Perimenopause 101 | Part 1

Perimenopause is the transitional phase that occurs before menopause, typically starting in a woman's 40s but sometimes as early as the mid-30s. During perimenopause, hormonal fluctuations begin to take place as the ovaries gradually produce less estrogen. These fluctuations can lead to a range of physical and emotional changes.

Signs that you might be entering perimenopause

1. Irregular Periods: One of the most common signs of perimenopause is changes in your menstrual cycle. Your periods might become irregular in terms of timing, flow, or duration. You might experience heavier or lighter periods than usual.

2. Hot Flashes and Night Sweats: Many women experience hot flashes, which are sudden feelings of heat that can cause flushing, sweating, and sometimes chills. These can also occur during the night, leading to night sweats that disrupt sleep.

3. Sleep Disturbances: Changes in hormone levels can lead to difficulties in falling asleep or staying asleep. This can result in insomnia or poor sleep quality.

4. Mood Swings and Emotional Changes: Hormonal fluctuations can influence mood, leading to mood swings, irritability, anxiety, or even depression for some women.

5. Vaginal Changes: Decreased estrogen levels can lead to changes in the vaginal tissue, resulting in dryness, itching, and discomfort during intercourse.

6. Changes in Libido: Some women experience a decrease in sexual desire and arousal during perimenopause due to hormonal changes.

7. Fatigue and Energy Changes: Hormonal shifts can lead to feelings of fatigue or low energy levels that may not be explained by other factors.

8. Weight Changes: Many women find that they gain weight more easily or that their body composition changes during perimenopause. This can be due to hormonal fluctuations and a slower metabolism.

9. Memory and Cognitive Changes: Some women report difficulties with memory, concentration, and mental clarity, often referred to as "brain fog."

10. Joint and Muscle Pain: Hormonal changes can contribute to joint and muscle pain, which may be new or more pronounced during perimenopause.

11. Digestive Changes: Some women experience changes in digestion, including bloating, gas, and changes in bowel habits.

12. Headaches: Hormonal fluctuations can trigger headaches or migraines in women who are prone to them.

If you're experiencing a combination of these symptoms and you're in your late 30s, 40s, or early 50s, it's possible that you're entering perimenopause. However, it's important to note that these symptoms can also be indicative of other medical conditions, so it's recommended to consult your doctor so they can evaluate your symptoms, perform any necessary tests, and provide guidance as you transition through this phase of life.

Lesser known symptoms of perimenopause

In addition to the commonly discussed symptoms, here are some lesser-known or less frequently mentioned symptoms of perimenopause:

1. Tinnitus: Some women may experience ringing in the ears or other ear-related disturbances due to hormonal fluctuations.

2. Changes in Body Odor: Hormonal changes can alter body odor, leading to unexpected shifts in how you perceive your own scent.

3. Gum Problems: Hormone fluctuations might lead to increased sensitivity or bleeding of the gums, as well as a higher risk of gum disease.

4. Electric Shock Sensations: Some women report experiencing brief electric shock-like sensations, known as "paresthesia," that can occur anywhere in the body.

5. Increased Anxiety and Panic Attacks: Hormonal imbalances can contribute to heightened anxiety levels and panic attacks for some women.

6. Dry Eyes: Hormonal shifts can impact tear production, leading to dry eyes and discomfort.

7. Acne Breakouts: Fluctuations in hormones can lead to an increase in acne, even in women who haven't dealt with it since their teenage years.

8. Changes in Hair Growth Patterns: Hormonal changes can cause hair to thin in some areas while becoming coarser in others.

9. Changes in Taste and Smell: Some women may experience changes in their sense of taste and smell during perimenopause.

10. Urinary Tract Changes: Hormonal shifts can lead to changes in urinary frequency, urgency, and incontinence.

11. Osteoporosis Risk: The hormonal changes of perimenopause can contribute to bone loss, increasing the risk of osteoporosis.

12. Heart Palpitations: Some women may experience heart palpitations, which can feel like a racing or fluttering heart.

13. Changes in Allergies: Hormonal fluctuations can lead to changes in the severity of allergies or the development of new allergies.

14. Restless Legs Syndrome (RLS): Some women may experience sensations of discomfort or the urge to move their legs, particularly at night.

15. Breast Lumps and Changes: Beyond breast tenderness, changes in breast tissue density and the development of breast lumps may occur.

16. Changes in Nails: Hormonal fluctuations can lead to changes in nail growth, texture, and strength.

17. Painful Intercourse: Vaginal dryness and changes in vaginal tissue can make sexual intercourse painful for some women.

