Why Perimenopause Is So Easy to Miss, and What Filipinas Can Do About It

Nobody really tells you that menopause—the big M—doesn’t arrive all at once. 

Medically, it comes after 12 months without a period—a full stop. The years leading up to it aren’t nearly as orderly: periods that skip months at a time, then come rushing back in with a vengeance; a night of cold sweats, then three weeks of nothing; a mind that suddenly goes blank midday, then sharpens the next day. 

This is called perimenopause, a transition that can start in your late 30s or early 40s and last for several years before your final period. 

For many Filipinas, it passes without a name. A restless night gets blamed on stress, a short outburst because of a slight mishap at home, or a skipped period mistaken for something else. The symptoms are easy to dismiss, especially in a culture where we’re taught to push through and keep things running—even when we’re at our wits’ end.  

But perimenopause isn’t a biological clock ticking down to the end. It’s a transition, one that goes beyond the hot flashes and irregular periods, and one that’s easier to navigate once you know what’s happening to your body. 

What is perimenopause?

Perimenopause in Filipino women is a conversation that’s gaining traction in the country. In a previous Allure Philippines article, OB-GYN and reproductive medicine specialist Marie Josephine Almaria, MD, MSc, FPOGS, FPSRM, explained the definition of this natural biological transition. 

“Perimenopause is an actual stage before a woman’s last menstrual period,” Dr. Almaria said. “Some women may have symptoms; others may not. But regardless, it’s actually a very important phase, health-wise.”

Lizzette Caro-Alquiros, MD, MBA, FPOGS, FPSMFM, explained that while perimenopause is a less defined period in a woman’s life, it’s still a very important one. “Perimenopause can begin anywhere from 2 to 10 years before that twelve-month mark,” she said, “and there is no clean starting line.” 

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A condition with no clear diagnosis

As for the symptoms, the Australian Department of Health, Disability, and Ageing outlined some known signs of perimenopause. These include trouble sleeping and fatigue; hot flashes or sudden feelings of heat in the face, chest, or skin; anxiety; brain fog and forgetfulness; dry or itchy skin; bladder problems; changes in periods; joint pain; and others. Roughly half of women report mild to moderate symptoms, while others have none at all. 

During Halia’s Decoding Women’s Health: From 30s to Perimenopause event, Allure Philippines spoke with Rega Stellar Pe, Director at the World Institute for Incurable Diseases (WIID), who says that this is part of what makes perimenopause hard to detect. 

“For perimenopause especially, there’s no clear diagnostic, there’s no screening test, and there’s no one medical test that you can do. And every symptom of perimenopause and menopause can also be a symptom of something else,” she says. Some symptoms conflict with each other, she adds. 

“From shorter cycles to longer cycles, from extreme fatigue to extreme agitation, you feel so tired that you don’t want to move, or you feel very nervous and hyper. So many of these symptoms can be conflicting,” she explains.

Why doctors say to pay attention

Which is also why, from a medical standpoint, this transition shouldn’t be overlooked. Dr. Almaria called perimenopause a “period of vulnerability.” She also highlighted the reasons why monitoring a woman’s health is important during perimenopause. 

“It’s associated with several diseases, like metabolic syndrome, diabetes, atherosclerotic cardiovascular disease or the buildup of fat and cholesterol in arteries, obstructive sleep apnea, thyroid dysfunction, anxiety, and depression. During this time, it is also best to screen for breast cancer, continue cervical cancer screening, and initiate colon cancer detection,” she said. 

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Why some women are affected more than others

There’s still the question of why the experience is different for every woman. Pe believes that the severity of the effects of perimenopause depends on each woman’s health: sleep, stress, diet, and how she treated her body over the years. 

Family history, she adds, is also a useful clue to when a woman’s turn might come. Research points the same way for early menopause. A 2015 study by J.S.E. Laven, published in Seminars in Reproductive Medicine, also found that menopause is highly heritable, with genetics accounting for around 50% of the variation in the age at which women reach natural menopause.

Emotional and cognitive symptoms often overlooked

Anxiety, brain fog, and feeling disconnected from your own body are some emotional and cognitive symptoms that Pe says usually get overlooked. 

Many women, she says, only start to connect their symptoms to menopause once they start having night sweats and hot flashes. By then, they’ve already written off the earlier signs as something else entirely. Pe says that since these perimenopausal symptoms can have other causes, this makes it easier to overlook. 

Medically, anxiety during perimenopause can be attributed to two factors, according to Johns Hopkins Medicine. Hormonal shifts play a part: as estrogen and progesterone drop, so does serotonin, which adds to irritability, nervousness, and anxiety. Physical symptoms like hot flashes, night sweats, and disrupted sleep can also add to these symptoms. 

How can you manage perimenopause symptoms?

Pe approaches this from a holistic angle. She resists treating symptoms one at a time. Hot flashes, night sweats, brain fog, and mood changes, in her perspective, are a constellation rather than separate problems, and chasing each with its own remedy gets overwhelming. 

The first step, she says, is to go back to the baseline and fix the foundations of health, which is where wellness and holistic practices, such as breathing exercises and stretches, come in. 

Pe says this approach can complement medication. “And that’s why we can work in conjunction with other protocols they’re using.” She still recommends doing the necessary medical tests to understand everything behind the scenes. 

Pe recommends doing breathing exercises and stretches to clear and relax the mind and body, which line up with the stress-management techniques, like yoga and meditation, that John Hopkins Medicine lists for easing anxiety during perimenopause. 

To ease symptoms, whether physical, emotional, or cognitive, OB-GYN and pelvic floor specialist May Anne Tabaquero, MD, FPOGS, FPSURPS, points to the basics: a good diet, regular exercise, and mindfulness. “It is also good to have a support system,” she said. “By preparing for it ahead of time, proper diet and exercise, regular OB check-ups, and curating your own tribe to help you with the changes that you will experience, perimenopause—and eventually menopause—will be easier to go through.”

No one can control how their perimenopause and menopause experience will go. What you can do is to walk into it prepared—mentally and emotionally.