This week: The mental health side of perimenopause can get much more serious than anxiety and rage. Plus, cervical cancer screening is going backward, why your hormones may be giving you dry eye, and what’s missing from your health record.
Suicidal thoughts can show up during perimenopause. Doctors can still miss it.
Everyone hears menopause and thinks hot flashes and night sweats. Even rage, anxiety, and depression are finally entering the conversation.
But no one’s talking enough about what happens when those changes get much more serious.
In one recent study at a menopause clinic, nearly 1 in 6 women said they had thoughts of death or hurting themselves.
The standard depression questions didn’t always tell doctors who was having suicidal thoughts.
And some women who had suicidal thoughts or self-harmed said they’d already gone to a doctor for help — but the possible menopause connection was missed. Some were treated for depression or anxiety without anyone considering whether changing hormones might also have a part.
That doesn’t mean HRT prevents suicide. It means doctors need to look at the whole picture.
What to ask: If your mood has changed a lot — especially if you’re thinking about death or hurting yourself — say that clearly. Ask whether perimenopause could be part of what’s going on and what treatment options make sense.
If you’re in the U.S. and thinking about suicide or need immediate help, call or text 988.
Your dry eyes could be perimenopause. Yep, even your eyes.
Seriously, who knew even your eyes could get dragged into this?
If your contacts suddenly feel like sandpaper, or your eyes are gritty, irritated, watery, or harder to focus, dry eye may be part of the problem.
Hormone changes can affect the glands that help keep your tears from drying out too fast. Less oil in your tears = more irritation.
What to ask: If your eyes are suddenly gritty, watery, red, or irritated — or your vision seems different — ask whether dry eye could be causing it.
Nearly 1 in 7 women 30–65 has never been screened for cervical cancer.
Most cervical cancer is preventable — so it’s pretty irritating to see screening heading in the wrong direction.
In 2005, about 5% of women ages 30 to 65 said they had never been screened. By 2023, it was nearly 15%.
More women are being diagnosed after the cancer has already spread.
A cancer this preventable shouldn’t be found late because women fell out of the system.
What to ask: Am I due for cervical cancer screening? Which test do I actually need? If you’re uninsured or underinsured, ask your local health department about free or low-cost screening.
Women can have a heart attack and still test “normal.”
A “normal” blood test can mean you’re having a heart attack and nobody catches it — if you’re a woman.
The “normal” level isn’t necessarily the same for women and men.
Women tend to have lower levels. So using the same cutoff for everyone can make an abnormal result for a woman look normal.
New heart attack guidelines are finally telling doctors to use different ranges for women and men.
File under: another thing in medicine that looked gender-neutral because men were the default.
What to ask: If you’re being checked for a possible heart attack, ask whether the test uses a different normal range for women. If you’re still having symptoms, ask whether you should be tested again.
Your bones start changing before your periods even stop.
Most of us think osteoporosis is something to worry about much later.
Our bones have other plans.
Bone loss starts speeding up about one to two years before your final period. And about 1 in 2 women over 50 will break a bone because of osteoporosis after menopause.
What to ask: Is there anything in your health history that puts you at higher risk for osteoporosis? If so, when should you get a bone-density test?
Asthma gets worse for women after puberty.
Before puberty, boys are more likely to have asthma — and then the pattern flips.
About 1 in 10 adult women has asthma, and women are more likely than men to have attacks bad enough to send them to the ER or hospital.
Hormones seem to be part of the story. Science just hasn’t figured out how. Some women notice changes around their periods or menopause, and some develop asthma for the first time later in life.
What to ask: If you’re wheezing, coughing, getting short of breath, or noticing that asthma you’ve had for years suddenly acts differently, ask whether you need breathing tests or a change in treatment.
There are finally actual guidelines for menopause at work.
New global recommendations cover manager training, flexible policies, temperature control, bathrooms, and asking for help without announcing your hot flashes to the entire office.
They’re voluntary, so your employer doesn’t have to use them.
But 68% of women say employers should play a role in supporting periods and menopause — and a majority want a clear process for getting help.
What to ask: Does your workplace have menopause support (not just a policy no one’s read)? If not, ask HR or an employee group about how to get one.
Doctors aren’t tracking menopause in health records. Even though women are telling them.
Women reported menopause in surveys about 193,000 times.
It was recorded in their medical records about 28,000 times.
That’s not a typo.
Among women who said they were menopausal, only about 14% had it listed in their medical records.
Doctors need the full picture. Researchers also use medical records to figure out who gets sick, when, and why.
If menopause isn’t recorded, it’s harder to understand how it may connect to heart disease, osteoporosis, dementia, diabetes, and everything else still poorly understood about women in midlife.
Decades of demanding more research on women. Kind of hard to deliver that when nobody’s writing the data down.
What to ask: Is perimenopause or menopause actually listed in your medical history? And are the symptoms you’ve talked about documented too?
And because apparently Woman™ Version 51.0 came with release notes, McSweeney’s has documented the bugs.
Know someone in the “wait, what the hell is happening” years? Forward this to her.
See you next Friday. — Trista