Alray Direct Gynecology And Intimate Health Center

What I Wish Everyone Knew About Perimenopause – FEW Things No One Has Told You

What I Wish Everyone Knew About Perimenopause – FEW Things No One Has Told You.

Most women in their forties are in perimenopause when they experience symptoms of night sweats, hot flashes, anxiety, depression, migraines, erratic menstrual cycles, or heavy bleeding. Women are often wondering about these changes but are talking very little about them. 

Many people know that the body does go through this phase of transition and sometimes their symptoms are chronic and maybe even debilitating. But what happens when you’re in perimenopause and you don’t even know it? And why aren’t you aware of this? The reality is that a lot of people go through perimenopause, but nobody talks about it and many clinical providers do not identify it. 

Perimenopause is a transition phase in a woman’s life leading up to the last or final menstrual period (FMP) which is called the final menstrual period. Perimenopause is marked by changes in the menstrual cycle along with other physical and emotional symptoms. This time can last from two years to 10 years with an average of seven years. 

Perimenopause is a natural physiological process where your ovaries gradually stop working and do not release any more eggs. Ovulation may initially become very erratic and can lengthen the cycles, shorten cycles and the flow may become irregular before your final period. 

Perimenopause varies greatly from one woman to the other and no two women will have the same journey which makes this condition so hard to diagnose with standard symptoms. 


Here are three signs and symptoms your body is entering perimenopause, and what you can do to make it more manageable.

1-The most commonly reported symptom is a hot flash in 40% of women and it can come like a warm sensation from your scalp, face, neck, and upper chest. It can last from 1 to 5 minutes. It can cause a lot of flushing associated with sweating, chills, dizziness, and having this at a very inconvenient time like a board meeting or a speech can be quite disconcerting. The frequency of these hot flashes can also vary; some women may just have once or twice a week and others may experience 10 in a day or night. 

2- The other common symptoms are mood swings, trouble concentrating, and trouble sleeping. There will be some cognitive decline like short-time memory difficulties, forgetfulness, feeling sad, and irritability. The trending low levels of estrogen hormones may be causing these symptoms of mood like premenstrual syndrome PMS.   

3- There is menstrual cycle irregularity- where cycles can be short, heavier, or lengthened. This is due to irregular ovulation, lack of progesterone, and fluctuating estrogen hormone levels. This can be a quality of life disrupter or cause anemia if heavy menses continues. 

4- Other symptoms are low sexual desire, vaginal dryness with physical intimacy, and frequent urination ( overactive bladder). Midsection weight gain due to slower metabolism may also occur.    


Non Prescriptive Treatment tips to navigate Perimenopause and early Menopause. 

1-Start journaling your symptoms, see if there is a pattern developing in your symptoms of perimenopause 

2-Start open discussions of this natural phase of transition in your body with a support network. Be mindful of changes happening in your mind and body during this time. Try to shed shame and stigma attached to this phase of midlife. 

3- Develop your own network of friends and family to support you. 

4- Lifestyle support- Start with a healthy diet removing processed carbohydrates and replacing them with fruits, vegetables, and whole grains, 1000 to 1200 mg of calcium in your diet, and daily exercise of at least 30minutes. Remove the triggers for your hot flashes like alcohol, tobacco, spicy food, and caffeine. Take a walk and get adequate sleep of 6-7 hours daily. Hydrate at least close to half a gallon daily.   

5-Non Hormonal medications are available – few studies prove their efficacy- Evening Primrose oil, Isoflavones, VitaminD, Black Cohosh, Red clover, St John’s Wort, and other dietary soy supplements. All supplements can have potential side effects and drug interactions. Please check with your provider if you are OK to stay on it for a long time with your existing health conditions and medications that you take.   


My labs are normal – Am I in perimenopause? When should I see my Menopause certified specialist? 

As mentioned above your estrogen levels are fluctuating and they may not reflect exactly your stage in this journey towards menopause. However, if a menopause specialist orders a few serial labs 2 -3 times, we may be able to know the trends of your estrogen and FSH. Once you are in menopause which is 12 months of absent menses we see very low estrogen less than 20pg/ml and FSH above 25-30IU which is diagnostic of menopause but not perimenopause. Hence it is very difficult to diagnose perimenopause with lab tests alone.


Dangers of ignoring your severe symptoms of Perimenopause or Early Menopause.

20-30 % of women get severe symptoms with worsening anxiety and inability to get quality sleep which has a deleterious effect on their daily functioning and moods. 

Ignoring your severe persistent symptoms after trying the above measures is dangerous to your health and quality of life. It is proven that late diagnosis and treatment of this perimenopause and early menopause can cause an increased risk of cardiovascular disease, stroke, and cognitive decline. 



When Can I see my doctor? 

 Thus Perimenopause and Menopause is a natural physiologic process but it does have physical and emotional symptoms. You do not need treatment if you’re coping well with the symptoms of both your physical and emotional well-being. 

However, if these symptoms bother you and they affect your daily quality of life and functioning then you need to see your Menopause specialist to consider hormones that have to be tailored to your individual needs taking a very detailed account of your risk factors in your personal health. This is a phase in your life that requires a super sensitive shared decision-making process. It needs time and expertise from your physician to come up with the right care plan for your symptom relief avoiding the adverse effects of this therapy if it were to happen.  

Your gynecologist will also be able to correct any adverse symptoms arising from such hormone therapy.  

Hence you will need a dedicated gynecologist who is certified in Menopausal medicine and works with you as your partner in this historically unspoken journey towards menopause and beyond.