What is Perimenopause?

menopause/perimenopause Dec 19, 2024

A smiling woman in her 40s, embodying confidence and positivity

Many women come into our office wondering what's happening with their menstrual cycles and why their hormones seem to be all over the place. They often ask, "Am I going through menopause in my 40s, or is this something else?" One stage of life that is talked about less than menopause is perimenopause.

To understand perimenopause, we first need to clarify menopause itself.

The average age of menopause for women in the United States is 52. Menopause is defined as the point when you've gone one year and one day without a period. After this 366th day, you are considered postmenopausal. So, while you’re menopausal for just one day, you’re postmenopausal for the rest of your life. The 2 to 15 years leading up to menopause is what we call perimenopause.

What Happens During Perimenopause?

Perimenopause can last anywhere from 2 to 15 years, depending on factors such as race, ethnicity, and genetics. It begins when women start experiencing symptoms of hormonal imbalances, which may include:

Irregular periods and bleeding patterns
Sleep disturbances
Hot flashes or night sweats
Mood changes or irritability
Changes in weight distribution
Decreased libido
Vaginal dryness

In essence, perimenopause is a clinical diagnosis, made based on symptoms, age, and menstrual cycles. There's no specific lab or diagnostic test to confirm perimenopause.

Surgical Menopause: A Special Case

It’s important to note that women who undergo surgical menopause—meaning the removal of both ovaries and the uterus—skip perimenopause and go directly into menopause (as long as they weren’t already experiencing perimenopausal symptoms before surgery).

If you undergo a hysterectomy and ovary removal before the age of 52, the Menopause Society recommends taking menopause hormone therapy (MHT or HRT) at least until you reach the natural age of menopause—unless contraindicated. Make sure to discuss hormone therapy with your surgeon or a menopause specialist if you have questions after surgical menopause.

Is Hormone Testing Necessary?

Many women want to know what their hormone levels are during this time, but they’re often told it’s not particularly helpful. Why? Hormone levels fluctuate daily, sometimes even hourly, during perimenopause. A single lab draw only provides a snapshot, not the full picture.

That said, we can test hormone levels on specific days of your menstrual cycle, such as Day 3 or Day 21. (Day 1 is the first day of bleeding, so Day 3 would be the third day of your period in a typical 28-day cycle, while Day 21 would be about a week before your next period.)

Testing on these specific days can give us an idea of whether certain hormones, like progesterone, are low while others, like estradiol (a form of estrogen), are high. However, lab tests aren’t necessary for diagnosing hormone imbalances during perimenopause. A menopause specialist can often identify these imbalances based on symptoms alone.

Managing Perimenopause Symptoms

Once we identify that you’re in perimenopause based on age, symptoms, and menstrual cycles, how can we manage these symptoms? Here are some common treatments for specific symptoms:

Vaginal bleeding: Progestin-IUD (Mirena), oral micronized progesterone, phytoestrogens from diet, or supplements like Vitex.
Vaginal dryness: Vaginal moisturizers, lubricants during intercourse, or vaginal estrogen, vaginal DHEA, hyaluronic acid.
Decreased libido: Testosterone therapy, medications like Addyi or Vylessi, or supplements like Maca, Ginseng, or Ashwagandha.

These are just a few examples of common perimenopausal symptoms and available treatments. If you're unsure whether your symptoms are related to perimenopause, consider booking a Discovery Call with our Nurse Practitioner, Jennifer, to gain clarity.

What to Expect

If you’re in your late 30s or early 40s, perimenopause might already be on your mind. One of the first signs of perimenopause is a drop in progesterone levels, which can lead to irregular and heavy bleeding, sleep disturbances, and mood changes such as increased anxiety. While progesterone steadily declines, estrogen levels remain variable, contributing to many of the symptoms women experience.

You Are Not Alone

The perimenopausal transition can feel overwhelming, but it's essential to remember that you are not alone. Many women experience similar challenges, and sharing your experiences can foster a sense of community and support. Connecting with friends, family, or support groups can provide comfort and validation. Seeking professional guidance from a menopause specialist can also make a significant difference, offering tailored advice and evidence-based treatments to help you manage your symptoms effectively.

Caring for your mental and emotional well-being during this time is crucial. Engaging in regular physical activity, practicing self-care, and incorporating stress-reduction techniques like yoga and mindfulness can alleviate emotional challenges and improve overall well-being. Educating yourself about perimenopause is empowering and can help reduce fear and anxiety. Remember, with the right support and information, you can navigate this phase with confidence and grace. We are here to guide you through this journey, ensuring you feel empowered to embrace this new chapter in your life.

If you’re looking for more information about perimenopause, check out Episode 19 of the Uplift For Her podcast, where Dr. Cracroft and Jennifer, DNP talk all things perimenopause and menopause.