Perimenopause is the natural transition period between healthy, reproductive function and the onset of ‘official’ menopause (defined by 12 consecutive months without a menstrual period). Perimenopause, which is really more of a biological progression than a series of specific events, is often a time of hormonal imbalance and fluctuations in estrogen, progesterone and testosterone.
In many ways perimenopause is like puberty, when your hormones can be all over the map. The median age when perimenopause begins is 47.5 years, though for some women it can begin as early as their mid-30s, and for others, as late as their 50s. The median age of onset of menopause itself is 51.3 years.
When women ask me how they can be sure they’re in perimenopause, I suggest they look to their symptoms for clues. Are your symptoms new? Are some of them familiar, but now suddenly worse than before? Are your symptoms erratic, with no clear pattern to them? Any of these may indicate that you’re in perimenopause with hormones that are fluctuating wildly.
Why does perimenopause cause symptoms?
As with other parts of your endocrine system, sex hormone levels and the menstrual cycle are regulated via constant feedback between the hypothalamus, pituitary and ovaries. For this ‘hypothalamic-pituitary-ovarian axis’ to function properly, each part must be sensitive enough to respond to incoming signals from the other areas.
The number of follicles (sacs that each contain an immature egg) in the ovary decline as we age, causing them to become less responsive than before. As a result, the hypothalamus steps up its signaling for awhile, including follicle-stimulating hormone (FSH) and luteinizing hormone (LH), also called ‘gonadotropins.’ In a sense, they’re now yelling louder to get attention. During perimenopause, the ovaries may be either non-responsive or hyper-responsive. In the latter case, the loud FSH signal may cause estrogen levels to spike.
A common misconception is that menopause (and the period leading up to it) means a gradual but steady decline in estrogen. In fact, estrogen levels during the perimenopausal period can sometimes climb higher than they’ve been for years — one reason for sometimes dramatic changes in your menstrual periods. Another misconception is that all symptoms result from diminishing estrogen.
In reality, many different symptoms can be associated with a wide range of factors, not just low or changing estrogen levels. Hormone fluctuations have a much bigger impact on symptoms than the actual levels of the hormones, and when these fluctuations are too wide or occur too quickly, your body can have trouble managing them (See chart below). Besides fluctuations in estrogen, FSH and LH, there are also changes in levels of progesterone, testosterone and DHEA.
With hormone imbalance, you may experience symptoms: irritability, anxiety, depressed mood, irregular periods, muscle aches and joint pains, menstrual migraines, poor memory, disrupted sleep, hot flashes, vaginal dryness, or changes in sex drive. I’d also like to point out that these symptoms might appear before you notice any change in your periods, though the problems are certainly compounded when they coincide with erratic periods.
It’s normal to change
This diagram illustrates normal variation in sex hormones across a woman’s lifespan.
Our bodies are remarkably effective at managing changing levels of hormones throughout our lifetime. However, the cumulative effects of poor diet, chronic stress, lack of sleep, too little exercise, and environmental toxins often undermine the body’s ability to compensate, causing sex hormones to fall out-of-sync. During times of the most dramatic changes — such as pregnancy and perimenopause — these changes can feel especially uncomfortable. Perimenopause is the time to offer your body the kind of support it needs to restore hormonal balance and ensure a smooth transition into menopause.
What can make symptoms of perimenopause more severe?
A 2004 study showed that women who suffered from PMS during their reproductive years are twice as likely to also have symptoms in perimenopause. Peri- and post- menopausal women experiencing feelings of depression are also more likely to have had a depressed mood during PMS, after childbirth, or while using oral contraceptives. Because these scenarios involve dramatic fluctuations in hormones, a woman who is generally sensitive to such fluctuations will likely be sensitive to hormonal changes in perimenopause as well.
Even so, symptoms like depressed mood can also show up for the first time in a perimenopausal woman. The good news is that, many symptoms, especially mood swings, improve as our bodies gradually adjust to menopause. There is also a lot we can do to smooth out the fluctuations causing the symptoms.
Women who carry extra life burdens tend to have more extreme hormonal imbalance. And in my experience, the heaviest health burdens relate to chronic stress and emotional issues. If you describe your life as a journey, you might consider that perimenopause is like standing at the baggage claim.
Chronic stress and unresolved emotions are like baggage that we need to handle right now, or it just keeps on circling around. Compounding perimenopausal symptoms in many women are concerns that can often accompany general aging, such as parenting strain, caring for aging parents, economic stress, poor sleep, concurrent health conditions, and even uncertainty, in general, about the aging process.
Chronic stress can amplify the effects of changing sex hormone and neurotransmitter levels in perimenopause and menopause, as well as the ratios between these hormones, resulting in more dramatic symptoms. It’s helpful to remember that the basic building blocks for hormones can either head toward the production of stress hormone (cortisol) or sex hormones. With chronic stress, continual production of cortisol causes sex hormone production to take a back seat. As a result, both stress management and adrenal support are critical in turning this around.
Also high on the list of burdens are spotty nutrition, inadequate sleep, and sedentary lifestyle. These factors can escalate symptoms in perimenopause because they reduce your body’s natural ability to detoxify and maintain balance. In today’s fast-paced, disconnected, eat-and-run world, it’s not a surprise that younger and younger women are experiencing perimenopausal-type symptoms of hormonal imbalance.
How can I relieve my perimenopause symptoms?
Perimenopause and menopause share many of the most common symptoms. I’ve found that the most effective approach to relief covers the foundation of women’s health: a healthy and balanced diet, enjoyable exercise, rest and relaxation, herbs and nutrients targeted to hormonal balance, and solid emotional support. This combination can make all the difference for women who are looking to relieve their symptoms.
At Women's Health Network, we suggest starting with a great multivitamin-mineral complex like our Essential Nutrients, to provide the key levels of micronutrients your body requires, but which are often lacking. Such targeted nutritional support may be enough to begin healing your hormonal pathways.
If not, the next step is gentle phytotherapy (medicinal herbs). (Our Herbal Equilibrium is specially formulated to help balance hormones and relieve symptoms for women transitioning through perimenopause.) Phytotherapy supports the body’s ability to restore hormonal balance by mimicking hormonal actions at a molecular level to help balance out the highs and lows. These herbs also interact with your body’s tissues to facilitate natural hormone regulation.
Most women find that adding high-quality nutrients and phytotherapy is enough. Others need more support for ideal symptom relief. You can add more essential fatty acids as omega-3s or amino acids like 5-HTP. Complementary therapies like acupuncture or chiropractic can also help. Different women have different needs, so you may want to work with a healthcare practitioner to decide which specific therapies can best help you.
From “what the heck?” to “I can do this”
Perimenopause can be difficult at first, especially if you don’t know what’s happening in your body. Some women fret that they waited too long to have children. Others see it as the “beginning of the end.” But during this natural transition, you don’t have to accept anything less than having optimal health and great hormonal balance. One woman shared with us that she had been “in denial” for years about what was going on in her body before seeking relief for her physical issues. Ultimately, she found the relief she needed along with peace of mind about where she was on life’s timeline.
Wherever you may be on your journey through perimenopause, the symptoms you feel will ultimately influence your actions and reactions to life itself. I encourage you to choose not to let your symptoms define you during this stage and ensure you get what you need to feel the way you want.
You do have the power to help yourself thrive during this time. And we are always here to help. Many women have discovered, much to their surprise that perimenopause is a wonderful time of growth and transformation.
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9 Woods NF, Mitchell ES. Symptoms during the perimenopause: prevalence, severity, trajectory, and significance in women's lives. Am J Med. 2005 Dec 19;118 Suppl 12B:14-24