Hormones are constantly changing. As they ebb and flow, they control how our female bodies feel and adapt and perform. Like the director of a lifelong play, hormone fluctuations choreograph each phase of our lives.
When the curtain rises on opening night, we get our first period and enter puberty. Then, our period performs every month for our fertile years, sometimes featuring cramps and PMS. If our script includes children, our period steps aside for a while and allows pregnancy and breastfeeding to take center stage.
But somewhere along the way, another hormonal storyline begins: perimenopause. It may sneak in slowly like a mysterious villain or make a sudden, grand entrance like a drama queen. Either way, during this perimenopausal phase, you may feel out of sorts, like you aren’t the star of your own life anymore.
That sounds a bit melodramatic for a phase that’s a normal part of aging. But for many women, perimenopausal symptoms bring daily drama that changes the story arc of their lives.
What is perimenopause?
OK, so perimenopause can create drama. But what exactly is perimenopause and how do you know if it has begun?
Perimenopause is a transition between your reproductive years and the end of your fertility. It’s a time of sex hormone fluctuations. Hormones are chemical messengers that travel through the blood to exert an effect on specific tissues. The effect of each sex hormone depends on the overall balance among all the hormones, including estrogen, progesterone, and testosterone. (1)
Estrogen levels, particularly, can rise a bit and then drop, over and over, as the ovaries gradually slow down their release of eggs. Researchers describe perimenopause as “disruptive” because its hormonal rollercoaster can cause troublesome physical and emotional symptoms in most women. (2)
While perimenopause often begins in your 40s, it can start as early as your 30s or as late as your 50s. It may last from a few months to up to 15 years. It ends with menopause, which is when you’ve gone a full year without a period. (3)
In perimenopause, your symptoms are directly related to hormonal fluctuations as estrogen, progesterone, and testosterone typically start to decline.
The many signs and symptoms of perimenopause
There’s a long list of symptoms that could point to perimenopause. While the list below isn’t exhaustive, it highlights the major players. (4,5)
Bladder problems: A decreased ability to control urine release may cause small leaks (urge incontinence) or uncontrollable emptying of the bladder (stress incontinence). Frequent urinary tract infections are common in late perimenopause.
Body odor: Some women notice changes in the way their body smells. This is often caused by changes in the breakdown of skin oils from declining estrogen.
Cognitive issues: Brain fog and difficulty concentrating can affect work performance. More than half of women in perimenopause experience memory problems like forgetting common words or familiar people’s names.
Dry eyes: Light sensitivity and blurred vision may accompany dry, scratchy eyes. Some women even develop dry eye syndrome that typically warrants evaluation by an ophthalmologist.
Fatigue: About 80% of women feel tired, like they have no energy. This exhaustion can last a long time, or it can come and go.
Hair loss: Up to half of women have hair loss in perimenopause, and all women have thinning hair. More hair appears in the shower drain or hairbrush, and a widening part or smaller ponytail diameter can be common.
Headaches: Frequent or severe headaches may occur more often. Fluctuating or falling estrogen levels can trigger migraine headaches, especially in early perimenopause.
Heart palpitations: This may be an increased heart rate, changes in heart rhythm, or the feeling of skipping beats. These may be perimenopause-induced, but if you have frequent or persistent palpitations, you might need to seek further support from a medical professional.
Mood-related changes: Around a quarter of women experience anxiety and depression related to perimenopausal hormone changes. Mood swings are also common.
Musculoskeletal pain: Estrogen deficiency weakens joints and decreases lubrication, which can lead to pain, stiffness, and even conditions like frozen shoulder. Decreased collagen and elastin production makes cartilage in joints more likely to break down.
Sexual symptoms: Less natural lubrication often results in vaginal dryness and irritation as well as increased potential for discomfort or pain during sex. Decreased desire for sex is common too.
Skin changes: Skin health can be affected as skin becomes dry, thinner, and sometimes itchy. At the same time, a loss of collagen and elastin contributes to wrinkles.
Sleep disturbances: While night sweats can contribute to waking up often, some women also have trouble falling asleep and lie awake for hours after going to bed. Others can fall asleep quickly but wake in the wee morning hours and can’t get back to sleep.
