Is This Perimenopause? Recognizing the Signs and Taking Control

Heather Armstrong DNP, AGACNP-BC

Recently, perimenopause has taken center stage, and people are talking about it more than ever. You may have seen posts on social media feeds, heard podcast episodes focused on this topic, and browsed books explaining this phenomenon on the shelves of your local bookstore. 

With so much available information, where do you begin? 

What Exactly Is Perimenopause Anyway? 

On average, menopause occurs at age 52. It’s the end of the female menstrual cycle, and it becomes official after the absence of a period for 12 months in a row. Perimenopause is the transition period leading up to menopause and could begin in the mid-30s for some women and up to the mid-50s for others. However, the average age to begin perimenopause is in the mid-40s, and it can last anywhere from a few months to a few years. 

During this period, hormone levels begin to fluctuate. Estrogen and progesterone, hormones produced by the ovaries and essential to the reproductive system, begin to decline. Estrogen is responsible for most of the unwanted symptoms during perimenopause and for regulating progesterone and signaling ovulation. When menopause occurs, very little estrogen is produced, and the ovaries no longer produce eggs, resulting in the cessation of menstruation. 

It’s important to note that pregnancy can occur even with some skipped periods leading up to menopause. Even with declining estrogen, ovulation can still occur. People should practice safe sex to prevent unwanted pregnancy until achieving 12 consecutive period-free months.

Symptoms of Perimenopause

Symptoms in perimenopause can easily be confused with other conditions. Some women experience a range of symptoms that can be moderate to severe, impacting their quality of life, while others have minimal or very mild symptoms. 

It’s important to discuss all symptoms with your healthcare provider so they can help determine the cause. 

Symptoms vary but usually include one or more of the following:

• Hot flashes

• Night sweats

• Mood changes, including irritability, mood swings, or depression 

• Anxiety 

• Sleep disturbances, such as insomnia

• Urinary frequency, needing to pee more often

• Vaginal dryness, leading to discomfort during sex

• Low libido

• Skipped or irregular periods

• Changes in period flow, heavier or lighter than usual

Seek evaluation with your medical provider to rule out more serious conditions for periods that are heavier than usual: 

• Needing to change a pad/tampon every hour with large blood clots

• Having a period lasting more than a few days beyond your usual cycle

• Periods occurring less than 21 days apart

Diagnosis and Treatment 

Testing 

While there are no definitive tests available, some tests can indicate perimenopause or be used to rule out other conditions that could affect hormones. 

Measuring FSH ( Follicular Stimulating Hormone), produced by the pituitary gland and stimulating the egg release during ovulation, could indicate movement toward menopause if it is consistently high. However, due to significant fluctuations in levels throughout the month,  measuring hormones is not a reliable way to test for perimenopause. Hormone levels can also be affected by certain medications or other medical conditions. 

Treatment

Perimenopause is the natural progression to menopause, and there is no treatment to stop this process. 

Symptoms can be uncomfortable for some women, impacting their sleep and quality of life. There are many medication options, from hormone replacement through pills, patches, and creams to other non-hormone medications to manage hot flashes and mood changes. 

While hormone replacement is safe for most people, you should discuss this option with your healthcare provider before starting to evaluate any risk factors that may outweigh the benefits of taking these medications. 

Many lifestyle changes can help manage symptoms of perimenopause:

• Eat a healthy diet. 

• Maintain a healthy weight. 

• Partake in weight-bearing exercises or strength training.

• Dress in layers to easily remove clothing during hot flashes.

• Use a fan or lower the thermostat when possible.

• Improve sleep hygiene — avoiding TV and computer screens before bed.

• Limit alcohol and caffeine intake. 

• Practice stress management techniques, such as mindfulness or meditation.

• Quit using tobacco products, such as cigarettes.

Perimenopause is a natural yet often misunderstood transition. Understanding the symptoms and hormonal changes during this time empowers women to seek appropriate care and manage discomfort effectively. While there is no cure to stop perimenopause, lifestyle adjustments and medical treatments can greatly improve quality of life. Remember, open communication with your healthcare provider is key to navigating this stage with confidence and support.

References

Cleveland Clinic. (2024, June 24). Menopause. https://my.clevelandclinic.org/health/diseases/21841-menopause

Cleveland Clinic. (2024, August 8). Perimenopause. https://my.clevelandclinic.org/health/diseases/21608-perimenopause 

Assessed and Endorsed by the MedReport Medical Review Board