Is this perimenopause?

Am I in perimenopause? Is this the ‘change’? How do I know? Should I be worried?

These questions come up often so we put together this quick reference guide to help narrow things down.

What is perimenopause?

Perimenopause commonly crops up between the ages of 40-50 (can be earlier too) and is the time leading up to menopause. The average length of this stage is anywhere between 4 and 10 years (longer for some!). Hormones (estrogen, progesterone and testosterone) wildly fluctuate and physical changes occur. Progesterone is often the first hormone to decline, therefore changes in menstrual cycles are a common first indicator of perimenopause.

Any unusual change in menstruation should be discussed with your doctor, but if you are in the perimenopausal age range of (40-50), irregular bleeding should not be immediate cause for concern. However, if bleeding is persistent, over a longer period of time, unusually heavy, and/or causing pain then it’s important to see a doctor (fibroids, cysts, polyps are common contributors). Periods can become quite heavy in perimenopause, these are often called “super-soaker events” and soaking through two pads an hour for two hours requires medical investigation.

The perimenopause transition occurs over a number of years in two phases (1) the early phase and (2) the late phase.

1. The early phase of perimenopause often involves changes in cycles, where they are lengthened by seven or more days (heavier, lighter) and skipped periods.

2. The late phase of perimenopause is characterized by more skipped periods (>60 days between periods). According to Dr. Jen Gunter, “when a women starts skipping two menstrual periods in a row, there is a 95% chance her final menstrual period will be within the next four years”, but this is only a rough guideline.

Is this perimenopause? Answer the following questions

• Are you within the ages of 40-55? (can be earlier)
• Have periods become irregular? (heavier/lighter, spotty, further apart/closer together, different coloured blood, clots?)
• Have you experienced other symptoms? (not everyone experiences irregular periods or hot flashes)
• Do you just feel “off”, or where everything hurts and you have no idea why?
• Have you ruled out those symptoms as being due to something else? (like thyroid disease, other medical conditions, vitamin/nutrient deficiencies, current medications, stress, lifestyle or environment changes?) It is crucial to get any new or persistent symptom checked out, as many peri/menopausal symptoms mimic other diseases/issues
• Have you had hormonal blood work indicating ’normal’ levels, but yet you still feel like something is off?

If you answered ‘yes’ to the above questions, then you can assume you are in perimenopause

• Not everyone experiences irregular periods as a first symptom. Even if periods are still regular but you notice other things (like bouts of uncontrolled anger/irritability, weepiness, sleep disruption, thinning hair, achy joints, vaginal dryness, sudden weight gain particularly around the middle, drop in libido, etc) then yes, you can still assume you are entering perimenopause, and irregular periods will come later.

• Family history does not necessarily predict how or when you will experience menopause, and neither does the age in which your periods started. There are many variables that determine this, such as lifestyle, whether or not you’re a smoker, overweight, a certain ethnicity, etc.

So how do I know?

• Symptoms. The symptom list is long and encompasses many things you didn’t know were related to hormones. So again it’s important to get any new and persistent symptom checked by doctors before assuming it’s perimenopause. If your symptoms have been ruled out as being due to something else, then those symptoms (along with your age) eventually diagnose perimenopause. This may mean you have to track things over time to see patterns and this is why perimenopause is often ‘confirmed’ in hindsight.
• Irregular Periods. Irregular periods are defined as missed periods, longer/shorter,closer together/further apart, heavier/lighter, flooding, spotting, clotting, and/or dark/different coloured blood. Tracking periods becomes an important tool as it helps to identify patterns and anomalies which is helpful to doctors as well. Everything we know about period predictability goes out in the window in perimenopause, but it should not be cause for alarm.
• Hormonal testing does not provide a definitive diagnosis of perimenopause. Many doctors rely heavily on the FSH test (hormonal blood/saliva) as their main diagnosing tool. Because hormones wildly fluctuate during peri/menopause, the test cannot capture anything more than what hormones were doing on that day, which has no bearing on anything. Therefore, a hormonal test taken at one point in time only indicates what your hormones were doing on the one day the test was taken, and are not indicative of what hormones are doing the other 29 days of the month. (Further details on hormone testing)

Medical professionals know very little about women’s health in general and even less about menopause

Common dismissive responses from doctors:

• You are too young to be in menopause
• You are anxious/stressed, here’s a prescription for antidepressants
• Lose weight, exercise more, do yoga and then you’ll feel better
• It’s normal aging, you’re fine
• Dry vagina? You need to have more sex
• You can’t have hormone therapy until you are menopausal/post-menopausal; you need birth control pills
• Hormonal blood tests will confirm if you are in peri/menopause, and if hormones are normal, there’s nothing more we can do

Now that you think you are likely entering perimenopause…what now?

• It’s time to invest in yourself!
• Read the Menopause Wiki. Familiarize yourself with other symptoms, various treatment options, and see links to scientific resources.
• Learn about menopause and what happens to our bodies without estrogen as we age. (See Resources in the Menopause Wiki)
• Consider lifestyle changes. Alter diet, increase exercise, supplement deficient vitamins, modify work environment.
• Track symptoms. Keep a diary/use an app, noting any new or unusual things that pop up. Also keep track of any medications, supplements and/or vitamins.
• Determine if symptoms are manageable. Ask yourself, are they mild?, sometimes disruptive but okay? annoying? affecting your daily routine? ruining your quality of life? unbearable?
• Consider treatment options. Whether that be OTC remedies or prescribed MHT/HRT, look at the scientific research and determine what’s best for you. There are risks to everything, but arming yourself with knowledge is the best way to make informed decisions.
• Determine if systemic hormone therapy is right for you and discuss with your doctor.
• Learn more about how to ask your doctor for treatment options (hormone therapy, etc).
• Ask for localized vaginal estrogen. It is important for everyone entering perimenopause to use localized vaginal estrogen as part of their regular routines to ensure vaginal/urinary health.
• Prioritize your health. Demand better care from your doctors/health care professionals, and know you deserve to feel amazing!

Finally know that you are NOT alone, you are NOT crazy, and you do not have to suffer! We will get through this!