Weight gain: On average, perimenopausal women gain 1.5 pounds each year. Body shape often changes too, with fat gain around the tummy, creating an apple-shaped profile that can lead to increased risk for metabolic problems.
You might be struggling with several of these symptoms, or you might have one or two. Each woman’s perimenopause experience is uniquely different.
How to talk with your provider
If perimenopause is such a big deal, women and their doctors obviously understand it and know how to manage it, right? Sadly, not always. Many practitioners aren’t well-educated about perimenopause, so they don’t consider hormonal issues as a possible culprit behind symptoms. And, sometimes women tell their doctors about perimenopausal symptoms only to be dismissed as being “too young” for perimenopause.
It helps to have a plan for approaching your healthcare provider.
Advocate for yourself
You know your body best. If you’re feeling off, it’s not in your head, no matter your age. Find a provider who is trained in hormones, understands the scope of perimenopause, and is willing to consider hormone fluctuations as a possible root cause of your symptoms.
Ask about balancing your hormones through compounded bioidentical hormone replacement therapy (BHRT) as a possible solution. BHRT provides hormones that match the ones your body makes naturally.
Identify your symptoms
The more details you can provide for your practitioner, the better. Compile a list of symptoms you’re experiencing that you think are related to perimenopause. Make note of any other symptoms as well. Describe how often you have each symptom and how long it usually lasts. Bring all this information to your appointment.
Remember, the sooner your perimenopausal symptoms are addressed, the sooner you may start to feel better.
Request lab testing
Diagnosing perimenopause can be tricky, so you want a provider who takes both your symptoms and your lab results into consideration. Lab tests that you may want to request include:
- Thyroid panel: TSH, total T4, free T3, and reverse T3 (6,7)
- Hormone panel: estradiol, testosterone, progesterone, and follicle-stimulating hormone (6)
- Basic metabolic panel: glucose, electrolytes, kidney function labs (8)
- CBC: hemoglobin and hematocrit, red and white blood cells, platelets (9)
Your provider may order other tests depending on your symptoms or pre-existing health conditions, but this bloodwork may be a good place to start.
The drama of perimenopause isn’t something you have to just accept and live with. If show-stopping symptoms are affecting your wellness, contact a knowledgeable provider and get checked out. You deserve to be a vibrant leading lady, no matter your phase of life.
References:
(1) Roths A. Loving Life During Menopause: How to Rock the Hormone Symphony. Belmar Pharmacy webinar. The Change Is Personal blog.
Link: Watch Now! FREE Menopause Webinar | The Change is Personal
(2) Santoro N, Roeca C, Peters BA, Neal-Perry G. The menopause transition: signs, symptoms, and management options. J Clin Endocrinol Metab. 2021;106(1):1015. doi: 10.1210/clinem/dgaa764
Link: Menopause Transition: Signs, Symptoms, and Management Options | The Journal of Clinical Endocrinology & Metabolism | Oxford Academic
(3) DeRosa A, Stute P. Symptoms of perimenopause/menopause and how they may be affecting your productivity and work. European Menopause and Andropause Society podcast.
Link: Symptoms of perimenopause/menopause and how they may be affecting your productivity and work – European Menopause and Andropause Society | EMAS
(4) Menopause Symptoms Checklist. National Menopause Foundation®. 2024. NMF_SymptomChecklist2024_ENG-.pdf
(5) Gersch F. Menopause: 50 Things You Need to Know. Callisto Publishing. 2021.
(6) DeRosa A. A Woman’s Hormonal Health Survival Guide. DeRosa Media LLC, Scottsdale, AZ. 2018.
(7) Thyroid function tests. Medline Plus. National Institutes of Health. National Library of Medicine.
Link: Thyroid function tests: MedlinePlus Medical Encyclopedia
(8) Basic metabolic panel. Medline Plus. National Institutes of Health. National Library of Medicine.
Link: Basic Metabolic Panel (BMP): MedlinePlus Medical Test
(9) Complete blood count. Medline Plus. National Institutes of Health. National Library of Medicine.
Link: Complete Blood Count (CBC): MedlinePlus Medical Test
