Answers to your Perimenopause Questions
How do I know if I’m in Perimenopause?
“I’m irritable all the time, and sweaty at night - am I in perimenopause?”
“My periods are suddenly all over the place - is this normal for my age?”
Questions like these pop up all the time in my practice! While the definition of menopause is defined as the singular day, 12 months after a person’s last menstrual period, the lead up to this final menstrual period is often less well understood. As a Naturopathic Doctor, it’s my job to listen carefully, ask the right questions, and help people understand how their symptoms may be related to hormone changes associated with menopause transition. Knowledge is power, and my goal is to answer your questions and leave you with solutions you feel comfortable and confident pursuing.
How do I know if I’m in perimenopause?
By medical definition, a person officially enters perimenopause when their menstrual cycle becomes so irregular that the time between periods varies by more than 7 days, and is persistent across consecutive cycles (i.e. not just one wonky cycle). This could look like shorter 21 day cycles, if your cycle is typically 30 days long, or longer 40+ day cycles if your typical cycle length is 32 days long, or some combination of the above. If we were to measure certain hormones, we would also see increases in specific hormones associated with ovulation, telling us that your brain is having a harder time asking the ovaries to mature an egg each cycle. Perimenopause is part of the normal progression towards menopause, where the body’s production of hormones including estrogen and progesterone adjust to new levels. Not everyone experiences the same symptoms, and how long these symptoms last can also vary. Most people with ovaries have their final menstrual period in their late 40s or early 50s. Perimenopause symptoms can begin anywhere from 4-10 years prior.
I’m not “officially” in perimenopause - but something doesn’t feel right
Many people will often begin having symptoms associated with hormone change well before they see this seven day shift in cycle length, and this is part of the puzzle of diagnosis. Shifts in estrogen and other hormones during the late reproductive stage before the official start of perimenopause can cause temperature regulation concerns, resulting in night sweats or daytime hot flashes/flushes. Mood swings can become more intense, sleep can be disrupted, and sexual satisfaction can be affected by changes in libido and vaginal health. If someone is noticing these symptoms and still having regular periods, the challenge becomes determining whether those symptoms are due to shifts in sex hormones like estrogen and progesterone, or whether there is something else to consider.
Is it perimenopause, or is it __________?
Naturopathic doctors are trained to do a full and thorough intake to assess the whole person. I ask questions about personal and family health history, nutrition, sleep, exercise, medications & supplements, social relationships and stressors so that I can better understand the factors contributing to how someone is feeling. We may also discuss lab testing, or review your menstrual cycle tracking to get more insight into the cause of your symptoms. Perhaps the sweaty sleeps are actually due to an underlying thyroid condition, or the mood changes are part of a larger picture of depression. Even menstrual cycle length changes can be due to shifts in nutrition, stress, or illness, so gathering info becomes crucial to avoid a misdiagnosis.
What can I do to feel better?
Once we land on a diagnosis or area of focus, the treatment options can really vary based on your goals and preferences. A comprehensive plan may involve discussion of hormone replacement therapy, oral contraceptive pills, IUDs, mood support medications, supplements, nutrition, and exercise. We will discuss safety, expected outcomes and how to track progress, so that you feel supported. A big part of my practice is sharing info about what to expect, and how to take good care of yourself over the next decade or two of your life as hormones continue to shift and change. Preventative care includes conversations around bone health, cardiovascular risk, and cognitive changes. We will likely talk about the importance of strength training, getting enough calcium, and managing stress. No wonder we need longer visits! I may ask you to follow up with your family doctor or primary care provider to discuss medications outside my scope, or appropriate screening exams. The goal is always to shine a light on your experience so that you feel heard, and to share information on the options available to you, so you can make a confident choice in your health care.
If you’ve been up late googling why you can’t sleep, or felt alarmed watching TikToks on how awful perimenopause can be - it may be time to book an initial consultation with me! I am accepting new patients, and happy to reconnect if it’s been a while since your last follow up.
In the meantime, it is always helpful to continue or start tracking your menstrual cycle, and any symptoms that are bothering you, so you can share this info with a provider in your circle of care. This could look like using an app or paper tracker to note down days of bleeding, plus symptoms like fatigue, pain, low mood, or whatever feels relevant to your experience. If you have concerns about heavy and/or irregular bleeding, a visit to your primary care provider may be a good first stop so that they can offer imaging, a pelvic exam or other relevant tests that we can then review together in your visit. The website of the Menopause Society (menopause.org) is also a reputable site for evidence based information on all aspects of menopause, with helpful summary “MenoNotes” and videos.
References:
Soules MR, Sherman S, Parrott E, Rebar RW, Santoro N, Utian W, Woods N. Executive summary: Stages of reproductive aging workshop (STRAW) FertilSteril. 2001;76:874–8. doi: 10.1016/s0015-0282(01)02909-0
https://menopause.org
