the bucket of water just has ripples. In perimenopause, it’s as if the car is going over big hills, bumps and potholes (like any typical Irish road trip!) and the water is sloshing violently, spilling over. HRT is like trying to hold the bucket still. It’s not perfect but it helps.
HRT is a medication and as with any medication, there are potential benefits, risks and side effects. We know that HRT can impact the risk of breast cancer and may cause side effects such as unexpected vaginal bleeding, mood changes and headaches. However, the benefits may outweigh the risks for some women, who find their worsening PMS, low mood, migraines and new nighttime sweats resolve. It really depends on the individual.
Take home points if you think you’re in perimenopause:
1. Don’t forget about contraception. If you are still having periods (and have not gone at least one year without a bleed – two years if you are under 50!) then you need to consider your need for birth control. There are lots of options here and it is worth discussing this with your GP or healthcare provider.
2. Remember that you are not alone and reach out for help if you feel you need it.
3. Perimenopause is sneaky. The symptoms can wax and wane, come and go.
4. This is a great time of your life to start health planning – be aware of the risks of heart disease, bone density loss and look at lifestyle interventions that can be beneficial. Start taking vitamin D (over the counter), plenty of calcium in your diet and weight-bearing exercise.
5. It’s not all bad news - perimenopause is a time to take control of your long-term health and feel positive – women are amazing! We need to embrace new stages of life as they happen, educate ourselves and most of all, support each other.
Dr Caoimhe Hartley, clinical lead of the Complex Menopause Clinic in the Rotunda Hospital and founder and clinical lead of Menopause Health in Dalkey County Dublin, is an expert panellist at the upcoming National Menopause Summit Cork supported by M&S which takes place on Friday, 20 October in Cork City Hall. Details can be found at www.
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Protected cycle lanes are needed in Dublin. Painting a white line on the road and calling it a cycle lane does not offer any protection to cyclists.
@Nomis Andrews: hardened rubber uprights need to be parallel to every cycle lane
Damaged bumper rather than an injured cyclist
@Nomis Andrews:
The lycra brigade never use the cycle lane in my experience
Try riding a bike to work for a year in traffic, see if the reasons become apparent to you.
@Nomis Andrews: the article says the bus was turning right, so it would seem the victim was on the right hand side of the lane.
Condolences to the family of Mary White. And also the driver must be given a bit of sympathy as well. The faults/reasons in this incident are difficult at best to side on. Instead of taking sides why dont both motorists and cyclists show each other more due care and attention.
On a side note, I cycle myself late at night, but my lights are rated at 700 lumens front and dual 50 lumen rear reds. You should not be driving or cycling if you cant notice something that bright. Was Mary’s lighting strong enough for the driver to notice her? Visibility is paramount for cyclists. Im not trying to say her lights were at fault. A sad incident. Be safe everyone.
@Finn Faulkner: you’re right it’s a tragic and difficult case, but a court of law, having heard all the established facts, found him guilty. That in itself is rare enough.
@IrishSportives.ie: with respect, it’s not rare. The outrage that often follows in such cases from certain quarters usually hangs on it ‘only’ being a suspended sentence – not that the person is found not guilty.
@IrishSportives.ie: Yes, i completely agree. My sympathy for the driver is limited, but he will have to live with that for the rest of his life. He maybe should have pleaded guilty…..
@Finn Faulkner: I believe he should have pleaded guilty, but I suppose he had his livelihood to consider. He also allowed his barrister to try and victim blame the woman who died, but a Garda witness put the record straight on that one.
I noticed that more and more drivers are cutting the corners when they are turning right at a junction. They show a complete disregard for the safety of others road users.
@Vincent: Same with curves in the road too. Cutting them to “straighten out” the road.
@John Flood: yep. Driving to fast to take the curve in their lane.
Very sad.
So deeply remorseful yet you plead not guilty there needs to be a penalty for the not guilty plea
@Seán O’Sullivan: Exactly. If he was that remorseful he would have taken a plea deal and avoided dragging the family through court. He was obviously desperate to save his job and happy to sacrifice them on the way
Life is so cheap in this country…
This Bus driver will live on to drive one of the biggest vehicles on the road, to pass many more cyclists and pedestrians…
Who knows what could happen, the potential is there again for him to kill due to his carelessness, he wanted to save a few seconds by cutting a corner, yet he cut the life of the victim off permanently…
It’s almost impossible to get any jail time in this country if you kill a vulnerable road user with a motor vehicle on Irish roads..
