Perimenopause is clearly having its moment now, and long may it last. More and more women are talking about their symptoms, experiences, and how they’re charting a way forward.
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Last week, I asked Google if itchy breasts were the result of wearing a poor quality bra, or perimenopause. Then I conducted an in-depth investigation into the ties between falling hair and falling estrogen levels. On Reddit.

Soon after, ChatGPT and I had a tete-a-tete about poor memory. Was I struggling to remember someone’s name because I wasn’t paying attention when we were introduced, or because of perimenopause?

‘Honestly, it could be either or neither!’ the chatbot responded. Very helpful.

I find myself asking the internet a lot of questions about perimenopause. It started last year, while working on a project that touched upon menstrual and menopausal health in the workplace. While the women on the team took great pleasure in schooling the men about menstruation, we quickly realised how woefully inadequate our own knowledge around menopause was.

And so, down a terrifying rabbit hole I went, reading about everything I could find that was menopause related: from brain fog and anxiety, to vaginal dryness and night sweats of biblical flood proportions. It seemed as if any and all horrific things a woman might experience with regards to her physical or mental health post the age of 35 might be because of menopause. Or, as the chatbot told me—it might not.

When All Fours blew up group texts

It was around the same time that I read Miranda July’s All Fours. Shortlisted for the Women’s Prize in fiction this year, The New York Times called it “the first great perimenopause novel”. It was being hotly discussed among select groups of urban women in their 40s back then, thanks to a newfound ease about sharing midlife experiences. The book’s protagonist is a 45-year-old artist who abandons her plans to drive from LA to New York solo soon after embarking on the trip, only to check into a motel room not far from her own home.

Miranda July’s All Fours.

In the first part of the book, she transforms the room into a jewel-like sanctuary, and then begins an affair with the decorator’s husband, a younger man who has dreams of becoming a dancer while working at the local Hertz rental. The novel is tender, deliciously dirty, and outrageously funny, raising questions around desire, libido, longing and freedom that were at times uncomfortable and at others, felt like a clarion call. But it was the second half that stayed with me, where the protagonist’s female friends shared their own experiences around perimenopause.

These were lived experiences that July herself gathered while writing the book. It echoed many of the women’s stories I’d read online on discussion forums. There was a real sense of pain, shame, anger, and often bafflement underpinning their experiences. ‘Why did no one warn me this was coming?’ many of them asked.

Midlife Margaret

Perimenopause is clearly having its moment now, and long may it last. More and more women are talking about their symptoms, experiences, and how they’re charting a way forward. And while there’s a slew of recently published books on dealing with menopause, the one that I’d like to read, would be a sequel to Judy Blume’s Are You There God? It’s Me, Margaret. Just as dear Margaret helped a pre-teen me find a safe space to grapple with topics like periods and bras, I’m sure her 43-year-old self is the right medium to comprehend just why my body feels like it’s on fire every now and then.

Judy Blume’s Are You There God? It’s Me, Margaret

But since the likelihood of this is low, my Instagram feed is standing in as an often highly unreliable source of information. I do not recommend this unless you’re willing to wade through reels in which women dance, work out and chug protein shakes while offering up a certain kind of perimenopause related-content: seven top tips to stop night sweats, five supplements to ease perimenopause, the single exercise you need to do to lose weight and build muscle, why Japanese women have less pronounced perimenopausal symptoms and how you can copy them. Wait, is that cultural appropriation? Hang ne a second while I ask Google.

The writer is a children’s book author and columnist based in Bengaluru.

According to the World Health Organization (WHO), while most cases of H1N1 are mild, severe complications such as pneumonia or respiratory failure can occur, particularly in individuals with underlying health conditions. Vaccination remains the most effective way to prevent influenza and its complications.

Science Quiz: On H1N1

Annual vaccination is recommended to protect against seasonal influenza, including H1N1

START THE QUIZ

1 / 6 |
What is the scientific name of the H1N1 virus?

Answer :  Influenza A virus (H1N1 subtype)

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2 / 6 |
What is the primary mode of transmission of the H1N1 virus?

3 / 6 |
H1N1 primarily affects only humans and does not spread among animals. True or False ?

4 / 6 |
How can you prevent the spread of H1N1 ? Mention three important measures

Answer : To prevent the spread of H1N1 (swine flu), three important measures include frequent handwashing with soap and water, practicing good respiratory hygiene (covering coughs and sneezes), and getting vaccinated against influenza

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5 / 6 |
Many H1N1 influenza pandemics have occurred over the years. Can you mention the year in which he most recent one took place?

Answer : There have been three H1N1 influenza pandemics . 1) 1918 – The “Spanish Flu,” caused by the H1N1 virus, resulted in an estimated 50 million deaths worldwide. 2) 1977 – Known as the “Russian Flu,” this pandemic was caused by an H1N1 virus similar to the one from 1950, leading to a milder outbreak. 3) 2009 – The “Swine Flu” pandemic, caused by a new H1N1 strain, led to widespread illness but fewer deaths compared to earlier pandemics. The most recent H1N1 pandemic occurred in 2009.

