What is perimenopause and why is it overlooked?

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Perimenopause: Understanding the Transition and Its Underaddressed Challenges

Perimenopause is a natural biological phase that precedes menopause, typically beginning in a woman's late thirties or forties and lasting for several years. During this period, hormonal fluctuations lead to a range of physiological changes, affecting the menstrual cycle, energy levels, concentration, sleep patterns, mood, and overall sense of well-being. These gradual shifts can significantly impact a woman's daily life, influencing her capacity to manage work and family responsibilities. Despite its profound effects, perimenopause often receives less attention compared to menopause itself, leading many women to experience these changes with limited understanding or support.
The Nature and Manifestations of Perimenopause

As women approach menopause, their bodies undergo significant hormonal recalibration. Oestrogen and progesterone levels begin to fluctuate and decline, leading to a variety of symptoms. These can include irregular menstrual cycles, with periods becoming heavier, lighter, more frequent, or less frequent. Beyond reproductive changes, women may experience persistent fatigue, difficulty concentrating, sleep disturbances, and noticeable shifts in mood. These symptoms, while common, can be pervasive and affect a woman's cognitive function and emotional state, impacting her ability to perform daily tasks effectively.
Societal Factors Contributing to Overlooked Symptoms

The challenges faced during perimenopause are frequently exacerbated by societal tendencies to dismiss or downplay its symptoms. Persistent exhaustion, brain fog, or reduced focus are often attributed to stress, insufficient sleep, the natural process of aging, or the demands of a busy lifestyle. This normalization of symptoms means that women may not seek medical advice or may have their concerns overlooked by healthcare providers. Consequently, the underlying physiological causes, such as declining iron stores, may go unaddressed, prolonging discomfort and potentially leading to more serious health issues like iron-deficiency anaemia.
The Link Between Iron Deficiency and Perimenopausal Symptoms

Low iron levels, a condition that affects approximately one in three Malaysian women of reproductive age, can manifest with symptoms like tiredness and brain fog, which are common during perimenopause. A ferritin test, which measures iron stores in the body, can help identify these deficiencies before they develop into full-blown iron-deficiency anaemia. Emerging research suggests a correlation between iron status and cognitive performance during the menopausal transition, with preliminary studies indicating that better iron status is associated with improved cognitive function. This highlights the importance of assessing iron levels, even in women who have not been diagnosed with anaemia, as it could be a contributing factor to their perimenopausal symptoms.
Initiatives to Enhance Awareness and Access to Screening

Recognising the gap in awareness and support for women experiencing perimenopause, initiatives like Alpro Pharmacy's Me. NO PAUSE aim to empower women with knowledge and facilitate early detection of potential health issues. By offering subsidised ferritin checks for RM1, this program seeks to remove financial barriers and encourage women aged 35 and above, particularly those exhibiting symptoms like persistent tiredness or brain fog, to undergo screening. This approach, supported by collaborations with organisations such as the Malaysian Pharmacists Society and Universiti Teknologi MARA, underscores a commitment to integrating community pharmacy practice with academic research to improve women's health outcomes through accessible screening and timely professional guidance.

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What is perimenopause and why is it overlooked?

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