@Dotty Dunleary: can’t see any bus company giving him a job, not after being found responsible for a death, the insurance would be phenomenal.
@edelno5 .: As far as I know, Dublin Bus insures itself.
May you Rest In Peace Mary.
Your soft voice, sincere smile, compassion, and sincerity, will always be remembered by your previous work colleagues at OLHSC.
Very good video by the RSA on just how vulnerable cyclists are when moving with HGVs and LPSVs, it shows clearly how often in the space of seconds cyclists are not seen as they pass vehicles that have by their nature blind spots. Sympathy to the family of the cyclist and spare a thought for the driver.
@William Bryan: hi I am taxi driver and when I am behind cyclist in traffic in bus lane I stay behind till gap in traffic I know there situation :ie manhole or gully or pot holes I cycle for years to and from work
WTF Judge Useless & very wrong let Driver walk free
@Brian Flavin: After reading the full story I disagree with you.
@Ciarán O’ Donoghue: i m disagree you
@Brian Flavin: No, you disagree with the sentence.
@Ciarán O’ Donoghue: how can he disagree with a sentence if he can’t write one?
@Eoin Byrne: watch out lads the grammar Nazi is about!!!!
1. 13 tonne buses don’t cut corners on their own .
2. Since the driver was Deacon couldn’t a confession or a few prayers be prescribed.
No jail time for killing a person. Well done..
It is difficult for me to accept the judge’s ruling as it was for me to accept the jury’s finding about the Wellington Quay deaths.
@Denis Patrick Gill: W@nker comment of the week, and it only Monday.
RIP to the lady who lost her life. Perhaps we should all be more aware of the dangers to both cyclists and motorists on the roads. Last Thursday night we were stopped at traffic lights on the quays travelling towards O’Connell Street. We had a clear left indicator on signalling our intention to turn left after the lights changed. Cyclists came up our left hand side and remained there despite the indicator being on. Rolling down the window I asked the nearest cyclist did he not see our indicator. Having removed his headphone he asked what I had said. Then he apologised and moved in front of us. What would have happened if we hadn’t spotted him and the lights had turned green? Just an observation.
@Mary Dunphy:
(b) A pedal cyclist may overtake on the left where vehicles to the pedal cyclist’s right are stationary or are moving more slowly than the overtaking pedal cycle, except where the vehicle to be overtaken—
(i) has signalled an intention to turn to the left and there is a reasonable expectation that the vehicle in which the driver has signalled an intention to turn to the left will execute a movement to the left before the cycle overtakes the vehicle,
SOURCE: http://www.irishstatutebook.ie/eli/2012/si/332/made/en/print
One can deduce with certainty that the vehicle you were travelling in was stationary at the traffic lights by way of your observation that whilst stopped at the traffic lights, “cyclists came down our left hand side and remained there”. This certainty is further supplemented by the fact you were able to engage in conversation with one of them at the traffic lights.
“What would have happened if we hadn’t spotted him and the lights had turned green?”
Goodness knows but should a driver of a vehicle turn left in the very circumstances you describe above, s/he would be fully liable for any collisions that may occur on grounds of negligent driving.
@Mary Dunphy: You need some driving lessons love. Indicators do not and never have allowed priority. It’s amazing you don’t know this.
So Mary Dunpy came to a story about an incompetent driver to declare that she’s an incompetent driver.
@Bob Moore: As you may not have noticed I was not driving at the time. We did indeed notice the cyclist and asked if he had seen that we were indicating to turn left. Having removed his headphones he admitted he hadn’t as he was feeling quite tired at the time. It was merely a point in observation which was applied to both motorists and cyclists and obviously you have some type of chip on your shoulder if this is your nasty reaction to an observation. There was never any danger to the cyclist under the circumstances so what’s your point?
@Mary Dunphy: “what’s your point?”
You came to a story about an incompetent driver to declare that you’re an incompetent driver.
Incredibly sad. She had all the “necessary” equipment and yet it proved to be no use against careless driving. The sentence handed down by the judge is bitterly disappointing.
My thoughts are with her family and friends, justice wasn’t served.
@C Moloney:
Bus driver is still on the roads. The courts allowed a killer bus driver to carry on over Christmas.
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