This September is the first-ever Perimenopause Awareness Month, thanks to incredible work being done by Let’s Talk Menopause, a nonprofit organization dedicated to raising awareness about menopause and its impact on women's health. As the name suggests, Perimenopause Awareness Month aims to increase awareness around the multitude of physical and emotional changes women experience during the transitional phase before menopause. Perimenopause kicks off the process that ultimately culminates in menopause—the permanent cessation of ovulation. It comes with its own signs, symptoms, and experiences just like the (only slightly) more-discussed main event of menopause.
Perimenopause is the slow-moving start to a new stage of life, so naturally, it comes with lots of questions. Here are some of the most common ones, along with answers from our medical team, with Dr. Barbara Frank OB-GYN at the helm.
What exactly is perimenopause again?
In the simplest terms, the term perimenopause captures the years that immediately precede menopause. Here’s what’s happening during that time. When you're born with ovaries, those ovaries have millions of eggs—all the eggs you’ll ever have. Eventually, those eggs run out for many reasons—for instance, because they've died off over time, you've ovulated every month for decades, you've had some kids, or you’ve gone through chemotherapy and/or radiation. When the eggs we’ve been born with are gone (or mostly gone) it triggers a drop in estrogen levels, which in turn causes us to stop ovulating or cycling through our periods.
All women will enter menopause one way or another. But, if you go through menopause naturally, you will likely go through perimenopause. When you haven’t had your period for a full twelve months, you are officially out of perimenopause and in menopause.
When does perimenopause usually start?
Perimenopause typically occurs in your 40s and 50s, but it can happen even in your 30s. Perimenopause and menopause have historically been under-researched and under-funded, and it definitely wasn’t on our health class curriculum or anything our mothers or grandmothers discussed. As a result, women have been left without adequate information and care during these critical life stages. Even healthcare providers are typically not well versed in this stage of women’s lives, with studies indicating that the topic often receives less than five hours of dedicated instruction throughout their entire medical education.
Is there a test I can take to see if I’m in perimenopause?
Wouldn’t it be lovely if there was a clearcut test that was positive or negative for perimenopause? Much like a pregnancy test, it could say, “yes, you are in perimenopause” or “nope, your time is yet to come.” While it’s not a simple binary, there is a lot of science emerging in the testing category to help women gain clarity about what’s happening with their hormones. If you want to try using a test, a brand we love and trust is Proov, which offers a test called the Empower Perimenopause Test Kit that measures four key hormones at four points in your cycle to provide insights into the stage you may be in and better understand your hormones.
How do I know if it’s stress, perimenopause, or something else altogether?
If you suspect you are in perimenopause, the best thing you can do is schedule an appointment with your women’s health provider. Most health professionals diagnose perimenopause in their patients by taking into account the symptoms they are having and their age. However, perimenopause symptoms often mimic certain health conditions like hypothyroidism, so your doctor may also order some blood tests to rule out other causes. For example, you may be recommended to do the following blood work:
- A thyroid function test to check for thyroid dysfunction
- A cholesterol panel (LDL, or low-density lipoprotein, may increase in menopause)
- Tests for liver and kidney function
At Dr. Frank’s OB-GYN practice, this testing is an important dimension of their assessment, but that might not be true of all practices, so we encourage you to advocate for yourself with regard to getting testing that can help clarify what you’re experiencing. Not every provider will be quick to test, but these results can provide a lot of insight into what’s going on, and what you can do to live your healthiest life.
Do I need to treat perimenopause, and if so, when?
Perimenopause in itself is not a health condition. In fact, it’s a completely normal phase of life. So there is no such thing as”treating perimenopause”. That being said, perimenopause has many, many symptoms. These include everything from mild insomnia to fatigue to changes in weight, blood sugar, cholesterol, mood and memory, to debilitating panic attacks – the list goes on. Seeking treatment and support for how we manage any symptoms early in our perimenopausal journey is critical. The earlier you address the symptoms, the sooner you’ll be able to feel better.
Being proactive with healthy lifestyle habits can help ward off unpleasant symptoms. For example, maintaining a healthy weight, eating a wholesome diet rich in vegetables, and getting plenty of sleep and exercise may help lessen your symptoms. If you have specific concerns—like worries about changes to your skin or body odor—you should talk about those with your healthcare provider.
How does incontinence show up during perimenopause? What do I need to know?
According to Dr. Frank, most of the connection between perimenopause and incontinence is due to “simple” things: as you age, gravity takes over and your pelvic floor muscles start to relax and there's an increased risk of incontinence. Maybe you’ve had children, and your pelvic floor is weaker due to either a vaginal or cesarean birth. The drop in estrogen that accompanies perimenopause also is tied to pelvic floor weakness.
At this point, we need to keep an eye on all these other healthy habits that we previously discussed. A healthy weight and a good exercise regimen both can help support the pelvic floor. Work on your Kegel exercises by squeezing in the muscles around the pelvic floor, hold and count to five, then release. Do three sets of ten and then three more sets at a quicker pace. A pelvic floor PT (AKA Kegels Expert) is an amazing resource for creating a custom plan for strengthening your pelvic floor and they can provide direct feedback to make your exercises as effective as possible. We’re big fans of the pelvic floor PTs at Origin and even created an immersive webinar diving into the topic of perimenopause and the pelvic floor, if you’re interested.
(Need more Kegels content now? We did a whole blog post on that.)
At Attn: Grace, we’re here for you through all of life’s stages, from pre-parenthood to post-menopause. As a woman-founded brand, this isn’t just personal care: this is personal.