Nearly a year into new motherhood, Justine Cox thought she was ready to jump back into some of her old routines. Her breastfeeding journey was coming to an end and, while exhausted and battling monthly bleeding she describes as “haemorrhaging”, she figured that it was just par for the course for a 43-year-old new mum.
Almost immediately, her triumphant return hit a snag. “My body didn’t want to run,” says the vibrant leadership coach and intrepid traveller. “Before I had Nash, I used to run about five kilometres a day, four to five days a week. It was the weirdest thing; it just didn’t want to run. I tried going to the gym and it didn’t want to do that either.”
Soon after, Justine learned the changes she was experiencing weren’t just physical.
“I would go to the supermarket, needing three things and forget all three things – I could go for one thing and forget just the one thing,” she says of the fog that appeared to be engulfing her previously razor-sharp mind.
Late last year, things looked similar for Cathrine Mahoney, host of the podcast So, I Quit My Day Job. Sitting in a TV writer’s room, she recalls searching for story ideas when words began to fail her. “And you know, it was something as simple as ‘spoon’,” she says of her sudden cognitive decline. “I was like, oh my God, I cannot get my words out.”
Despite increasingly debilitating symptoms, neither woman knew what was causing these sudden changes. But as it turns out, both Justine and Cathrine were in the company of 73 per cent of women who don’t realise they’re in perimenopause.
Perplexed and perimenopausal
Part of the problem, according to Dr Fatima Khan, a menopause specialist who runs a menopause clinic out of Melbourne’s Epworth Hospital, is a lack of education about what perimenopause is, when it hits and what it involves. Justine recalls conversations with friends sharing they had no idea that ‘menopause’ is essentially the end of the journey, and perimenopause accounts for the possible decade of symptoms experienced in the lead-up.
“I said to my girlfriends, ‘Why haven’t we been talking about this? Why haven’t we been told about this?’”
While women are encouraged to ‘have it all’ while still juggling the bulk of maternal and domestic responsibility, Dr Khan has seen the uphill battle that perimenopause presents for women like Justine who choose to have kids later in life than previous generations.
“Let me tell you about five of my patients yesterday,” she says. “They were all around 45, with three kids under 10, working a full-time job, at the peak of their careers.”
Dr Khan compares one of the effects of drastic hormonal fluctuations to the overstretching of a spring. “It’s called ‘allostatic load’,” she explains. “We know when the hormones fluctuate, there is a reduction in stress resilience.” So, instead of springing back into shape like it might when our hormones are stable, she describes “a cumulative effect” on perimenopausal women, with demands from work, domestic life and kids causing the spring to stop bouncing back.
Another challenge, according to Dr Khan, is misdiagnosis and the resulting strain on our healthcare system. “My typical female patient will have gone to a cardiologist for heart palpitations, a rheumatologist for joint pain, a neurologist for debilitating migraines,” she says. “So, they’ve gone to multiple specialists and – after spending two or three thousand dollars – they realise, ‘Oh, it’s just perimenopause’.”
A silent epidemic
Some of the most commonly misattributed symptoms of perimenopause are related to mental health. Of the approximately 5000 respondents in the Menodoctor Survey Australia, an online survey by Dr Linda Dear, close to two-thirds reported experiencing low mood and the same was found for anxiety. Dr Khan says these common peri symptoms are resulting in an overprescribing of antidepressants for middle-aged women, rather than an investigation into the root cause.
In a survey conducted by Natalie Moore and Lisa Saunders, co-founders of Own Your Health Collective, which supports women and workplaces with menopause education and management, 50 per cent of respondents reported a change in their social connectivity and relationships. “A lot of women talk about feeling so alone. That confidence level can really drop as you’re trying to work out what’s going on,” says Lisa.
“You don’t want to miss anything, you want to be able to have it all. But you can’t have it all. ”
Dr Fatima Khan
This was certainly the case for both Justine and Cathrine, who experienced a paradoxical kind of social isolation. “I didn’t want to be with other people, but I felt incredibly lonely,” Cathrine recalls of when she was at the height of her perimenopausal symptoms.
“I didn’t reach out to girlfriends for help,” admits Justine. “The only things I used to ask them about were related to the baby, never about me.” The resulting isolation is what Dr Khan describes as “a silent epidemic of loneliness” in perimenopausal women.
Professional snakes and ladders
The timing of perimenopause also has a direct impact on women’s finances. When her son was nearly 12 months old, and Justine spoke with her new chief executive about returning to her corporate role in Human Resources, she was met with a flat-out refusal to accommodate her desired part-time schedule along with immediate travel demands. Going on nearly a year without more than five hours of sleep each night, a growing list of unexplained symptoms, and a still breastfeeding baby, she was faced with a seemingly impossible choice.
“I thought, ‘They’re trying to make it difficult for me’,” she recalls, which resulted in her leaving the security of her previous nine-to-five to start her own coaching business.
As a freelancer, Cathrine wasn’t immune from the career impacts either. “As someone who speaks and writes for a living, it was debilitating,” she says. “I cancelled a lot of stuff. I didn’t go to things. I didn’t want to be around people.”
In her clinic, Dr Khan has a front-row seat to the impact perimenopause can have on career women in their 40s with young kids. “You don’t want to miss anything; you want to be able to have it all,” she says is the false promise that women are being sold. “But you can’t have it all.”
Perimenopause is now hitting women who are already juggling a young family at a crucial point in their professional lives. “So, when their male counterparts are moving up the ladder and increasing hours, they are reducing,” says Dr Khan.
And for something that half the population will experience, it’s an issue that’s too costly to ignore. The Australian Institute of Superannuation Trustees recently estimated that menopause could be costing women “a collective loss of $15.2 billion in forgone income and super for every year of early retirement”.
Getting clued up on the change to your workplace
There are signs of change. Some workplaces are introducing menstrual/ menopause leave, including a trial taking place in the Victorian Public Service. But there’s still a long way to go when it comes to reducing the economic, physical and emotional impact on women in perimenopause and beyond.
It’s something Natalie and Lisa are working hard to help women and workplaces achieve. In their workshops they like to challenge popular attitudes towards “the change”, pointing out, “It’s probably one of the biggest personal development phases that a woman will go through.”
“As someone who speaks and writes for a living, it was debilitating … I didn’t want to be around people.”
Cathrine Mahoney
They like to ask participants, “How can you come into your power? What do you actually want this phase of life to look like?”
Once they were able to identify what they were experiencing, both Cathrine and Justine saw drastic improvements with the help of a range of available treatments, from natural therapies to Hormone Replacement Therapy. Both women are now thriving while working for themselves, on their own terms.
“I’m grateful that I’m alive and ageing,” says Cathrine, who is now back to her old self again. “I want to have a huge life. I’m only 49 – I could be here for another 50 years!”
This article originally appeared in the September 2024 issue of The Australian Women’s Weekly. Pick up the latest issue from your local newsagent, or subscribe so you never miss an issue.
