Is This Perimenopause?

Health Professional

Your periods are changing. They are coming closer together, and then farther apart, with more bleeding or less, more cramps or less and now you're passing clots. You may find your sleep is disturbed. You wake at 2 or 3 or 4 a.m. and are wide-awake, unable to get back to sleep. And your moods are suddenly an issue Irritability, impatience, short fuse...weepiness, low mood, lack of interest and motivation.

At your annual check-up you ask if these changes could be a signal of hormone change and you hear: "You're too young; it can't be perimenopause. You're still having periods; it can't be perimenopause. Your FSH isn't elevated; it's not your hormones. You're just depressed; it's not your hormones. You're just stressed; it's not you hormones."

Well the fact is it may just be your hormones! Women's levels of reproductive hormones, estrogen-progesterone-testosterone, begin to change anytime from the age 35 on. The word menopause actually means "end of the monthlies" and merely describes your very last menstrual period.

The average age of menopause is 51. The time leading up to it, which may last for several years, is peri-(around, near)menopause and is the time during which women will experience the most significant symptoms of the change. As the hormone levels drop and the balance among them changes, symptoms will arise. When women slow down or stop ovulating, they do not produce as much progesterone.

Just as low progesterone levels precipitate the familiar symptoms of PMS, the lower levels in perimenopause may result in similar issues, especially in sleep patterns and mood swings. However, there will be less predictability because the hormones are no longer following the previous menstrual pattern and may change on a day to day basis. Also, as the ovaries age, they produce less estrogen and testosterone. The low progesterone symptoms then are accompanied by, or soon followed by, those brought on by low estrogen (hot flashes/night sweats, dry skin-hair-nails, dry vagina, to name a few) and/or lower testosterone (change in, or lack of, interest in sex).

It's not in your head. These symptoms are very real and can significantly impact the quality of a woman's life. The two most common symptoms to bring new patients into my office are problems with mood and sleep. However, these are often accompanied by others as yet unmentioned, but significant: bladder changes, headaches/migraines, fuzzy thinking, muscle and joint aches and pain, discomfort with intercourse, painful breasts, heart palpitations, negative response to touch.

All of the symptoms are the possible result of our changing hormone levels and balance. There are many recommendations that can help to ease or even eliminate them which I will address in subsequent postings. But the first, and I think the most important, step is recognizing that this is perimenopause and beginning to get educated about the normal process of this life change.

And, yes, it is normal, but that does not mean that women have to, or even should, grit their teeth and press on. Perimenopause is an excellent opportunity to take an honest look at our lifestyle behaviors. What am I doing that contributes to good health that I want to continue? What are the changes I have talked about making but have not yet made? What are my bad habits that need to be eliminated? Our goal is healthy aging.

This should be the start of something GOOD!