Sue H. shares her struggle with debilitating headaches and brain fog following her second pregnancy, which began at age 36. Initially attributing her symptoms to stress or menopause, she eventually discovered they were related to hormonal imbalances. Many women experience similar challenges during the “In Between” phase leading to menopause. Doctors often overlook these symptoms, leaving women like Sue seeking appropriate treatment. Awareness and understanding of early menopausal symptoms remain low, impacting diagnosis and care for those affected.
“Today feels great,” shares Sue H. as her espresso brews. “Yesterday was tough. I endured another bad headache and my thoughts felt sluggish.”
Though Sue thrives on socializing and enjoys good company, frequent headaches and persistent brain fog often disrupt her life. As she settles at the dining table with her coffee, she describes the sensations: “It’s like having the flu. Everything appears distant, as if viewed through a curtain.”
Changes After Her Second Pregnancy
This fogginess and recurring headaches are just a few of the issues that began to plague Sue H. after her second pregnancy at 36.
The initial symptom was weight gain, which triggered a cascade of additional problems: fatigue, low energy, sleep disturbances, and fragile skin. “I dropped a glass, and the tears just flowed.”
“It’s Hormonal!”
For a long time, Sue attributed her discomfort to stress from raising young kids and her responsibilities as a high school teacher. She briefly considered menopause but dismissed it since her periods remained regular, although they were heavier than usual and accompanied by severe cramps: “I became acutely aware of ovulation.”
Her family doctor conducted thorough blood tests and a CT scan, both returning normal results. Four years after her symptoms first appeared, just before the lockdown, Sue found herself on the brink of burnout and took a sick leave. It was then she stumbled upon an article about menopause, which made her realize, “It’s the hormones!”
Menopausal Symptoms in Your 30s?
“Sue isn’t alone,” affirms Dr. Susanna Weidlinger, a senior physician at the Menopause Centre at Inselspital Bern. “I see many women like her.” Specifically, these women are in the pre- or perimenopausal stages—the transitional phases leading up to menopause.
This transition may come with headaches, sleep issues, bloating, joint pain, breast tenderness, spotting, irritability, or mood changes—all of which can intensify during perimenopause.
Decline of Progesterone in the Mid-30s
The root cause of these symptoms is a decline in progesterone from the mid-30s. Progesterone plays a crucial role in preparing the uterus for a fertilized egg’s implantation.
Previously viewed solely as a pregnancy or menstrual hormone, it’s now recognized that progesterone also possesses anxiety-reducing, relaxing, pain-relieving, and sleep-enhancing properties, as Dr. Weidlinger explains.
As progesterone levels drop, an imbalance occurs between this hormone and estrogen, which counteracts its effects. This situation is termed relative progesterone deficiency, leading to increased estrogen dominance.
There’s no universally accepted term for the phase just before menopause. Some refer to it as “in between,” while others call it “premenopause.” Dr. Weidlinger believes it signifies fertile years starting from the first menstruation.
Characteristics of “In Between” Women
Women in this “in between” stage share one commonality: they still have regular menstrual cycles, although alterations in flow, duration, and intensity are common, much like Sue H. experienced.
Dr. Weidlinger notes that the extent of discomfort during this phase varies widely among women, and statistics or dedicated studies on this transitional stage are scarce.
After receiving normal results from her general practitioner, Sue sought help from her gynecologist, who dismissed her concerns as typical for older women. “He said I was too young for menopausal symptoms and that I would just have to cope.”
Following multiple visits, including one where her husband described her experiences, the gynecologist finally agreed to hormone replacement therapy.
Dr. Weidlinger frequently hears similar stories from her patients. She observes that many doctors overlook this transitional phase, often directing patients to sleep clinics, rheumatologists, psychiatrists, or memory specialists rather than considering menopause.
Challenges in Diagnosis
Why is this the case? Dr. Weidlinger highlights three potential reasons. First, diagnosing this transitional phase can be tricky since women typically continue having regular periods. The hormonal imbalance between estrogen and progesterone is also difficult to detect through blood tests.
Additionally, women often juggle multiple stressors during this time, such as new jobs, parenting young or teenage children, or dealing with aging parents and midlife crises in their partners. “Not all issues stem from menopause,” says Dr. Weidlinger, “but some definitely do.”