What I Wish Everyone Knew About Perimenopause: A 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 often wonder about these changes but talk very little about them.
Many people know that the body goes through this phase of transition, and sometimes the symptoms are chronic and even debilitating. But what happens when you’re in perimenopause and you don’t even know it? And why aren’t you aware of it? The reality is that a lot of people go through perimenopause, but nobody talks about it, and many clinical providers do not identify it.
What is perimenopause?
Perimenopause is a transition phase in a woman’s life leading up to the last menstrual period, called the final menstrual period (FMP). It is marked by changes in the menstrual cycle along with other physical and emotional symptoms. This time can last from two to ten years, with an average of seven years.
Perimenopause is a natural physiological process in which your ovaries gradually stop working and no longer release eggs. Ovulation may become very erratic, which can lengthen or shorten cycles, and the flow may become irregular before your final period.
Perimenopause varies greatly from one woman to another. No two women have the same journey, which makes this condition so hard to diagnose with standard symptoms.
Signs your body is entering perimenopause
Here are some signs and symptoms that your body is entering perimenopause, and what you can do to make it more manageable.
- Hot flashes. The most commonly reported symptom, in 40% of women. A hot flash can come as a warm sensation over your scalp, face, neck and upper chest, and can last from 1 to 5 minutes. It can cause a lot of flushing along with sweating, chills and dizziness, and having one at a very inconvenient time, like a board meeting or a speech, can be quite disconcerting. Frequency varies: some women have them once or twice a week, while others may experience 10 in a day or night.
- Mood swings, trouble concentrating and trouble sleeping. There may be some cognitive changes, like short-term memory difficulties and forgetfulness, as well as feeling sad and irritable. Trending low estrogen levels may cause these mood symptoms, similar to premenstrual syndrome (PMS).
- Menstrual cycle irregularity. Cycles can be shorter, heavier or longer. This is due to irregular ovulation, lack of progesterone and fluctuating estrogen levels. It can disrupt your quality of life, or cause anemia if heavy menses continue.
- Other symptoms. Low sexual desire, vaginal dryness with physical intimacy, and frequent urination (overactive bladder). Midsection weight gain due to slower metabolism may also occur.
Non-prescription tips to navigate perimenopause and early menopause
- Start journaling your symptoms, and see if a pattern develops.
- Start open discussions about this natural phase of transition with a support network. Be mindful of the changes happening in your mind and body during this time, and try to shed the shame and stigma attached to this phase of midlife.
- Develop your own network of friends and family to support you.
- Lifestyle support. Start with a healthy diet, replacing processed carbohydrates with fruits, vegetables and whole grains; get 1000 to 1200 mg of calcium in your diet; and exercise daily for at least 30 minutes. Remove 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 with close to half a gallon of water daily.
- Non-hormonal options are available, though few studies prove their efficacy: evening primrose oil, isoflavones, vitamin D, 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 whether it is OK to stay on them long term with your existing health conditions and medications.
My labs are normal. Am I in perimenopause?
As mentioned above, your estrogen levels fluctuate and may not reflect exactly where you are in your journey toward menopause. However, if a menopause specialist orders a few serial labs (2–3 times), we may be able to see the trends of your estrogen and FSH. Once you are in menopause, defined as 12 months without menses, we see very low estrogen (less than 20 pg/ml) and FSH above 25–30 IU, which is diagnostic of menopause but not perimenopause. Hence it is very difficult to diagnose perimenopause with lab tests alone.
The dangers of ignoring severe symptoms
20–30% of women get severe symptoms, with worsening anxiety and an inability to get quality sleep, which has a harmful effect on daily functioning and mood.
Ignoring severe, persistent symptoms after trying the measures above is dangerous to your health and quality of life. Late diagnosis and treatment of perimenopause and early menopause can cause an increased risk of cardiovascular disease, stroke and cognitive decline.
When should I see my doctor?
Perimenopause and menopause are natural physiologic processes, but they do have physical and emotional symptoms. You do not need treatment if you’re coping well with the symptoms, both physically and emotionally.
However, if these symptoms bother you and affect your daily quality of life and functioning, you should see a menopause specialist to consider hormones tailored to your individual needs, taking a very detailed account of the risk factors in your personal health. This phase of life requires a sensitive, shared decision-making process. It takes time and expertise from your physician to come up with the right care plan for symptom relief, while avoiding adverse effects of therapy. Your gynecologist will also be able to correct any adverse symptoms arising from hormone therapy.
That is why you need a dedicated gynecologist who is certified in menopausal medicine and works with you as your partner in this historically unspoken journey toward menopause and beyond.
Looking for a certified menopause practitioner in Raleigh, in person, or by telemedicine in North Carolina or Wisconsin? Learn about our menopause and perimenopause care or request an appointment.