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Perimenopause: the how's and when's

What Are The First Signs of Perimenopause

All women will enter menopause one way or another. For most, they will enter menopause naturally when their ovaries stop producing follicles for fertilization and estrogen. Others may enter menopause medically because of a treatment that suppresses or removes ovarian function entirely. But, if you go through menopause naturally, you will likely go through perimenopause, a transitional stage between when you have regular menstrual cycles to none whatsoever.

Perimenopause typically occurs in your 40s and 50s, but it can happen even in your 30s. Unfortunately, most people do not know what perimenopause is, as it certainly was left out of most health classes in school. Not to mention, our mothers and grandmothers rarely shared their own experiences, and even our health care providers are not always well versed in this stage of women’s lives. 

So, if you (like most women) are in the dark about perimenopause, we are here to answer your questions about how to tell when it starts and when you should do something about it. 

Signs of Perimenopause

There are 34 symptoms of perimenopause. Most women will experience at least a handful of these symptoms. The most common symptoms of perimenopause include:

- Irregular period

- Hot flashes

- Night sweats

- Loss of libido

- Vaginal dryness

Other symptoms can include:

- Mood changes

- Weight gain

- Joint pain

- Depression

- Constipation

- Heart palpitations

- Anxiety

- Fatigue

And the list goes on.

Typically, the biggest indicator that you are officially in perimenopause is an irregular period. However, other symptoms may present before your period starts to change. A good rule of thumb is when you feel like something isn’t quite right, it may be time to check in with your doctor for a complete physical exam.

Is there a test I can take?

Wouldn’t it be lovely if there was a clearcut test that was + or - for perimenopause? Much like a pregnancy test, it could say, “yes, you are in perimenopause” or “nope, your time is yet to come.” 

Regrettably, no test can confirm you are in perimenopause. With that said, you will likely stumble across various tests online that claim to assess your hormones. The problem with these tests is that they take a snapshot of your hormones in one particular moment rather than capturing trends. Hormones fluctuate continuously during perimenopause and they can even change within one day. So, if you take the test on a Tuesday morning and then repeat it Wednesday afternoon, you may get two different results. Indeed, you may even have normal hormone levels but still be in perimenopause. Therefore, it is hard to get an accurate picture of what is going on with your hormones. 

The best way to determine perimenopause

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 have 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

 When should I treat perimenopause?

Perimenopause is not a health condition. Indeed, it is a completely normal phase of life. Therefore, treating perimenopause is not necessary. However, the symptoms can make you feel abnormal and downright crummy at times, and you don’t have to live in discomfort. Therefore, most women don’t start doing something about it until their symptoms become a problem. 

However, 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.  

How to prepare for your visit with your doctor

Keep a log of your symptoms.

Your doctor needs to know the symptoms you are experiencing. As seen above, you know that there are at least 34 symptoms of perimenopause, and they can be physical, mental, or emotional. 

Track your periods.

One of the hallmark signs of perimenopause is an irregular period, so make sure you have tracked any changes to your period, including:

- Duration

- Flow

- Color

- Spotting

- Time between periods

Make a list of medications and supplements.

Keep a record of anything you have tried to help with your symptoms. Anything ranging from herbal supplements and over-the-counter remedies to lifestyle changes like diet can help your doctor make good recommendations for you. 

Learn about perimenopause.

To get the most out of your visit, it helps to do some research ahead of time about what perimenopause is, what you can expect, how long it typically lasts, and treatment options for pesky symptoms. Being informed helps you ask better questions and can make you feel more empowered, especially when it comes to managing your symptoms with supplements, hormone replacement therapy, other medications, lifestyle changes, and alternative therapies.

Julia Walker RN, BSN, is a women's health nurse, writer, and member of the perry team. 

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