PERIMENOPAUSE is that vague period in a woman’s life when she transitions from her reproductive years into full on menopause. Similar to puberty, it is a NATURAL process that every woman must go through. However, unlike puberty it’s hardly talked about, which leads to a lot of anxiety and confusion when the transition starts. For many Jamaican women, this stage is often written off as “just stress” or mistaken for other illnesses. It’s time to shed light on this important topic.

Perimenopause USUALLY begins in a woman’s 40s and is caused by the gradual decline of reproductive hormones like oestrogen, progesterone and testosterone. The symptoms are wide and varied, including but not limited to:- irregular periods, fatigue, brain fog, sleep disturbances, mood swings, and hot flashes. These symptoms overlap with a lot of other medical conditions and can easily be confused with conditions like thyroid disorders, depression/anxiety, cortisol disorders or even brain tumours! These symptoms are also commonly found in women suffering from burnout—something many Jamaican women experience as they juggle work, family, and community obligations.

Risk factors

Now while there isn’t anything to completely prevent these symptoms, certain factors can increase the chance of more intense perimenopausal symptoms. Smokers in general tend to have worse symptoms than non-smoker. Other risk factors include obesity, having a sedentary lifestyle, and untreated medical conditions like diabetes and hypertension ( all common in our setting).

The HRT debacle

Over the past year, I’ve received numerous requests via social media and email about hormone replacement therapy (HRT). This surge in interest is likely due to its increasing prominence in mainstream media and among celebrities. However, there remains significant confusion and hesitation among medical practitioners when it comes to prescribing HRT.

For those of us who have followed the research over the past few decades, the narrative around HRT has been anything but stable. One moment, studies suggest it’s highly beneficial; then, new research emerges warning against its use. A few years later, experts revised their stance, only for another study to cast doubt once again. Now, we find ourselves back at the point where HRT is being reconsidered as a viable option.

This constant back and forth leaves many wondering: Should I trust what’s currently “in vogue”, or should I wait and see where the evidence lands next?

My approach

While many women want relief, they often hesitate at the idea of hormone replacement therapy (HRT) due to myths about its safety. However, HRT, when properly prescribed, can be highly effective for managing symptoms. Alongside this, there are natural options that align with Jamaica’s rich cultural heritage. Foods like yam and sweet potatoes, rich in phytoestrogens, can help to “balance hormones”. Herbal remedies such as vervain tea, traditionally used for calming, may be tried to ease mood swings.

Lifestyle changes can also make a significant difference. Regular exercise is key. A brisk walk around the neighbourhood, up the hill or on the beach can improve mood and sleep habits. Strength training is also important as part of the preparation for menopause, as increases in muscle mass are directly proportional to improvements in overall quality of life. Mindfulness practices like yoga or deep breathing can counter stress and improve overall well-being.

When to seek help

It’s important to know when to see a doctor. If symptoms interfere with daily life—whether it’s disrupted sleep, severe mood swings, or heavy, unpredictable bleeding—it’s time to act.

Perimenopause is a journey, not a destination, and no woman should navigate it alone. With the right guidance, you can thrive during this transition.

Dr Ryan Halsall, MBBS DMOG FACOG FMAS, is an OBGYN | Minimally Invasive Surgeon.