Perimenopause is the time in a woman’s life prior to entering menopause. Most people are familiar with menopause, which is when the ovaries stop producing hormones and women stop their periods. There are many options to deal with menopause (which is an entirely different podcast and blog). But perimenopause is a completely different animal compared to menopause. Perimenopause is usually between the ages of 40-50. I have seen some women enter perimenopause in their late 30s and well as in their early 50’s. But on average, perimenopause usually hits between the 40 -50. It can last for years. Which is unfortunate because the symptoms can really affect the quality of life. Many women have come to see me and tell me how their hormones are ruining their life. They have been to their general practitioners, gynecologists, PCP only to be told there is nothing wrong. These women end up feeling disregarded and frustrated because they are not finding answers or help. This is because perimenopause is not often discussed. Like I mentioned, everyone is familiar with menopause. But women in perimenopause are dismissed because many do not realize what perimenopause is. When I talk to these women and explain to them, yes it is your hormones causing your unwanted symptoms. They are stunned to find out there is a name for what they are experiencing. It’s called perimenopause.
So let’s get to it! Learn about the top five most common symptoms of perimenopause.
(I tried to put these in order of the most common. But honestly, these five symptoms are all equally common)
Women in perimenopause are often repeating over and over how tired they are. They are tired of complaining about how tired they are. I’ve had many patients remark on their family members (mainly kids, because they can be so honest), tell them they are repeating over and over how tired they feel.
But it is a different kind of tiredness. It’s more of a mental fatigue. I will ask my perimenopausal patients, ‘if I were to make you take a 3 mile hike with me right now, could you do it’? Which they reply, they could. How can you hike 3 miles and say you’re tired? It is because it is more of a mental fatigue. Yes, they could do the work/activity physically, but mentally they are just not into it.
Speaking of just ‘not into it’. Perimenopausal women often say their libido has not only left the building, it left the stratosphere. There are no physical issues going on here like you would see in menopause. In menopause when the estrogen has dropped dramatically, that can cause vaginal dryness, vaginal atrophy and pain with intercourse. In perimenopause, the estrogen has not declined that dramatically, so the libido issue is more of a mental one. Sex is just not on the brain. Perimenopausal women will say they are not interested or even thinking about sex. A hot-human can strut across your path, and it was like you didn’t even notice them.
Weight gain is a common complaint of both perimenopause and menopause. Women in their 40’s will often comment that it felt like they gained 15 pounds overnight. And the sad fact is that this weight gain was not due to any changes in their diet or lifestyle.
This is a very common issue in perimenopausal women. They have no trouble falling asleep. Your head hits the pillow and you are out in minutes, seconds even. But 3-4 hours later, you are up like it’s morning. And it can take hours to fall back to sleep. And of course by the time you do fall back to sleep, you need to wake up shortly. By morning, you are so tired.
As mentioned earlier, in perimenopause the estrogen has not dropped that much (as you see in menopause). But the progesterone has dived in perimenopause. This can cause period changes. It can cause days and days of spotting. It can cause heavier periods, which then can cause low iron (anemia). And/or it can cause two periods in one month, or changes in cycle length. Which of course makes it hard to predict when you next period will start, so make sure to keep some of those menstrual products around (everywhere…car(s), purse(s), pockets, even your grocery bags).
I have to say, there are more than just 5 symptoms of perimenopause. So I wanted to include some of the other changes that women might not attribute to their hormones when in perimenopause.
Hair changes: The change in hormones in perimenopause can cause your hair to get more curly (in my case, frizzy). It also makes your hair more vulnerable to damage (no more cheap drugstore shampoo/conditioner, here comes super expensive salon products). It can make your hair thinner and increase the shedding phase of hair.
Why are we breaking out on your 40’s? The change in hormones, mainly the drop in progesterone levels can cause the androgens (testosterone and DHEA) to become the leaders of the hormonal pack. So it can cause more acne, pimples, and even cystic acne prior to your period.
Short term memory, Forgetful:
No, it’s not dementia. In perimenopause we can become forgetful, absentminded, and seriously feel a little ‘out to lunch.’ Post it notes, lists, alarms on your phone become the norm (they are great helper tools to be honest). Even people, mainly family, because they have no manners (my own perimenopause head rearing) will remark, ‘you just asked that question!’ Short term memory can fly out the window. Not the long term memory. You can easily remember the dress you wore to a wedding 15 years ago (and what size it was, sigh). It is the short term memory that just won’t stick.
I don’t like to blame mood on hormones. There are so many factors in our lives that can drop a mood or change our moods. So I don’t like hearing others remark, ‘oh you’re in a mood, are you pms-ing, getting your period?” But between you and me, hormone changes in perimenopause can make us more irritable. In perimenopause when the progesterone drops and the estrogen and androgens are left in charge. Plus cortisol is not balanced, that can really cause irritability, or patience is short. Sure, not sleeping well and being tired can make you crabby, but the drop in progesterone can also wreck a mood.
I really could go on and on about the symptoms of perimenopause. Of course that doesn’t mean that perimenopause is really that horrible. I wanted to just show you that the reason you might be feeling the way you are, is because of your hormones. In fact, perimenopause is a great time of life. Trust me, I would not want to be 20 again (using plastic cutlery with only campbells soup in my cupboard). I really like my life right now at 49. But these symptoms can be helped and your hormones can be balanced.
