Perimenopause.
One day everything feels normal, and then, boom, you feel like a different person overnight.
Your periods are weird.
Sleep is hard to come by.
Your diet is the same, but you’re gaining weight.
You’re exhausted, anxious, and irritable.
What used to work just isn’t working anymore, and you’re left wondering,
“What the hell is happening to me?”
Enter perimenopause.
What is perimenopause?
According to the Stages of Reproductive Aging Workshop (STRAW+10), perimenopause is the entire menopausal transition, plus the first 12 months after the final menstrual period.
In other words, it’s the time leading up to your final menstrual period.
But to understand what perimenopause is, first we need to understand premenopause
According to Dr. Heather Hirsch, when you’re in premenopause, estrogen consistently goes up and down, but it drops right before a period. Estrogen is a natural SSRI, so our mood can be heavily affected right before shark week.
Progesterone does the opposite of whatever estrogen is doing at this time. It increases the week before your period (affectionately known as PMS week) and is at its highest right before a period. As progesterone increases, you might experience water retention.
In perimenopause, estrogen levels start to decline and become erratic. So instead of steady ups and downs, estrogen now plummets and spikes. This can cause breast soreness and migraines.
During perimenopause, progesterone declines earlier than estrogen. This isn’t ideal because progesterone increases GABA, a calming neurotransmitter. And when progesterone declines, GABA also declines, and this can cause anxiety and insomnia in some women.
Who does this affect?
Perimenopause only affects women and people assigned female at birth.
It typically begins around age 47, but it can occur as early as your mid-30s or as late as 60.
It can last 1-10 years before your final period, but the average is 4 years.
First signs of perimenopause
Dr. Heather Hirsch says one of the hallmarks of early perimenopause is a change in your periods. This could be frequency, duration, flow changes, etc.
You might be bleeding longer than usual.
Or this could look like a 21-day menstrual cycle instead of your usual 28-day cycle.
Whether it’s a light or heavy flow, it can seem like you’re always on your period.
You may also experience spotting in between your periods as progesterone declines.
It can feel like your period is playing peekaboo with you.
How does this affect you?
According to the Mayo Clinic, symptoms may include, but are not limited to:
Irregular periods
Hot flashes
Sleep problems
Mood changes
Vaginal and bladder problems
Decreasing fertility
Changes in sexual function
Loss of bone
Changing cholesterol levels
What you can do about it
So is perimenopause something we’re just supposed to endure?
Absolutely not. Here are a few things you can implement to stay sane during this transition.
Start a strength training program
Lifting weights just feels great, and it helps offset some of the unfortunate symptoms of perimenopause.
Plus, if you want to look toned? That’s strength training.
Want to move better with less pain and effort? Strength training.
Want fat loss? Well, that’s mostly nutrition, but more muscle gives you that sculpted look.
In addition, increasing your protein and getting good sleep are vital to feeling your best during this transition.
Start journaling/tracking your periods and symptoms
Unfortunately, no lab test can accurately tell you if you’re in the early or late phase of perimenopause, so doctors advocate for journaling and tracking your period/symptoms so they can look at that data when deciding on your best treatment plan.
This could look like a simple notebook, a calendar, or an app on your phone. If you’re concerned about digital privacy, go the paper route. But however you decide to track, it’s important to start recording when your periods start and end. Over time, it will start to show patterns that will be hard to notice without the recorded data.
Perimenopause is a clinical diagnosis based on symptoms, not solely on lab tests, and journaling/tracking is an important part of the diagnosis process to help you reach a conclusion with your doctor much more efficiently.
When to see a doctor
Some women see a healthcare professional for their perimenopausal symptoms, but others either tolerate the changes or don't have symptoms that bother them.
Because symptoms may be hard to notice and can happen slowly, you may not realize they are caused by perimenopause.
If you’re experiencing irregular periods or any of the above symptoms, it’s time to see your healthcare professional. And since you’ve documented and recorded what you’ve been going through, it will be easier to see and understand what your body has been going through.
Whatever you do, don’t gaslight yourself.
Hormone therapies
Finally, low-dose birth control or other hormone therapies like menopausal hormone therapy (progesterone, estrogen, and vaginal estrogen) are some other things you can ask your doctor about when it comes to mitigating some of your symptoms.
These are outside the scope of what I can comment on, but they’re part of the perimenopause treatment toolkit.
Your journey up to and through menopause will look different than others, but we all deserve to understand ourselves and our bodies.
My hope is that more and more women will share their journeys so others feel less alone.
The more we understand, the better we can advocate for ourselves, get support, and navigate troubled waters with strength and poise.