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 simpler terms, it refers to the transitional years leading up to menopause, when your menstrual cycles and reproductive hormones begin to change.
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 interacts with several neurotransmitter systems, including serotonin, which is one reason hormonal fluctuations can affect mood in some women.
Basically, your brain notices the hormonal rollercoaster leading up to shark week.
Progesterone follows a different pattern: it rises after ovulation and reaches its highest levels before your period (affectionately known as PMS week).
That hormonal shift can contribute to symptoms like water retention for some women.
In perimenopause, estrogen levels can become much more variable and unpredictable. You may still have periods when estrogen is relatively high, but you can also experience much larger fluctuations than you did before.
Those hormonal fluctuations can contribute to symptoms such as breast tenderness, headaches or migraines, and changes in mood.
As ovulation becomes less consistent during perimenopause, progesterone production can become more variable. Progesterone also has effects on the brain through neuroactive metabolites, including allopregnanolone, which interacts with GABA-A receptors, the part of the brain responsible for regulating inhibition, calmness, and arousal.
Researchers think changes in these hormonal and neurochemical systems may contribute to sleep and mood symptoms for some women during the menopause transition, but the relationship is complex.
Who Does this Affect?
Perimenopause occurs in people who have ovaries and who experience the menopausal transition
Perimenopause most commonly begins in your 40s, although the timing varies considerably from person to person.
The transition can last several years, although the length also varies considerably.
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
Strength training can’t stop perimenopause, but it is a useful tool in the perimenopause toolkit.
Strength training helps you build and preserve muscle so you love what you see in the mirror, and it gives your bones a reason to stay strong as bone loss becomes more of a concern.
Who doesn’t want to feel more capable and look great naked?
And honestly? Lifting weights just feels fucking good.
So 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
There isn't a single blood test that can reliably tell you exactly where you are in perimenopause. Hormone levels can fluctuate considerably during this transition, so clinicians generally use your age, menstrual history, symptoms, and other relevant information to make the diagnosis.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
Hormonal treatment, including certain birth control options and menopausal hormone therapy, are among the treatments healthcare professionals may consider for some perimenopausal and menopausal symptoms. Whether they're appropriate for you depends on your symptoms, medical history, age, and individual risk factors, so this is a conversation to have with your healthcare professional.
This is outside my scope as a personal trainer, but I think it's important to know that treatment options exist.
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.