Friday Journal Club: Could it be perimenopause?

Journal: Perimenopause symptoms, severity, and healthcare seeking in women in the US

As a provider, I cannot tell you how many times I would see women in their 30s and 40s in an urgent care setting for the complaint of brain fog, fatigue, dizziness, and issues with concentrating. I will admit, I was guilty of sighing before these visits and feeling like the patient was probably going to leave frustrated because ‘nothing was found, again’. I would find a normal EKG, normal neurologic exam, normal vital signs, normal, normal, normal. But I will say now, until you experience brain fog yourself, you cannot understand how concerning and debilitating it can feel. I am bringing this article to our Friday Journal Club to shed light on just how early we (patients and clinicians) should be watching out for perimenopause symptoms.

This report is from a survey of 4432 US women with an average age of 42.6 years. Data was collected through an online survey combined with the Flo App which tracks menstrual cycles, ovulation, and pregnancy. They tracked specific perimenopause symptoms and trends in how early these symptoms occurred and specifically what symptoms came on at what age. They also reported on rates of help-seeking for perimenopause symptoms and the pattern of symptom severity based on age.

I love this study because it sheds light on the misconception that women first experience perimenopause symptoms in their early 50s. A significant number of women aged 30-35 experienced perimenopause related symptoms. In fact, of the women in this age group, 55.4% of them reported symptoms as moderate or severe on the Menopause Rating Scale. When they looked at women aged 36-40 that number jumped to 64.3%.

The researchers then looked at which symptoms present first and if there are trends as women age. Psychological symptoms like anxiety, depression, and irritability presented earlier than physical symptoms, peaking in women aged 41-45 years. Symptoms such as vaginal dryness, bladder issues, and hot flashes peaked in women aged 51-55 years.

It is very easy to blame all these symptoms on other factors including careers, parenting, lack of sleep, and relationships. This study sheds light on the fact that it is never too early to be in perimenopause and which symptoms to look out for among certain age groups. While we hope clinicians are continuously educating themselves on new research, we also have to educate and advocate for ourselves.

Please leave any thoughts or questions below or any requests for next week's Journal Club topic!