UNO editor Hayley Barnett sits down with leading expert Dr Linda Dear to unpack menopause’s grey zone of symptoms, the buffet of options beyond HRT, and why midlife's uninvited guest is more frenemy than foe.

It’s 3am on a Thursday morning. I’ve been lying here for the past hour tossing and turning, trying desperately to get back to sleep. What better time than now, I think, to write about my perimenopause woes?

I’ve had the same problem every day for the past week and it’s probably linked to the amount of sugar and caffeine I’ve been consuming as a solution to stay awake during the day. It’s a vicious cycle and, if I’m being honest, has become more of a lifestyle linked to my own vicious cycle, of the menstrual kind.

But, according to Dr Linda Dear, it doesn’t have to be this way. About a year ago, UNO interviewed Linda about the issue of menopause, and women still talk to me about it one year on. Linda is one of the country’s leading menopause experts who just happens to reside in Tauranga and runs her business, Menodoctor, from the Bay. Women come to her from all over New Zealand begging for help with symptoms that are increasingly affecting their professional and personal lives. 

“Most women who come to me are having symptoms of perimenopause and it’s impacting them either at home or at work or both,” says Linda. “A lot of the time, I’m just confirming what they already know − that it’s hormone related. But it can be such a grey zone and nobody’s really sure, including sometimes their own GP. They want to know they're not going mad or that they’re not ill or sick.”

I sit down with Linda to discuss my symptoms and what might help. I had completed a questionnaire before arriving for our appointment. Hot flushes? No. Sleep problems. Yes. Frequent urination. Yes. Night sweats. Yes. It dawns on me that waking drenched in sweat during a five-degree winter’s night probably isn’t normal. 

All these symptoms, though ‘not normal’, are actually very normal for a woman my age and beyond − 40 plus. But again, says Linda, they don’t have to be.

In my case, the contraceptive pill would help with PMS problems, she says, but so would HRT – and actually HRT comes with a lower risk of blood clots and other side effects, as it uses body identical lower dose estrogen. It also helps with insomnia. Sold.

But Linda is quick to point out that HRT is not the only option – and not always the right answer for every woman. Though she sings HRT’s praises, Linda describes herself as more holistic than many doctors in this area. She’s not against HRT and says for some women it’s the only thing that will help. But she also likes to offer natural alternatives.

“There are many things you can try,” she explains. “I like to offer what I call ‘the menopause buffet’. Women should be introduced to the whole table of treatments, and there are many that you can mix and match − and others that you can’t. But everything is optional, even the buffet itself. You don’t need to do anything if you don’t feel like it. You can just sit and enjoy the show if you prefer.”

The options include everything, from herbal supplements, like St John’s Wort, through to the contraceptive pill and SSRIs (antidepressants). 

“Lifestyle changes like adding weights sessions to your workout routine make a huge difference for some people,” says Linda. “Or just increasing protein in the diet − that can completely change everything.”

After asking me to take a blood test, Linda prescribes me some HRT with detailed instructions for patches and progesterone pills and suggests buying some iron tablets and ashwagandha for my sleep. 

While I’m grateful for the help, I wonder about those who can’t pinpoint certain times in the month, but who have similar symptoms. How can you tell if it’s perimenopause and not just dealing with life’s demands, I ask? Let’s face it, our forties are a very demanding time. We’re often dealing with kids, mortgages, careers, relationships, not to mention the possibility of World War III, climate change, the government, that weird rash Google tells you is 

probably fatal? Surely, the doom scrolling has something to do with our highly anxious states and lack of sleep. 

“We do need to be careful about blaming perimenopause for everything,” says Linda. “That’s why I don’t want to become an HRT factory. I also don’t want to deny anyone of that either, since we’ve gone far too long without it. We have to go through the symptoms and come up with a plan together. It’s about trial and error, finding out what helps and what doesn’t.”

We talk about my sleep issues and how they’re much worse if I drink even just one glass of wine.

“She loves to ruin our fun,” says Linda, who talks about perimenopause in the third person, referring to this time in a woman’s life as a friend, or more so, a frenemy. ‘She’ apparently is not a fan of alcohol, and neither is Linda. She explains the dangers of alcohol and its link to many different illnesses, one of which is breast cancer. It’s ironic then that it was only a decade or so ago that women were fearful of hormone replacement therapy (HRT) for its links to breast cancer.

“We think the breast cancer risk, which is very small – around an extra eight cases out of 10,000 women who take it – only starts after a woman has been taking HRT for at least five years. So taking HRT for less than five years likely carries no risk at all. But taking it for five years or longer means we do have to factor in a small risk of breast cancer. But this needs to balanced against the health benefits that HRT can bring, such as reducing heart disease, osteoporosis and diabetes. Research has also shown that when you start HRT before you turn 60, this leads to a longer lifespan. So these are pretty big benefits to think about.”

Despite there being a range of treatments, potions and lotions, and lifestyle suggestions, Linda is quick to point out that this time shouldn’t necessarily be looked upon as a negative.

“She’s not all bad,” Linda says. “Though there are some negative sides, we also need to see some good in this phase, as it’s a time of growth. A lot of women get through this and become a better version of themselves eventually − they feel more like themselves than they ever have. They can feel stronger and more empowered.”

As a woman, whether you decide to do something about perimenopause, or just ride the wave, there is definitely one thing to look forward to.

“Our periods stop!” smiles Linda. “We all have to admit the idea of that is quite nice.” 

Dr Linda Dear is UNO’s new menopause expert.
Look out for her column in the next issue.

Telltale signs you might be in perimenopause:

• Irregular or missed periods

• Hot flushes

• Sleep disturbances

• Memory and cognition issues

• Vaginal atrophy

• Mood swings

• Decreased sex drive

• Weight gain

• Hair, skin and nail changes

• Frequent urination

• Changing cholesterol levels