18. Changes in Body Temperature Regulation: Fluctuating hormones can affect how the body regulates temperature, leading to feelings of being overly hot or cold.

19. Increased Migraines: Hormonal shifts can trigger migraines in women who are prone to them.

20. Changes in Muscle Mass: Hormonal changes can affect muscle mass and tone, potentially leading to changes in overall body composition.

Remember, not all women will experience these uncommon symptoms, and the severity and duration of symptoms can vary widely.

How does the hormonal shift unfold

Perimenopause is characterized by significant hormonal shifts that signal the gradual approach to menopause, the cessation of menstruation. These hormonal changes are driven primarily by fluctuations in the levels of two key hormones: estrogen and progesterone, which are produced by the ovaries.

During a woman's reproductive years, the ovaries release eggs during each menstrual cycle, and the levels of estrogen and progesterone rise and fall in a predictable pattern. However, as a woman enters perimenopause, these hormonal patterns become less predictable, leading to a range of physical and emotional changes.

1. Decline in Progesterone: One of the initial hormonal changes is a decrease in progesterone production. Progesterone plays a crucial role in preparing the uterine lining for a potential pregnancy. As the ovaries produce fewer eggs and ovulation becomes irregular, progesterone levels also decline. This can lead to changes in the menstrual cycle and contribute to symptoms like irregular periods, heavier or lighter bleeding, and changes in PMS symptoms.

2. Fluctuating Estrogen Levels: Estrogen levels also start to fluctuate during perimenopause. While overall estrogen production decreases, the levels may vary significantly from cycle to cycle. These fluctuations can cause symptoms such as hot flashes, night sweats, mood swings, and changes in libido.

3. Inhibiting Follicle-Stimulating Hormone (FSH) Surges: The hypothalamus-pituitary-ovary axis, a complex feedback loop involving the brain and reproductive organs, plays a significant role in perimenopause. The brain releases follicle-stimulating hormone (FSH) to stimulate the ovaries to produce estrogen. However, as the ovaries become less responsive to FSH due to declining egg reserves, the brain releases higher levels of FSH in an attempt to stimulate ovulation. These FSH surges can lead to irregular menstrual cycles and are often associated with symptoms like hot flashes and mood changes.

4. Changes in Other Hormones: In addition to estrogen and progesterone, other hormones like testosterone and thyroid hormones may also be affected during perimenopause. Testosterone, which plays a role in libido and overall energy, may decrease, contributing to changes in sexual desire. Thyroid hormones are also crucial for overall metabolism and energy regulation, and shifts in thyroid function can lead to changes in weight, energy levels, and mood.

Some women may experience more pronounced symptoms due to hormonal fluctuations, while others may have a smoother transition. The duration of perimenopause can also vary, lasting anywhere from a few years to a decade.

Blood work that your doctor may order...

Diagnosing perimenopause typically involves assessing a combination of factors, including symptoms, menstrual patterns, and hormone levels. While there isn't a single blood test that definitively diagnoses perimenopause, certain blood tests can provide valuable information. These tests help rule out other potential causes of symptoms and provide insights into hormonal changes associated with perimenopause.

1. Follicle-Stimulating Hormone (FSH): FSH is a hormone released by the pituitary gland that plays a role in the menstrual cycle. Elevated FSH levels may indicate a decline in ovarian function, which is common during perimenopause.

2. Estradiol: Estradiol is a form of estrogen produced by the ovaries. Estradiol levels can vary significantly during perimenopause, and lower levels are associated with the transition. However, single measurements of estradiol may not provide a full picture, as levels can fluctuate.

3. Luteinizing Hormone (LH): LH levels rise just before ovulation and trigger the release of the egg. Elevated LH levels, particularly when paired with changes in FSH, can be indicative of perimenopause.

4. Thyroid Function Tests: Thyroid function tests, including TSH (thyroid-stimulating hormone), T3, and T4, can help rule out thyroid-related causes of symptoms that may mimic perimenopause.

5. Anti-Müllerian Hormone (AMH): AMH levels can provide an estimate of ovarian reserve and may be used to assess the remaining egg supply. Lower AMH levels can be associated with closer proximity to menopause.

6. Prolactin: Elevated prolactin levels can cause menstrual irregularities and should be checked to rule out other potential causes of irregular periods.

7. Complete Blood Count (CBC): A CBC can help identify anemia or other potential underlying health issues.

It's important to note that the diagnosis of perimenopause is typically based on a combination of clinical evaluation, medical history, and laboratory tests. Your healthcare provider will consider your symptoms, menstrual history, and the results of these tests to make an informed assessment.