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Understanding Perimenopause: What You Need to Know

October 16, 2023

What is Perimenopause?

Perimenopause, which translates to “around menopause,” refers to the time period in which women experience the onset of symptoms leading up to menopause. First, menopause is officially diagnosed after  12 consecutive months without a period.  Perimenopause happens before menopause and is characterized by irregular menstrual cycles, either very heavy, very long, shorter, to skipped cycles, and many other symptoms.  Perimenopause can last up to 8-10 years, and often begins in a woman’s mid-40s, and sometimes earlier. Many women experience a peak in perimenopause symptoms about 1-2 years before menopause begins. 

Hormonal Changes during Perimenopause:

Perimenopause is characterized by fluctuating hormone levels, particularly estrogen, progesterone, and testosterone. Estrogen levels decline as menopause approaches, eventually leading to the absence of ovulation and menstruation. Follicle-stimulating hormone (FSH) and luteinizing hormone (LH), which regulate the menstrual cycle, also fluctuate during perimenopause, and contribute to irregular periods. Although tests like AMH (anti-mullerian hormone) can provide insights into ovarian reserve, accurately predicting the timing of menopause remains challenging through blood tests.

Symptoms of Perimenopause:

Perimenopause can bring about a range of symptoms, although each woman’s experience can vary. Common symptoms include irregular periods, very heavy or skipped periods, hot flashes, night sweats, mood swings, weight gain, worsening PMS, difficulty sleeping, emotional changes, difficulty with concentration and memory (known as “brain fog”), vaginal dryness, and dry skin. It’s important to note that not all women will experience all symptoms, and the severity can vary from person to person. Additionally, there may be racial and ethnic differences in symptom experiences, such as Black women experiencing more severe vasomotor symptoms, compared to Asian women.

Navigating Perimenopause:

Navigating perimenopause can be challenging, but there are evidence-based options available that can be helpful. It’s also important to note that not all symptoms are always due to perimenopause. Other conditions, such as thyroid abnormalities, medical issues and medication side effects, may cause similar symptoms. For this reason, it is essential to talk to a healthcare provider for a thorough physical and mental health evaluation. While doctors may order tests to check hormone levels, it’s important to understand that hormones fluctuate significantly during perimenopause, making it challenging, and not usually useful, to provide a definitive diagnosis through hormone testing. A “diagnosis” of perimenopause is primarily based on age, and the irregular menstrual symptoms someone is having. 

There are many interventions that can help someone who is struggling with the symptoms of perimenopause. Menopause hormone therapy (MHT), also known as hormone replacement therapy (HRT) is a very good treatment option, especially for many women with significant hot flashes and vaginal dryness or urinary issues. Other perimenopause-related symptoms may also be relieved with HRT. For those not able to take hormonal therapies, other non-hormonal treatments can help with various symptoms. For women who have significant mental health issues prior to perimenopause, and notice that their mood, anxiety or anger is much worse at this stage, antidepressant or anti-anxiety medications and talk therapy may be the most helpful approaches.  

Perimenopause is a significant phase in a woman’s life, and understanding its intricacies is the first step towards taking charge of your health and well-being. By seeking evidence-based options with expert health care professionals, you can navigate this transition with confidence and embrace the changes that come with it. Remember, BRIA can also help on the perimenopause journey, and provide the support and services that may be helpful to you.

Written By:

Dr. Ariel Dalfen

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