Perimenopause a phase many endure in silence

Life is a journey and the path to womanhood is one of its most winding and unpredictable. From birth, a girl’s body slowly begins to change. You may remember learning in a primary school science class or a biology lesson that girls grow into women through different stages, with several physical changes along the way.

This journey begins in adolescence, marked by the growth of breasts, the onset of menstruation, the development of underarm and pubic hair, changes in skin and hair, and the body becoming more curved and capable of carrying life.

These changes mark the beginning of womanhood. Just when everything finally starts to make sense, the body shifts again.

This new phase is unfamiliar to many and is often surrounded by fear or whispered warnings, especially when it arrives before someone has had children. This stage is known as perimenopause. While menopause is often discussed, its precursor, perimenopause, is rarely mentioned.

Dr Fredrick Kairithia, a Consultant Obstetrician, Gynaecologist and Public Health Practitioner at Calgary Healthcare defines perimenopause as the transitional period before (leading up to) menopause when a woman’s hormones start to fluctuate causing a wide range of physical and emotional symptoms and her monthly periods become less regular.

The World Health Organisation (WHO) explains that perimenopause begins with early physical signs and ends twelve months after a woman’s last menstrual period. Menopause itself is when a woman has gone for a full year without a period, marking the end of her reproductive years.

While these two terms are sometimes confused, perimenopause is the lead-up to menopause, not the end itself. It is also different from premenopause, which refers to the stage in a woman’s life when she is still having regular periods and her hormone levels are stable.

According to the British Menopause Society (BMS), premenopause spans from a girl’s first period until the onset of perimenopause. It is typically symptom-free, with no hot flushes, mood swings or irregular cycles.

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These well-known symptoms usually begin during perimenopause, the stage of change that often starts in a woman’s forties and can last anywhere from two to eight years.

Dr Kairithia, who doubles up as the Secretary for the Association of Professors of Obstetrics and Gynaecology of Kenya, explains that perimenopause typically begins in the mid-forties, though it can start as early as the early forties or as late as the mid-fifties.

“During this stage, hormone levels change gradually and menstrual cycles may become shorter, longer, heavier or lighter,” he says. He adds, “Menopause marks the point when a woman can no longer bear children and her periods stop completely.”

For Fiona Wanjiku, now aged 49, the journey into perimenopause began at 45. She first noticed changes in her sleep and started experiencing hot flushes at night. “If I slept, I would wake up in the middle of the night with hot flushes,” she says.

“I knew menopause was setting in since I read widely about perimenopause and menopause symptoms in books and understood what my body was going through long before I saw any doctor,” she says.

To avoid sinking into depression, Fiona turned to books, learned about her symptoms, and found practical ways to cope.

She began dressing in layers to manage the hot flushes and switched to wigs when her hair started thinning, becoming dry and prone to breakage. Her skin became dry, so she added more legumes, avocados and iron-rich foods to her diet to help with energy and her appearance.

The most disturbing symptom for her was insomnia. “I love my sleep. Not being able to fall asleep was the hardest part,” she says. “It nearly broke me emotionally and pushed me into depression because I treasure my rest.”

Mary Kamau, now aged 46, began noticing breast tenderness, heavier menstrual flow and shorter cycles. Her skin became itchy, and she started struggling with brain fog and irritability. “Right now, my periods are irregular. I experience brain fog, dry, itchy skin and irritability,” she says.

It was during a women’s seminar at church that she first heard the word ‘perimenopause,’ though she hasn’t seen a doctor about it yet. Instead, she leans on WhatsApp support groups and home routines.

“I drink moringa tea, follow two low-carb meals a day, cut out sugar and listen to advice from other women,” she says. However, not all effects are physical.

“Family-wise, perimenopause has affected my sex life. Sometimes I’m not interested. My immunity has also gone down, and my irritability has distanced me from my children,” Mary adds. She has developed a new level of independence. “I make decisions without consulting as much, even on big projects,” she says.

Mary believes that stigma makes this transition harder. “Many women around me think perimenopause is a disease,” she says. “We need to talk more, read more and help each other know that this is a normal stage of life that we can get through.”

Dr Kairithia confirms that the signs both women describe, including irregular cycles, mood swings, hot flushes, brain fog, sleep problems, vaginal dryness, low libido and weight changes, are typical of perimenopause.

“Perimenopause is a natural transition, but because of the silence around it, many women feel confused and scared when the symptoms begin,” he says. “Hormone fluctuations, especially in oestrogen, explain the low energy, mood changes and memory issues.”

He adds that periods can vary greatly in flow and timing and that a woman may still be fertile even with irregular cycles. “Until menopause is fully reached, there is still a chance of pregnancy,” he explains.

In some cases, hormone tests such as follicle-stimulating hormone, oestrogen and antimullerian hormone may be useful, especially if a woman wants to conceive, but he notes that these tests are not always needed to diagnose perimenopause.

Global estimates show that by 2030, over one billion women around the world will be postmenopausal, with most of them having gone through perimenopause.

A 2022 survey by the African Menopause Society reported that nearly 80 per cent of women aged forty to fifty-five had moderate to severe symptoms, yet only 22 per cent had consulted a health care provider about it.

Despite these rates, the topic remains mostly unspoken in both community spaces and clinical settings. Women like Fiona and Mary often have to manage the changes on their own because stigma prevents open conversations and support.

“The silence is cultural,” says Kairithia. “Menstruation is still taboo in many homes. So menopause, which involves intimate symptoms like vaginal dryness or reduced libido, becomes even harder to talk about.”

“Medical professionals should take the lead in asking middle-aged women about perimenopausal symptoms instead of waiting for them to speak up.”

This silence contributes to misinformation. Many women, like Mary, are led to believe they are ill. Some are even wrongly diagnosed with depression or other psychological conditions before perimenopause is considered.

“With the right guidance, lifestyle changes alone can ease symptoms, or hormone therapy may be considered after a proper assessment,” adds Dr Kairithia.

What makes it harder is the lack of policy attention. While adolescent reproductive health receives considerable focus in the national health guidelines, midlife women’s health remains underdeveloped. Perimenopause isn’t often discussed in clinics unless the patient brings it up, and few do.

Dr Kairithia advises that lifestyle changes can make a significant difference. He encourages women to eat balanced, nourishing meals, stay hydrated and move regularly.

“A balanced diet, regular physical activity, sleep and relaxation, taking supplements, avoiding smoking and staying hydrated help a lot,” he says.