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).
Other:
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.
Skin changes:
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.
Mood Changes:
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
All content found in this blog, including: text, images, audio, video or other formats were created for educational purposes only. The purpose of this website and blog is to promote consumer/public understanding and general knowledge of various health topics. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Please consult your healthcare provider with any questions or concerns you may have regarding your condition and before undertaking a new health care regimen. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. If your healthcare provider is not interested in discussing your health concern regarding this topic then it is time to find a new doctor.
Other Related Episodes:
Episode 116 How Do I Stop Weight Gain During Perimenopause?
Discover the common and unfamiliar symptoms that you might be experiencing. Get access to cases of real women with hormonal conditions.
In this episode, we discuss the best way to reduce triglycerides. Sasha, a podcast listener, asked us how to lower her triglycerides. We then go into depth about triglycerides, how to lower them, and why they could be high in the first place.
How to read a lipid panel
Supplements for lowering triglycerides
Lifestyle changes for lowering triglycerides
What do high triglycerides mean?
Building blocks for triglycerides
Improving metabolic health
Can menopause increase triglycerides?
High triglycerides and thyroid hormones
Sacha’s Question:”I know this isn’t a hormone question but was hoping you could give me some direction. I was wondering what is the best way to lower triglycerides? thank you for your help!”
If you have a question, please visit our website and click Ask the Doctor a question.
Disclaimer: All content in this blog, including text, images, audio, video, or other formats, was created for informational purposes only. This video, website, and blog aim to promote consumer/public understanding and general knowledge of various health topics. This content is not a substitute for professional medical advice, diagnosis, or treatment. Please consult your healthcare provider with any questions or concerns youmay have regarding your condition before undertaking a new healthcare regimen. Never disregard professional medical advice or delay seeking it because of something you have read on this website. If your healthcare provider is not interested in discussing your health concerns regarding this topic, then it is time to find a new doctor.
In this episode, we discuss a podcast listener’s question. ‘Alesha’ is concerned that she should not take estrogen replacement therapy because she has fibroids. This is a common concern. The idea that estrogen can cause or propagate fibroids has left many menopausal women without support for their symptoms. Just because women have or have had a history of fibroids does not mean they are not a candidate for estrogentherapy. In fact, women with fibroid can take estrogen hormone replacement therapy.
In this episode, we go into depth about taking estrogen with fibroids. And we break Alesha’s question into:
What are fibroids?
Fibroids and estrogen replacement therapy
Can I take estrogen if I have fibroids?
What is adenomyosis?
Estrogen’s role in fibroids
Difference between perimenopause and menopause
How menopause can affect prediabetes
Alesha’s Question:
“Is there any hope for someone with adenomyosis take estrogen? If so, when is the right time? I know adenomyosis is stimulated by estrogen. I even had 1 dr offer a hysterectomy so I could take estrogen without any issues ??!! I have a history of heavy periods have had many trans vag ultrasounds and biopsy’s over the years Uterus was enlarged, lining was wnl. Had a hysterscopy to remove some cysts they found 4 hrs ago. Last ultrasound showed probable adenomyosis.i am almost 57and I am in late perimenopause. Cycles have been erratic just went 6 months without a cycle then had a normal cycle…for years of perimenopause I had symptoms of high estrogen. Most of the time for the last year I had symptoms of low estrogen. Poor sleep waking up 4-5x night, dry skin, vaginal dryness, night sweats, brain fog, difficulty concentrating which makes my job very difficult. I have also developed mild sleep apnea(sleep lab) and after my last physical I am on the edge of pre diabetes. ( am normal weight, I walk daily and lift weights, eat high protein diet with lots of veggies and healthy fats.) I am currently taking a progesterone troche( 1/4 lozenge 50mg 2x day) and vaginal estrogen. I was taking an oral progesterone 300 mg thought it would help with sleep but didn’t. The progesterone has helped with GI issues, puffiness, bloating, cramping and anxiety.”
If you have a question, please visit our website and click Ask the Doctor a question.
Disclaimer: All content in this blog, including text, images, audio, video, or other formats, was created for informational purposes only. This video, website, and blog aim to promote consumer/public understanding and general knowledge of various health topics. This content is not a substitute for professional medical advice, diagnosis, or treatment. Please consult your healthcare provider with any questions or concerns you may have regarding your condition before undertaking a new healthcare regimen. Never disregard professional medical advice or delay seeking it because of something you have read on this website. If your healthcare provider is not interested in discussing your health concerns regarding this topic, then it is time to find a new doctor.
In this episode, we talk about POI (primary/premature ovarian insufficiency) and earlymenopause. Samantha sent in a question about whether she is in menopause or hasPOI at the age of 36.We break Samantha’s question into:- What is POI (Premature/Primary ovarian insufficiency)?- Taking estradiol during perimenopause- Difference between perimenopause and menopause- What is an FSH?- Insulin resistance and perimenopauseSamantha’s Question:I am 36 and have been slowly noticing perimenopause/low estrogen symptoms for thepast year and a half. I went to an online provider and started HRT and haveexperienced so much relief! From mental symptoms to night sweats to dryness(everywhere) I have started to feel so much better being on estradiol and progesteronefor 3 months. I have been working with a functional nutritionist on my diet, walking daily,etc.i had gestational diabetes for all 3 pregnancies and also got my tubes removed lastyear. After I came off the birth control all of my symptoms started! I recently saw mynormal OBGYN so I could get my HRT through insurance and he agreed- but made itclear this isn’t menopause, could be POI, but seemed skeptical. I got bloodwork doneand my FSH has risen in the past few months from a 3.7 to an 8. But it’s still considerednormal. All of my thyroid and other bloodwork also comes back normal. Is POI apossible diagnosis? I feel crazy!!If you have a question, please visit our website and click Ask the Doctor a question.
