What is perimenopause? It may be a mouthful, but it’s an important and oft-overlooked condition. Perimenopause refers to the transitional period between menstruation and the menopause, and it can last anywhere from two to ten years. It’s likely to affect pretty much everyone with ovaries at some point in their lives, but despite this it’s poorly recognised and understudied.

The effects of perimenopause are caused by oestrogen fluctuations, and they can have serious health impacts, including:

  • Anxiety
  • Brain fog
  • Pain
  • Skin changes
  • Mood changes
  • Vaginal dryness/bleeding

However, because it is so poorly recognised, many people wrongly attribute their symptoms to age, stress, or other factors. This can lead to the development of secondary health conditions, physical and psychological, that get worse the longer they go untreated.

So why isn’t perimenopause more widely recognised? Surely something that affects over half the world’s population deserves more notice? Unfortunately, awareness has remained low. One reason is the wide array of symptoms. Because the hormonal fluctuations can cause a wide variety of symptoms with varying degrees of consistency, they’re often not recognised as perimenopause, or ignored. In fact, women (and we’ll talk about who gets to be represented by ‘women’ in a moment) are less likely to be believed about medical issues, which compounds the lack of awareness and means that medical professionals can completely ignore perimenopause.


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There’s also a lot of stigma around reproductive health. This affects people of all genders, but is particularly challenging for cis women, and even more so for trans and non-binary people. If people feel like they’ll be ignored or misunderstood if they seek medical support, they’re much less likely to do so – and it’s much more likely that the symptoms will get worse.

For trans people, this problem can seem insurmountable. Even initiatives that very positively promote perimenopause awareness and care, tend to focus on cis women. Trans men and non-binary people get left out of the conversation, despite the fact that they may still be affected. Not all transmasculine people have surgery or change their hormone profile, and those who don’t can still be affected by oestrogen fluctuations. A similar problem exists in cervical screening, where transmasculine people miss out on vital screenings because the system only accounts for cisgender women.

On the other hand, transgender women who use oestrogen therapy to maintain their hormone levels offer us a way of understanding the effects of menopause and their treatment. Transgender women who have fully suppressed their endogenous hormone profile through the use of blockers or surgery can experience symptoms of menopause if their hormones are stopped. The Centre of Excellence for Transgender Health at UCSF has studied how cisgender women are often told to avoid long-term hormone therapy for menopause, but such limitations do not typically apply to transgender women. On the other hand, the natural alterations in hormone profile that occur as cisgender women age can offer a guideline for safe, bio-identical gender transition in older trans women. That transgender women can choose whether to enter menopause or not offers a pathway for everyone with this hormone profile, regardless of gender identity.


Ask The Medical Team


Reproductive health website Health & Her offers a free symptom tracker usable by people of all genders, with links for expert medical advice and support. If you have any questions or concerns about transgender healthcare and menopause, our trained team are always standing by to help. And, if you’d like to share your story, either comment below, drop us a line, or you can find us on Twitter, Facebook, and Instagram.