Women make up nearly half of the global population, and almost every one of them will experience perimenopause. But unlike many other health transitions, a vast majority of women are still in the dark about the signs and symptoms signalling that it has begun.
They might feel anxious. Exhausted. Suddenly irritable. Unable to sleep. Foggy at work. Achy in their joints. Some might even find themselves struggling with heart palpitations that send them to the emergency room for help. And it’s usually not until they’re in the midst of it that the lightbulb finally goes on.
“I didn’t realize it until I had a conversation with my hairstylist,” recalls Darlene Mulcahey, who founded My Menopause at Work, a peer support network for public servants, after navigating a difficult perimenopause transition.
After describing her situation, her hairstylist told her she was probably going through perimenopause.
“What’s that?” Mulcahey remembers asking.
And she is certainly not alone.
According to a 2022 national survey by the Menopause Foundation of Canada (MFC), one in two women felt unprepared for menopause, four in 10 felt alone in the experience and most experienced seven symptoms.
Not only that, but the MFC also reports three in four women experience symptoms that interfere with their daily lives.
And yet, despite this impact on the lives of hundreds of millions of people, public understanding remains startlingly narrow.
Much more than period changes
“We’ve really been misled to believe that menopause is simply about period changes,” says Janet Ko, the MFC’s president and co-founder. “We don’t appreciate that (it’s) so much more … it’s an important health transition.”
Ko explains that perimenopause — the hormonal transition leading up to menopause — can begin up to 10 years before a woman’s final period, and since the average age of menopause in Canada is 51, that means symptoms can start in the late 30s or early 40s.
But because hot flashes dominate the cultural narrative, women who don’t have them, at least not initially, often miss the signs.
And there can be many.
The MFC’s symptom tracker categorizes them into four groups: physical; genital, urinary and sexual health; cognition and sleep; and mood and mental health.
“There are more than 30 symptoms,” Ko stresses, adding that estrogen receptors are found throughout the body – in the brain, bones, heart, and more – which helps explain why perimenopause can affect so many different systems. It also explains why symptoms can vary so drastically, from anxiety and depression, to joint pain and heart palpitations, to recurrent UTIs and sexual health issues.
The reality of a misdiagnosis
Of course, not everything is perimenopause, but when health providers don’t connect the dots between the symptoms their patients are experiencing, many women are left misdiagnosed or dismissed.
Sonja Rincón, for example, initially had no idea what was happening when her symptoms began. Told she was “too young” for perimenopause, her concerns were ignored until she was 43.
Looking back, Rincón – who would go on to co-found the menopause app Menotracker – now believes her perimenopause started unusually early. “I would say my symptoms started at the age of 37, more or less,” she explained on an episode of the Hotflash Inc. podcast.
At the time, she struggled with sleep problems and memory issues which she assumed were caused by stress. But these symptoms eventually became severe enough to cause serious concern.
“At some point, I had a month where I really thought I would develop some sort of dementia, which was really, really scary,” Rincón recalled.
She was needlessly prescribed antidepressants and remained on them for at least five years before learning that hormonal changes were likely the underlying cause. After starting hormone replacement therapy (HRT), her symptoms improved significantly.
Consequences of a ‘significant gap in care’
For Ko, that story is all too familiar. She recalls visiting the ER with heart palpitations she thought could be a heart attack, but turned out to be hormone related.
“We need to address the root cause of a significant gap in care: untrained healthcare providers,” she said.
Doctors, she stressed, should be ruling out perimenopause for patients by asking simple questions, for instance: “Your heart is fine. But, look, you’re 47 years old, do you have any of these other symptoms?”
That would go a long way in validating women’s experiences, she said, and making them feel like they’re “not going crazy.”
However, most doctors don’t talk about perimenopause partly because they don’t know much about it – the result of a much larger issue: the chronic underfunding of women’s health.
Only about 7 per cent of Canadian health research funding focuses specifically on women’s health, despite women making up around half the population. Without clear guidance from healthcare providers, women are frequently left to figure out their own care, and the consequences can extend well beyond individual wellbeing.
The MFC estimates unmanaged menopause symptoms cost the Canadian economy $3.5 billion annually in lost productivity and workforce exits. And, with over 4 million midlife-female workers and those over 40 comprising the fastest-growing cohort of working women, the problem isn’t getting better anytime soon.
A glimmer of hope
While the healthcare system may still lag in recognizing and treating perimenopause, women are learning to become their own strongest advocates. As Rincón puts it, “You have to be the CEO of your own health.”
Tracking symptoms, asking the right questions, and seeking out resources can make all the difference – not only for managing daily life, but for feeling seen and validated during a major life transition.
At the same time, there are signs of change on the horizon.
“There has never been a better time to be experiencing perimenopause,” Ko notes, pointing to evolving workplace policies, greater awareness, and expanding treatment pathways. “This is a period of tremendous strength [and] opportunity. Women are becoming who they were always meant to be.”
Emma Caplan-Fisher
