Overlooked and underdiscussed: Shining a light on perimenopause

What you probably already know: Earlier this month, actress Halle Berry criticized California Gov. Gavin Newsom for vetoing menopause-related legislation. In contrast, the state of Illinois recently mandated coverage for hormone therapy to treat menopause. Menopausal symptoms can vary drastically from person to person, as can the age of onset. Despite more than a million women in the U.S. experiencing menopause each year, many are caught off guard when they find themselves navigating months to years of perimenopause. “Women can start to notice some symptoms as early as their 30s,” says Rajita Patil, M.D., director of UCLA Health’s Comprehensive Menopause Care program. “But (they’re) so varied that many women, and even their doctors, don’t recognize them as signs of perimenopause.” 

Why it matters: Frank and honest conversations can help normalize this experience. Just last month, BBC technology editor Zoe Kleinman opened up about confronting brain fog on-air and was met with resounding support, receiving hundreds of messages and comments on LinkedIn. “Women have stopped me on the street to talk to me about it,” she says. Awareness of and access to treatment options are increasing as well — see the FDA’s recent decision to lift the black box warning for hormone replacement therapy. Still, confusion lingers, with studies showing a lack of general awareness surrounding this transitional stage. 

What it means: There’s room for more studies and education about perimenopause: how to recognize it, where to go for accurate information, and what treatment is available. “Women are recognizing that there are good ways to manage their symptoms, safe and efficacious,” says Dr. Susan Reed, professor emeritus of Obstetrics & Gynecology at UW Medicine, “and they’re angry that their health care providers either are not skilled enough to guide them, don’t have the time to discuss these issues, or feel these symptoms are not important.” She notes that each stage, from puberty to menopause, is “a window of opportunity for improved long-term health.” Dr. Reed is principal investigator for the menopause clinical trial network MsFLASH, which received NIH funding to help women better understand the menopause transition, with tools for discussing their symptoms with their providers. The Menopause Society is an excellent resource as well, offering an online database of doctors who specialize in treating menopause and perimenopause. 

What happens next: In a system where insurance companies reimburse health care providers, women’s health has taken a backseat. Considering that menopause symptoms contribute to an estimated $1.8 billion in lost work time per year, increased support in the workplace — from basic accommodations to training for managers and HR — is vital. The NIH will convene in the coming months for a workshop on the management of menopausal symptoms, aiming to identify research gaps. And yet, “funding for menopause research is less than 1% of the NIH budget,” Dr. Reed says. “We still have many questions to be answered that women deserve answers to. With pressure from women in Congress, we hope this funding stream will continue to improve.”