This piece was originally published on Elektra Health.
You’ve likely heard the term menopause before. But what about perimenopause?
While most of us are familiar with the idea of menopause, understanding of perimenopause is less common. Perimenopause means “around menopause” and is used to describe the transition period between the onset of your first symptoms and the onset of menopause, which is technically marked by 12 consecutive months without a period. A doctor would say that you’re “in perimenopause” when your cycles are irregular (i.e. varying by 7 days from your baseline, for example, a cycle of 33 days followed by a 26-day one) or when you skip cycles altogether.
Knowing what’s happening in your body and why it’s happening is so powerful. When you have this information, you’re able to be proactive and preventive — and if you need support along the way, you know how to access it.
Before we get into preparing for menopause, let’s talk a bit about some perimenopause specifics.
When, how, and why?
Perimenopause can be unpredictable. Periods change dramatically — they can become heavier and more frequent or lighter and intermittent. It’s generally a confusing time that catches many people by surprise.
Perimenopause is often broken down into two general phases: early perimenopause (when periods can still be regular) and late perimenopause (marked by skipped and/or irregular periods — more aligned with what people typically think of when they hear perimenopause or menopause). The full transition through menopause takes 8-10 years. And while most of us will start in our mid-40s, some may begin years earlier.
The takeaway? There’s no such thing as a one-size-fits-all experience when it comes to timing.
Perimenopause symptoms: what to expect
Some of the telltale signs of perimenopause — think hot flashes, night sweats, and mood swings — actually begin to subside once you reach menopause.
Below are common symptoms that signal the beginning of perimenopause, all of which can be traced back to changing hormone levels. (Though not everyone will experience any or all of these symptoms.)
- Weight gain
- Worsening PMS with both emotional and physical changes (e.g., breast tenderness and heightened anxiety)
- Irregular periods: This is an umbrella term that can include short or skipped menstrual cycles and heavy bleeding (often one of the earliest symptoms)
Throughout the remainder of your journey, you may notice a number of the following perimenopausal symptoms (but not always, and not all at once): hot flashes and night sweats, irregular periods, difficulty sleeping, emotional changes (e.g., irritability, mood swings, and mild depression, especially before your period), difficulty with concentration and short-term memory, vaginal dryness and/or discomfort during sex, and dry skin.
This might sound overwhelming, but there are lots of ways to mitigate these symptoms. First, we’ll explain a bit more about them.
Are the symptoms constant for the entire duration of menopause?!
It depends. Some symptoms come and go and others are more constant. What you can expect, however, is for symptoms to peak about 1-2 years before the onset of menopause. This happens because of an accelerated drop in estrogen.
How long will these symptoms last?
Typically five years — but remember, the perimenopausal experience isn’t one-size-fits-all for everyone. Some people may only experience a change in their period when nearing menopause, while others will experience it for upwards of 10 years.
Are these symptoms *always* due to perimenopause?
Not always, no. There are several common conditions, including thyroid abnormalities and even medication side effects that can cause similar symptoms, so be sure to check in regularly with your healthcare provider.
Is there a test for perimenopause?
Not really. Doctors may order tests to check your hormone levels and thyroid function, but these tests are imperfect at best since hormones fluctuate during perimenopause.
The low-down on hormones during perimenopause…what’s really happening?
Hormonal fluctuations are to blame for the symptoms listed above. But let’s break it down further.
In your 20s and 30s (i.e. during premenopausal cycles), hormones enjoy a predictable ebb and flow. During postmenopause, hormones are low but steady. But the in-between perimenopausal period is marked by one long hormonal fluctuation, with levels of the two key female hormones (estrogen and progesterone) varying quite a bit.
Progesterone starts to decline first, followed by estrogen, which fluctuates quite a bit as it does so. Testosterone also slowly declines. Those aren’t the only hormones that play a role.
Pre-menopause, FSH (follicle-stimulating hormone), and LH (luteinizing hormone) work together to produce a period. FSH causes eggs to mature in the ovaries and LH triggers the egg’s release. During perimenopause, FSH levels also fluctuate significantly.
Wondering what hormones you should keep an eye on and/or test to determine (around) when you’ll hit menopause?
Estrogen
Menopause occurs when ovaries don’t produce enough estrogen for ovulation (which means no periods).
FSH
Although FSH was once considered the “test” for menopause, it’s not the most useful in perimenopause. Levels vary far too much to rely on it as a predictor of the last period.
AMH
AMH (the anti-mullerian hormone) can help gauge the level of remaining egg cells (aka “ovarian reserve”). AMH decreases with age until it becomes essentially undetectable around menopause.
There are AMH tests in development, which can be used to assess whether a person’s last period will occur in the next 18 months or so (via a blood test). While it’s possible to do an AMH test now, we don’t know that it can accurately ballpark your menopause “ETA”. So for the time being, AMH testing is not a typical part of the menopausal hormonal assessment.
Interested in learning more about treatments? Tap here.