Disclaimer: All content in this blog, including text, images, audio, video, or other formats,was created for informational purposes only. This video, website, and blog aim topromote consumer/public understanding and general knowledge of various healthtopics. This content is not a substitute for professional medical advice, diagnosis, ortreatment. Please consult your healthcare provider with any questions or concerns youmay have regarding your condition before undertaking a new healthcare regimen.
Never disregard professional medical advice or delay seeking it because of somethingyou have read on this website. If your healthcare provider is not interested indiscussing your health concerns regarding this topic, then it is time to find a new doctor.
Can you be in both in perimenopause and menopause? Can you be menopausal andperimenopausal at the same time? The difference between perimenopause andmenopause is not a line in the sand. It is not like crossing through the Peace Arch fromBlaine Washington to the country of Canada. And at times, there is nothing peacefulabout perimenopause or menopause.There is a gray area where you are just moving out of perimenopause and intomenopause, where you are not quite in perimenopause but are not completely inmenopause. We delve deeper into the place that is between perimenopause andmenopause:- What is the difference between perimenopause and menopause?- Can you be both in perimenopause and menopause?- The difference between perimenopause and menopause- What it feels like to go from perimenopause to menopause- Can you take estrogen or biest when you are going from perimenopause tomenopause?- Is bleeding in menopause considered perimenopause?- Top symptoms of perimenopause- Top symptoms of menopause- Are you a candidate for estrogen replacement in perimenopause?If you have a question, please visit our website and click Ask the Doctor a question.Disclaimer: All content in this blog, including text, images, audio, video, or other formats,was created for informational purposes only. This video, website, and blog aim topromote consumer/public understanding and general knowledge of various healthtopics. This content is not a substitute for professional medical advice, diagnosis, ortreatment. Please consult your healthcare provider with any questions or concerns youmay have regarding your condition before undertaking a new healthcare regimen.Never disregard professional medical advice or delay seeking it because of somethingyou have read on this website. If your healthcare provider is not interested indiscussing your health concerns regarding this topic, then it is time to find a new doctor.
In this episode, we discuss a listener’s question about how to apply estriol to your face. ‘Connie’ is confused about whether she can use her Biest cream on her face. And she wanted to know the difference between estriol and Biest when it comes to treating menopausal symptoms.
We analyze Connie’s question into:
Applying estriol to the face
What is biest?
What is estriol?
What is the difference between estriol and biest?
Applying estriol vaginally
It is not a good idea to apply biest to vaginal tissues if you have a uterus
Connie’s Question:
“HI there, I loved your article on estriol for the face. I was prescribed an 80-20 bi-est cream for HRT. My question is, how is that different from a 0.3 estriol cream for the face like the kind My Alloy makes? Could I just use more of my Biest cream on my face? Would that be stronger than the My alloy 0.3 estriol cream? Lastly, the .3 estriol cream is not supposed to affect your overall hormone levels, but the Bi-est cream is supposed to affect your hormones and relieve symptoms of menopause. Why does one estriol work differently than the other? Thank you so much for any guidance you may be able to offer. It’s so hard figuring all of this out!”
If you have a question, please visit our website and click Ask the Doctor a question.
Disclaimer: All content in this blog, including text, images, audio, video, or other formats, was created for informational purposes only. This video, website, and blog aim to promote consumer/public understanding and general knowledge of various health topics. This content is not a substitute for professional medical advice, diagnosis, or treatment. Please consult your healthcare provider with any questions or concerns you may have regarding your condition before undertaking a new healthcare regimen. Never disregard professional medical advice or delay seeking it because of something you have read on this website. If your healthcare provider is not interested in discussing your health concerns regarding this topic, then it is time to find a new doctor.
In this episode we talk about where to apply hormone creams. Sadie, our listener wants to know if she needs to rotate the application sites of her hormone cream.
In this episode we discuss:
Where to apply biest cream
What to apply testosterone cream for females
Places you should not apply your testosterone cream
Best absorption sites for hormone creams
Sadie’s Question:”I have been using hormones for a little over a year. I swear by them!! I have not rotated sites at all. I use testosterone/DHEA cream behind both of my knees and E3/E2 on both of my inner thighs every morning. I take a progesterone capsule at bedtime. My doctor and everything I read says to rotate sites. I found an article by Dr. Collins and now I found your article about not having to rotate sites, so I am going to keep doing what I have been. I put the cream on both of the backs of my legs and thighs. My question is should I alternate one back of knee and then the other and the same with the inner thighs or does it matter?
If you have a question, please visit our website and click Ask the Doctor a question.
Disclaimer: All content in this blog, including text, images, audio, video, or other formats, was created for informational purposes only. This video, website, and blog aim to promote consumer/public understanding and general knowledge of various health topics. This content is not a substitute for professional medical advice, diagnosis, or treatment. Please consult your healthcare provider with any questions or concerns you may have regarding your condition before undertaking a new healthcare regimen. Never disregard professional medical advice or delay seeking it because of something you have read on this website. If your healthcare provider is not interested in discussing your health concerns regarding this topic, then it is time to find a new doctor.