If this resonated with you or you feel like you are in perimenopause, we have other blogs and podcasts about balancing your hormones.
Have questions? All questions are welcome. Just click on the link: Ask the Dr
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Episode 052 – What Biest Ratio is Best for Menopause?
This is such helpful information. I have often wondered who 80:20 is good for and who 50:50 is good for.
One thing I'm still confused by is the estrogen weight gain component. You said that estrogen (as well as menopause in general) could be the cause of her weight gain. I can relate. I was very thin my whole life, now 53 and about 30 lbs overweight. But you also said she might benefit from getting her estrogen balanced, and she was not using enough.
If too low a dose made her gain weight, won't an increased dose cause more weight gain? I have heard other podcasts and read articles that in menopause, we gain weight because our estrogen falls. Estrogen seems to be blamed for weight gain, whether it's high or low. Can you help clarify? There's something I'm not understanding. Thank you! Tracy
Often estrogen has been the scapegoat for weight gain. I'm sure you have heard too much causes weight gain. Too little can pack on the pounds. It can be pretty confusing. So which is it? Is too much estrogen causing my pants to become uncomfortably tight? Or is it too little estrogen that has given me the gut I never had?
Well, it’s not that simple. Estrogen levels do have a hand in weight gain and weight loss. But it is not the only variable. It really is the combination of the balance of estrogen with other hormones in your body. To name a few main players, progesterone, insulin, and cortisol, as well as enzymes, lipoprotein lipase (LPL), and hormone-sensitive lipase (HSL). Okay, I know that sounds vague and doesn't answer the question. Let's back up a bit and look at what women are saying about estrogen.
As soon as menopause hits, women complain that they are instantly 15-30 lbs heavier. Not because of diet or lifestyle. It's like menopause adds an unwanted 15-30 lbs overnight. Then some women are on hormone replacement therapy, taking estrogen, and are horrified because the HRT caused them to gain 10 lbs in a month. So what is it? Did the lack of estrogen in menopause cause that 20 lb weight gain? Or did that hormone replacement estrogen create rolls that were never there? Well, actually, both are true. Before you throw out your jeans in favor of high-waisted yoga pants, let’s learn about the other players in weight gain.
Progesterone will buffer estrogen. Estrogen does like to grow things'. That is why in puberty, you grow breasts and hips. Progesterone helps to balance some of the growth' that estrogen can cause. That is why in perimenopause, when the progesterone drops and the estrogen is running the show, the weight gain begins. That is also why when a woman starts estrogen therapy for menopause but not enough progesterone, there is weight gain.
‘Doc, I really don't feel like myself. I think it's my hormones. Could it be my hormones? Can you test my hormones?'
How many times have I heard new clients tell me this story? They go to see their GP, Gyno, or Internist, asking to have their hormones tested. Only to be told that there is no testing for hormones. Or that it's not necessary to test hormones. Only to leave feeling dismissed, with no answers to why they do not feel well.
While I understand that your GP, Gynocologist, and Primary Care Physician are not the jack of all trades,’ there are many tests for hormones. There are blood tests, urinary testing, and even saliva testing. The more difficult part of hormone testing is the interpretation. The basic lab values assigned by the labs are very vast, and without experience and training, it can be quite difficult to determine if there is a hormone imbalance.
If you are feeling like you have a hormone imbalance or having symptoms concerning your hormones, below is a list of common hormones to be tested and why. Because blood lab testing is so popular, I am going to stick to blood testing. Later we will have more labs and interpretations for urine and saliva.
To start, blood testing is just a look at one moment in time with respect to your hormone levels. In a menstruating woman, her hormone levels are changing every day. But in a menopausal woman where the ovarian function has ceased, her hormone levels are going to be pretty level day to day. So in a female that is still having her period, I like to try and aim for getting the blood drawn around day 12 and/or day 21. In a 28-day cycle, the estrogen will surge around day 12, and the progesterone will surge on day 21. This can give us better insight into her levels of progesterone and estrogen. In a menopausal woman that has not had a period or has sporadic periods with common menopausal symptoms, I will have her draw her blood any time of the month.
FSH and LH:
FSH stands for follicle-stimulating hormone, and LH stands for luteinizing hormone. These are not actually hormones. They are stimulating hormones.' Meaning both the FSH and LH are released from the pituitary gland (in your brain) in response to estrogen and progesterone production. The FSH and LH work in what is called a negative feedback loop.’ Meaning if the levels of estrogen and progesterone are high, then the FSH and LH are low. In turn, if the estrogen and progesterone levels are low, then the FSH and LH are high. It is like when you want your husband to take out the garbage. If he doesn't, you might raise your voice until he does. It is the same with all stimulating hormones. If the ovarian production of hormones is low, as in menopause or perimenopause, the FSH and LH levels will look high.
Estradiol and Progesterone:
Always test estradiol to get specific results for estrogen levels. Estradiol is much more specific for estrogen levels than simple total estrogens. Ideally, in a menstruating woman having the blood test around day 21 will give you insight if that woman is ovulating. It will so give you insight if there is progesteron