How do I know if I'm perimenopausal?
What is perimenopause, how to know if you're in it, and helpful ways to manage the many possible symptoms along the way.
Most of us grow up aware that menopause will happen at some point in midlife, but how many of us know about perimenopause and when that begins? With so many different symptoms and no clear timeline to follow, a lot of women are asking the question: How do I know if I’m perimenopausal?
What is perimenopause?
The natural menopause journey has 3 main stages: perimenopause, menopause, and post-menopause. Perimenopause covers the months and years leading up to menopause when your hormones are fluctuating and causing all kinds of physical and mental symptoms.
On average, women move into perimenopause in their late 30s / early-mid 40s. However, with premature menopause and Primary Ovarian Insufficiency fertility levels decline, and the menstrual cycle stops before the age of 40.
There are ethnic differences in how women experience perimenopause and menopause. Research shows that Black, Latina, and Asian women may begin perimenopause earlier than white women, and may have a longer transition phase.
Periods continue during perimenopause, although it might not be a regular cycle and it may be longer, shorter, lighter, or heavier than before. And if your menopause journey is surgically or medically induced, you may not experience the perimenopause phase at all — you may jump straight to menopause.
Menopause is that point in time when your periods have stopped. The average age for women to reach menopause in the US is 51, though women of color often experience it earlier than this.
Menopause means 'end of periods', and is defined as that day on the calendar when you haven't had a period for 12 months (or 2 years if you're under 40). At this point you can say you've done it — you've gone through menopause!
The post-menopause phase is everything after this point – i.e., the rest of your life after your menstrual cycle has stopped. You may find a few symptoms lingering on, but these should settle down as your body adjusts to producing much lower levels of sex hormones.
What are the symptoms of perimenopause?
According to the Menopause Invisibility report by Gen-M, there are at least 48 different symptoms associated with perimenopause and menopause. There are the common ones that you've probably heard about, like hot flashes, anxiety, night sweats, weight gain, and brain fog, but there are plenty that are less well-known, including:
Altered sense of smell and taste
Acid reflux and bloating
Vulvovaginal dryness and pain
Burning mouth and tongue
Pins and needles in your hands, feet, arms, or legs
If you’re in your late 30s or early-mid 40s and you’re starting to notice some of these symptoms — whether your periods are changing or not — you could be in perimenopause.
According to the Menopause Invisibility report by Gen-M, there are at least 48 different symptoms associated with perimenopause and menopause.
The reason for such a crazy range of symptoms is because estrogen and progesterone act in lots of areas of the body. From bones and nerves to the heart and digestive tract, our sex hormones do way more than just run the menstrual cycle.
Take the brain for example: a lot of women notice increasing anxiety and difficulty sleeping in their late 30s to early 40s. Their monthly cycle is the same and menopause may be ten or twenty years away yet, so they don’t make the link between these symptoms and their hormones.
But the brain is one of the first places to be affected by changing estrogen and progesterone levels. Progesterone has a calming effect on the nervous system, and estrogen influences our sleep/wake cycle. So, when these hormones fluctuate during perimenopause, we can experience difficulty sleeping, mood swings, and frequent anxiety.
Thyroid function can be affected by perimenopause and may cause similar symptoms. A trusted healthcare provider can help you determine the difference.
Can perimenopause symptoms be something else?
There is a crossover between some perimenopause symptoms and other health conditions. It’s always worth speaking to your healthcare provider if you are concerned about what’s going on, especially if you have a family history of health issues.
Health conditions to consider include:
Thyroid function can be affected by perimenopause and may cause similar symptoms. Weight gain, constipation, low energy, and brain fog are all signs of low thyroid function (underactive thyroid) while anxiety, racing thoughts, weight loss, diarrhea, and palpitations are classic signs of overactive thyroid.
Pregnancy! It may be the last thing on your mind at this point in life, but until you’ve reached menopause there is still a chance you can fall pregnant.
Over-exercising: a high-intensity training regime can cause periods to stop.
Sleep apnea: night time waking can be due to hormone changes but can also be caused by sleep apnoea, a serious sleep condition. Left unchecked, sleep apnea can increase the risk of Type II Diabetes, heart disease, and high blood pressure.
Depression: mood swings and low mood are common during perimenopause but if symptoms persist or get worse, speak to your healthcare provider about support.
Arthritis: joint pains are common in midlife, but persistent pain and swelling may be a sign of osteoarthritis or rheumatoid arthritis.
Cancers: persistent fatigue, night sweats, and itchy skin can be signs of lymphoma, a type of cancer.
Perimenopause is a unique journey for each of us, and symptoms can change as we get nearer to menopause. Making diet and lifestyle changes is a good place to start, alongside finding a supportive healthcare practitioner to discuss any concerns
How can I manage perimenopause symptoms?
Diet and lifestyle changes are a great place to start. Food and drink, movement, relaxation, and sleep all provide the foundations for a healthy well-being and can go a long way toward easing perimenopause symptoms.
And, if you then decide to try Hormone Replacement Therapy (HRT) or herbal alternatives for hormone balance, your body will be in a better place to respond to them.
Try these five top tips for managing perimenopause symptoms:
Minimize caffeine: this can be hard to stomach when you rely on a coffee fix, but caffeine is a major trigger for symptoms of anxiety, gastrointestinal problems, insomnia, and fatigue. Tolerance to caffeine can change over time and you may not be able to handle it as well as you used to. Try gradually replacing coffee, tea, and caffeinated sports drinks with water and herbal alternatives and see what a difference it makes.
Nourish your gut: there’s a group of microbes in the gut called the estrobolome that processes deactivated estrogen. When the estrobolome is out of kilter, it produces too much of an enzyme that reactivates estrogen, sending it back into circulation. More estrogen might sound like a good thing but it’s not, and this recycled estrogen can worsen hormone imbalances. To keep your estrobolome in check, include fermented foods like sauerkraut, kimchi, natural yogurt, and kefir, and eat fiber-rich fruits, vegetables, and whole grains.
Eat a rainbow of fruits and vegetables every day: the colorful compounds in fruits and vegetables help manage inflammation and hormone balance. Aim to include as many different colors as you can in each meal.
Include plenty of good quality protein in every meal and snack: We start to lose more muscle mass after menopause, and this affects metabolism and bone health. Make space for at least ¼ plateful of protein-rich foods with each meal. Eggs, good-quality meat, fish, shellfish, beans, pulses, nuts, and seeds are all good sources. Collagen powder can help top up protein levels – vegetarians and vegans can use pea, hemp, or soy protein.
Include phytoestrogen foods each day: chickpeas, tofu, tempeh, miso, alfalfa sprouts, and ground flaxseeds are all rich in plant-based estrogen compounds called phytoestrogens. These compounds help balance out fluctuating estrogen levels during perimenopause and can ease troublesome symptoms.
Perimenopause is a unique journey for each of us, and symptoms can change as we get nearer to menopause. Making diet and lifestyle changes is a good place to start, alongside finding a supportive healthcare practitioner to discuss any concerns.
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Sally Duffin is a UK-based health writer, registered nutritionist/nutritional therapist, and author of Natural Nutrition for Perimenopause: What to Eat to Feel Good and Stay Sane. She has worked in the natural health industry for over 20 years as a nutrition practitioner, writer, and educator, and loves nothing more than empowering people to take charge of their own health. Outside of the nutrition world, Sally enjoys creative writing, making things, and buying more books than she has time to read.
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