Kristy Ram­nar­ine

Kristy.ram­nar­ine@cnc3.co.tt

Hot flash­es. Ir­reg­u­lar pe­ri­ods. Vagi­nal dry­ness. For mil­lions of women, these aren’t ran­dom in­con­ve­niences—they’re signs of one of life’s least talked-about tran­si­tions: per­i­menopause and menopause.

While per­i­menopause and menopause are close­ly re­lat­ed, they are not the same. In fact, they mark dif­fer­ent stages in a woman’s re­pro­duc­tive life. Ob­ste­tri­cian-Gy­ne­col­o­gist Dr Sherene Kalloo breaks it down:

“Per­i­menopause is the tran­si­tion­al phase that sig­nals what will hap­pen dur­ing menopause,” she said.

“I’ve had pa­tients who in­di­cat­ed they were go­ing through this tran­si­tion as ear­ly as 35 and oth­ers in their ear­ly 40s. A woman’s es­tro­gen and prog­es­terone lev­els be­gin to fluc­tu­ate dur­ing this time.

“Menopause is the point when a woman has gone 12 months with­out a men­stru­al pe­ri­od and nat­ur­al fer­til­i­ty ends. This usu­al­ly oc­curs around age 50 but can hap­pen ear­li­er or lat­er. Once menopause is reached, the body en­ters post­menopause. Symp­toms may per­sist but gen­er­al­ly be­come less in­tense over time.”

The symp­toms of per­i­menopause and menopause can over­lap, but they dif­fer in tim­ing and in­ten­si­ty.

“Per­i­menopause is the hor­mon­al roller­coast­er lead­ing up to menopause, so symp­toms are more er­rat­ic and tied to fluc­tu­at­ing es­tro­gen and prog­es­terone,” Dr Kalloo ex­plained.

“By the time some­one reach­es menopause, the body has set­tled in­to a low-es­tro­gen state. Symp­toms are of­ten stead­ier but can last longer.

“Most pa­tients com­plain about hot flash­es, fa­tigue, ir­ri­tabil­i­ty, vagi­nal dry­ness, dif­fi­cul­ty with sex­u­al in­ter­course, uri­nary is­sues, re­cur­rent in­fec­tions, yeast in­fec­tions, headaches, tin­gling, and ring­ing in the ears. There are many symp­toms as­so­ci­at­ed with per­i­menopause and menopause.”

De­spite be­ing a uni­ver­sal ex­pe­ri­ence, these tran­si­tions are still shroud­ed in si­lence, stig­ma, and mis­in­for­ma­tion.

“In­ter­est­ing­ly, a study found that in the Caribbean, it’s taboo to talk about menopause,” Dr Kalloo not­ed.

“I feel much of it comes from the stig­ma at­tached. So­ci­ety of­ten views women at this stage as old­er and less ca­pa­ble, even though many con­tin­ue to achieve sig­nif­i­cant per­son­al and pro­fes­sion­al goals. Most women don’t like to re­veal their age—it’s about both stig­ma and so­ci­ety ac­cept­ing women who are menopausal.”

The 2025 Menopause Ex­pe­ri­ence & At­ti­tudes Study re­vealed:

“Many bar­ri­ers pre­vent­ing op­ti­mal sup­port in menopause stem from the stig­ma as­so­ci­at­ed with this nat­ur­al life stage. Over half (59%) of those sur­veyed be­lieve menopause is a taboo top­ic that peo­ple are un­com­fort­able dis­cussing. On­ly a quar­ter (25%) think menopause is por­trayed pos­i­tive­ly in so­ci­ety, and two-thirds (66%) think menopause and its symp­toms are of­ten not tak­en se­ri­ous­ly.”

The study, de­vel­oped by Japan­ese multi­na­tion­al phar­ma­ceu­ti­cal com­pa­ny Astel­las in part­ner­ship with glob­al clin­i­cal ex­perts and menopause ad­vo­ca­cy lead­ers, ex­am­ined so­ci­etal at­ti­tudes, per­son­al ex­pe­ri­ences, and the stig­ma sur­round­ing menopause and per­i­menopause. Da­ta were col­lect­ed on­line from De­cem­ber 2024 to Jan­u­ary 2025, cov­er­ing both the gen­er­al pub­lic and in­di­vid­u­als with menopause ex­pe­ri­ence across Aus­tralia, Brazil, Cana­da, Ger­many, Mex­i­co, and the US, in­volv­ing 13,800 peo­ple.

Dr Kalloo points out that ef­forts to des­tig­ma­tize menopause are grow­ing.

“Des­tigma­ti­za­tion has been hap­pen­ing over the years,” she said.

“Women are work­ing more, be­com­ing in­de­pen­dent, and achiev­ing what they need to. These myths and taboos sim­ply need to be elim­i­nat­ed.”

Menopause can al­so bring mood swings, sleep prob­lems, re­duced li­bido, and even anx­i­ety or de­pres­sion. These shifts can af­fect in­ti­ma­cy, com­mu­ni­ca­tion, and pa­tience on both sides. If a part­ner doesn’t ful­ly un­der­stand what’s hap­pen­ing, or if the per­son go­ing through menopause feels dis­missed or un­sup­port­ed, re­sent­ments can grow.

“It’s not just a prob­lem for women but for men as well, be­cause men need to un­der­stand what women are go­ing through,” Dr Kalloo said.

“There are many mar­riages that strug­gle or even break down due to menopause and a lack of mu­tu­al un­der­stand­ing. Some women don’t ex­pe­ri­ence se­vere symp­toms and man­age well, but for those who do, it can be very chal­leng­ing.”

Lifestyle changes can make a sig­nif­i­cant dif­fer­ence in eas­ing symp­toms and sup­port­ing long-term health.

“Women shouldn’t wait un­til symp­toms start to make changes—they should be­gin in their 30s,” Dr Kalloo ad­vised.

“It’s about prop­er nu­tri­tion, reg­u­lar ex­er­cise, avoid­ing smok­ing and ex­ces­sive al­co­hol, and tak­ing rec­om­mend­ed sup­ple­ments like Evening Prim­rose cap­sules. These are our first steps be­fore con­sid­er­ing Hor­mone Re­place­ment Ther­a­py (HRT).”

More on HRT in Part 2.