Perimenopause 101: What You Need to Know
Ask a room of 20- or 30-something women about menopause and
they’ll likely be able to tell you a thing or two about what symptoms
to expect and what’s going on in the body. But ask the same group
of women about perimenopause and you might hear crickets
instead. If this is the first time you’re hearing about perimenopause,
you’re definitely not alone.
The world “perimenopause” literally means “around menopause”
and describes the transition period between a woman's first
symptoms of perimenopause and full-blown menopause, which is
marked by 12 consecutive months without a period. After that, a
woman will remain in menopause for the rest of her life, an era that
is also commonly described as “post-menopause.” Perimenopause
typically begins 8 to 10 years before menopause when women are in
their early- to mid-forties.
Perimenopause Symptoms: What to Expect
It’s common to mistake popular symptoms of perimenopause—like hot flashes, night sweats, and mood swings—for those of menopause. But for many women, those symptoms start to subside once they reach full menopause. In other words, the worst is over by the time your period goes away completely.
Most symptoms of perimenopause are due to changing hormone levels. According to the Cleveland Clinic, the beginning of perimenopause is typically marked by the following symptoms:
Breast tenderness and pain
Worsening of PMS
Irregular periods (anything from 21 days to 35 days is considered normal)
Periods that are heavier or lighter than usual
You’ll be sure you’re in perimenopause when you notice you’re experiencing:
Hot flashes, night sweat, and cold flashes
Vaginal dryness and/or discomfort during sex
Emotional changes like irritability, mood swings, and mild depression
Dry skin, dry eyes, or a dry mouth
Some of these symptoms come and go and some happen all the time. They typically peak about one to two years before menopause when the drop in estrogen accelerates.
So how long will these symptoms—which can range from mild to severe—actually last? Typically about 5 years, but it varies greatly among women. In fact, as we learned in our deep dive into hot flashes and night sweats, some women can experience symptoms well into their 70s.
Perimenopause Facts: What’s Really Happening to Your Hormones
We know hormones are to blame for the symptoms above, but what’s really happening to our hormones during perimenopause? Just understanding the science behind our symptoms can help us better cope with them.
The worst is over by the time your period goes away completely.
In perimenopause, one of the first hormones to fluctuate
is inhibin. This hormone tells the pituitary gland to make
less follicle-stimulating hormone (also known as FSH).
During perimenopause, FSH levels are all over the place. One day it might be high, which signals to the ovaries to make more estrogen, and the next day they may be low. As a result, estrogen levels are also fluctuating up and down during perimenopause until the ovaries stop producing eggs altogether.
In perimenopause, you’ll also be ovulating less frequently, which means that progesterone—the hormone that increases after ovulation—will remain low. You can thank low levels of progesterone for your missed periods. Antimüllerian hormone (AMH) is also a key player in perimenopause. AMH is made by our ovaries and decreases as we age until it’s undetectable, which occurs in late perimenopause.
Common medications and treatments for perimenopause include low-dose oral contraceptives for a short period of time and hormone replacement therapy. That said, most doctors will suggest lifestyle changes before medication, as these medications do have some risks.
If you’re experiencing perimenopause symptoms—or simply want to do your best to prevent them—lifestyle is key. “It is well known that perimenopause is associated with bodily changes including weight gain, increased belly fat, less energy expenditure, higher insulin resistance, and a higher risk for metabolic syndrome (a predictor of cardiovascular disease and diabetes).” Says Dr. Anna M. Barbieri, M.D., an OB/GYN at Mount Sinai School of Medicine. Studies have also shown that women with healthy lifestyles experience fewer perimenopause symptoms and are better able to cope with the symptoms they do experience.
Dietary Changes for Perimenopause
On top of the typical healthy lifestyle recommendations like eating plenty of fresh vegetables and fruits, getting eight hours of sleep per night, limiting alcohol and avoiding tobacco, exercising regularly (including weight-bearing exercise in addition to aerobics to protect the bones), and reducing stress, there are some perimenopause-specific lifestyle changes you can make as well. According to Andrew Weil, M.D, leading integrative medicine physician and founder of the Arizona Center for Integrative Medicine, some herbs and supplements to consider are black cohosh, Dong quai, vitamin E, Evening Primrose oil, vitamin D, and B vitamins.
So what about perimenopause-specific dietary changes? It’s often recommended that women increase their intake of whole soy
products and flaxseeds to take advantage of their mild estrogenic effects. Dr. Barbieri, also recommends a diet that is low in processed foods and simple carbs. That said, she does not suggest the same nutrition plan for every patient. "There is not one perfect diet for everyone. But the common themes are plant based and whole food, and low on refined carbs and sugar.” She says it’s all about balance. “I love to see the tremendously beneficial effect a dietary change can have on my patients while being aware that we also do not cross over into obsession and rigid patterns.”
For too long too many women have entered perimenopause without the tools and resources they need to thrive. Arming yourself with knowledge during perimenopause can make all the difference. Understanding exactly what’s happening to your hormones and knowing that perimenopause looks and feels different for every woman can eliminate the fear of the unknown and empower you to tackle perimenopause with the same strength and perseverance you’ve used to overcome life’s other tests and challenges.
Perimenopause & Premature Menopause FAQS — North American Menopause Society
Perimenopause — Dr. Weil Center For Integrative Medicine
Perimenopause — Mayo Clinic
Menopause, Perimenopause, & Postmenopause — Cleveland Clinic
Menopausal Transition: What Is It? — American Society for Reproductive Medicine