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6 / 6 |
Visual Question : This pioneering scientist first identified the influenza virus in the 1930s, paving the way for H1N1 research. Who is he?

Answer : Dr. Richard E. Shope — He was the first to isolate the influenza virus from pigs in 1931 — a critical step in understanding swine flu (H1N1)

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William Blake could have scarcely estimated just the expanse that a palm full can contain, when he said ‘hold infinity in the palm of your hand’, but science today can give him a fair estimate. Smaller and smaller wearable devices, with the surface area the extent of a mere watch dial, have come to play, measuring all kinds of health parameters on the go – heart rate, blood oxygen, even continuous blood glucose levels. Here’s yet another wearable, but one with a difference. Researchers have zeroed in on a wearable that can study the streams of molecular substances that pass through the skin, as a measure of studying the health status of individuals. What is different is that this wearable is ‘non contact’ relying on an enclosed chamber immediately adjacent to the skin’s surface to do its job. 

A collaboration of American and South Korean experts from the domains of materials sciences, dermatology, engineering, bio-medics and chemistry worked to produce a small device, just about the size of a smartphone face, that has demonstrated unique capabilities to measure the flux of water vapour, volatile organic compounds  and carbon dioxide at various locations on the body, to examine not just skin health but general health too. The particular use has been to study wound healing properties in diabetes and has the additional advantage of non contact operation, therefore potential damage to fragile tissues can be avoided. 

Catch it early, cost-effectively

John A. Rogers who is the Lewis Simpson and Kimberly Querry Professor of Material Sciences and Engineering, Biomedical Engineering, and Neurological Surgery at the Northwestern University, U.S. and is steering the research says his team has been working on wearable technologies for about two decades now. “With the COVID pandemic, there began a heightened awareness of the value of technologies that could continuously monitor health status; catch very early signs of disease or infection or health complications, in remote and, cost-effective ways. We have introduced a number of skin interface devices for measuring vital signs like electrocardiograms, blood oxygenation, body temperature.” 

The wearable in question however is unique, he explains. “It is unique in the sense that the sensors don’t contact the skin. They’re actually separated from the skin, and instead of directly measuring underlying physiological processes- cardiac cycles, lung function, for example, we’re measuring, properties of the skin itself and measuring species that emerge from the body through the skin to the surrounding environment. And likewise, we are also measuring chemical species that can move from the environment into the body through the skin.”  

He adds this is something that people haven’t looked at before, and experiments have proved that there’s a lot of interesting information that emerges, related to wound healing but also basic health. The authors write up the results in a recent paper published in Nature journal. This technology can provide unique insights for clinical decision-makers managing conditions such as dermatological diseases and dermal wounds, but who are also interested in understanding the underlying pathophysiologies better. It can also monitor hazardous chemicals that enter the human body via the skin, making it a viable option to monitor the health of persons working in hazardous industries and zones. 

How the skin works

He continues to explain: The skin is a layered substance with a pretty good impermeable water barrier on the very surface – called the stratum corneum. Underneath that is the epidermis and then the dermis. Those tissues are fairly permeable to water. But the stratum corneum is a very thin layer of dead cells, and serves as a barrier. If that barrier did not exist, you’d have tons of water evaporating and water loss just coming out through all surfaces of the body. So, it performs a very critical function as a water barrier. If that’s compromised in any way, then, you can be at risk for dehydration and, degradation in the properties of the healthy living part of the skin, the epidermis and, and the dermis. 

Therefore, measuring water permeation through the skin can tell you a lot about the barrier function of the skin, and various skin disorders can reduce the barrier functions, Prof Rogers explains. “You can monitor that. Transcutaneous CO₂ for example, coming right through the surface of the skin is important, and physicians already know how to interpret that.” He adds that their assumption is that the device, with its capacity to read and measure the environmental species that enters the body through the skin will likely yield additional insights that physicians are not aware of yet. 

What the device does

The device itself, he describes, is like a small pocket, with wireless electronics that can transmit data to your phone. It also has a chamber that forms a microclimate when the device is sealed against the surface of the skin. Suspended within that chamber is a suite of sensors, very small semiconductor devices that can measure water, CO₂, and various volatile organic compounds. On the back, there is a valve that can be opened and closed through a wireless trigger. When the valve is closed and the device is on the surface of the skin, the sensors measure a gradual increase in the concentration of water vapor and CO₂. When the valve is open to the surrounding environment, the heightened concentrations of those species can dissipate because now those species can just diffuse out to the surrounding environment. We make measurements with the valve closed, then open, and so on. The rate at which those concentrations increase determines the flux.”  

These low-cost devices can just be adhered to the surface of the skin, and measure these properties continuously, without a physician having to be at call. The device can be mounted anywhere on body and track outward flux and also inward flux at the same time. 

An additional vital sign

Prof. Rogers says there has already been some interest in the device from the perfumery industry. And while it has not yet been studied in an environment where the patient has suffered burns, he added that it would be an exciting pathway to launch on. Once adequate data emerges from the device over a period of time, measurements off the skin might turn out to be an additional vital sign that doctors rely on to estimate the health of their patients, in addition to the conventional vital signs.