It’s bloody time we got a clue about perimenopause

At 42 years old and a year into a Co-CEO role, I thought I was losing my mind. If I didn’t write something down, I would forget it. I would wake up in the early-early mornings anxious about small things, unable to get back to sleep. My skin was dry. My hair was dry. Everything was dry. The changes were both gradual and seemingly sudden: What was happening to me? 

Despite astounding innovation across life-altering categories in the last decades–AI, robotics, vaccines, space travel, to name a few–I still can’t answer that question definitively (and neither can ChatGPT), even if I wasn’t too embarrassed or afraid to ask it. 

And from what we’ve heard from our Clue user community, I’m not the only one feeling disoriented, overwhelmed, and embarrassed as my body changes. There could be many reasons for what I was experiencing–stress of the job being an obvious possibility. But there was another possibility at my age: perimenopause. It could be neither or it could be both. Whatever was happening, I was clueless.

Perimenopause and then menopause are inevitable for everyone with ovaries (as a reminder, that’s half the world’s population) and it’s about bloody time we as a society got a clue. We need to listen, learn, and lead in ways that better support each other during this life phase. It’s why we built our newest mode, Clue Perimenopause, and why I’m sharing my experience.

Perimenopause? Never heard of it.

We recently surveyed over 26 500 members of the Clue user community, and we were shocked by the low level of awareness for this life stage. 

Menopause is when your menstrual cycles end and you haven’t had a period for a full year. While more people are aware of menopause, and the term is often used to describe the entire phase, what many don’t realize is that it’s a transition that can take years. 

Perimenopause is this transitional time before menopause. It starts on average four years prior to menopause, typically during your 40s but may start as early as your 30s, and it could last as little as a few months, or it could drag on more than 10 years.

Common changes and symptoms associated with perimenopause read like a disclaimer on the back of a pill bottle: hot flashes, sweating, disturbed sleep, mood changes, anxiety, migraines, increased forgetfulness, changes in sexual desire, vaginal dryness and itchiness, lowered fertility/infertility, and increased abdominal body fat. Some of these symptoms can also continue or evolve post-menopause. 

The invisibility of perimenopause, in addition to low awareness of menopause, leaves too many unsupported during this transition.

It’s like looking for the light at the end of the tunnel only to find out that the tunnel is a maze with infinite turns. Why is it that something so natural and inevitable for everyone with a cycle is still such a disorienting and lonely experience?

Taboo strikes again

First, since it has to do with the female reproductive system, taboo strikes again. With so much emphasis put on the fertility of women, menopausal changes and what they signal leave many women feeling embarrassed to talk about their experience with their doctors, no less their friends and partners, and in the workplace. Another survey of 4000 women in the UK by the Fawcett Society found that 45% of women had not spoken to the doctor about their symptoms. 

We don’t hear about perimenopause and menopause often in the workplace (Clue is an exception) but that doesn’t mean it’s not affecting our colleagues. And the silence around it does a great disservice to our future selves.

Sadly, data shows that despite mid-life being the peak time for career success, for every woman at director-level who is promoted, another two female directors choose to leave their roles. A UK survey found that 18% of women going through menopause are thinking about quitting their jobs, and as many as a third are considering switching to part-time. Just think of the knowledge and expertise that are lost due to the lack of support and empathy for this life stage in the workplace.

The empathy (and awareness) gap

The other part of the problem is the empathy and awareness gap for the perimenopause experience amongst general practitioners and other doctors, resulting in people not getting a diagnosis or subsequent advice or treatment to help manage their symptoms. 

As one Clue user told us of her own experience: “Doctors are so uneducated and uninformed about how perimenopause affects so many different systems of the body.” 

According to the Society for Women’s Health Research, more than a third of women who are experiencing menopausal transition symptoms go undiagnosed. One in five women experience symptoms for more than a year before a healthcare provider formally confirms they are in perimenopause. 

In addition to a lack of awareness, there’s also a lack of incentive for doctors to support patients going through perimenopause. In Germany, I was shocked to learn that doctors are reimbursed only 13€ over three months to consult someone going through perimenopause and menopause. 

Our survey found that only 16% of respondents between the ages of 35-45 had heard about perimenopause from a healthcare provider. Even over the age of 51, less than half of respondents had heard about it from a healthcare provider.

An $800 Billion Problem

Tens of millions of people will enter perimenopause every year. Looking at the above under a health economics lens, that’s over $800B each year in healthcare costs and lost productivity. But that doesn’t begin to measure the physical, emotional, and psychological impact on relationships, career, sense of self, and ultimately quality of life that can come with perimenopause and menopause.

What so often happens with a tabooed topic is that women and people with cycles continue to lack the information and support they need. In our survey, nearly 90% of people said they did not feel well-informed on what to expect when it comes to perimenopause and menopause. 

We hear time and again the frustration that this entire life stage gets so little interest, and research; and the anger that lesser quality of life as one ages is just accepted. We are not invisible just because we’re older. 

Tracking to take charge

How might we combat centuries of taboo, close a gaping health empathy gap, and make the invisible visible? Given perimenopause is a transition, tracking the changes and experience through that transition is critical to taking charge of your health. 

You can understand patterns and changes. You can begin to answer the most common questions asked around this phase: Am I in perimenopause? And how long will it last? 

You can bring this information to your healthcare provider and get the right diagnosis and the right advice and support. And what’s more, every single data point you track within the Clue app not only empowers you as an individual, it shows our experience in aggregate and proves we’re not alone. It contributes to our overall knowledge base on menstrual health and moves us all closer to that global revolution in female health. 

Our call to action

It was scary for me to learn all the above about perimenopause because it felt like the beginning of a metaphorical end. But facing it, considering it as a possibility, and talking about it has also freed me to observe, process, and actively manage. 

My process began with education and self-observation, and it is my hope that Clue Perimenopause can kick-start this for others too. 

It’s also been scary for me to tell people about my experience–brain fog was hard to share with my colleagues (even at Clue!), and declining fertility was hard to share with my partner. But sharing made me feel more connected, both with those who haven’t and won’t experience perimenopause as well as with those who have or are. 

Clue has named September Perimenopause Awareness Month (naturally coming before October, Menopause Awareness Month) to raise awareness. This month is about sharing our experiences, being heard, being taken seriously, and feeling in charge–even if change is inevitable. 

This is my open call to others experiencing Perimenopause and Menopause: Tell your story. Track your experience. Let’s help ourselves, and each other.