How do I know if I am in Perimenopause?

How do I know I am in Perimenopause

Perimenopause is a natural part of a woman’s life. It’s the stage before your final period (menopause) when your body is transitioning to the end of its reproductive years.

The age of onset can vary and can start anywhere between 35 years old and 45 years old. This is when women will start to notice changes in their cycles and hormonal health overall.  Perimenopause can last from two to 10 years leading up to menopause when your body is transitioning to the end of its reproductive years. It can be a time that your body lets you know you need to start paying attention. It is the time when symptoms are most likely to occur, but know they are temporary and will not last forever.

As a woman’s hormones begin to change in preparation for menopause, a woman’s egg numbers diminish and decline in quality, the ovaries slow down their production of the hormone’s estrogen and progesterone. Changes to your periods are often the first sign of perimenopause.  They can become irregular, heavier, lighter, shorter or longer, or some months may not come at all. This also means that some months you may ovulate, other months you may not, and sometimes you may ovulate twice in a cycle.

Despite potentially feeling like your hormones are bouncing around erratically during this time, it is a sequence of events taking place through this process. Oestrogen is high in relation to progesterone, but both will eventually decline.

Perimenopause is considered an important window of opportunity for long-term health. It is during this sensitive state of physiological change and instability that underlying health conditions can be revealed, and there is increased risk of small health issues amplifying into bigger ones later in life if left unaddressed. Making positive changes during this period will have long-term health benefits that your future self will thank you for.

Diagnosis of Perimenopause

There is no blood test to diagnose perimenopause. According to Canadian Endocrinology Professor Jerilynn Prior, a woman is in perimenopause if she is older than 35 and experiences three of the following nine changes:

• new heavy and/or longer menstrual flow
• shorter menstrual cycles (25 days or less)
• new sore, swollen or lumpy breasts
• new mid-sleep waking
• increased menstrual cramps
• onset of night sweats, in particular premenstrual
• new or increased migraine headaches
• new or increased premenstrual mood swings
• weight gain without changes in exercising or eating

In addition to period and cycle changes, there are around 35 different symptoms that women can experience:

• Insomnia and sleep changes
• Weight gain, especially around the waist, upper back, bra strap area, triceps
• Hot flushes
• Fatigue
• Changes in digestion
• Sweating and changes in body odour
• Heart palpitations
• Body aches and pain
• Headaches and migraines
• Decreased libido
• Hair loss/hair changes
• Skin changes, dryness, rosacea, hives
• Dry eyes
• Itchy ears
• Memory loss, brain fog and lowered cognition
• Bladder changes, leaking, pressure and UTI’s
• Pelvic pain, pain during intercourse, vaginal dryness
• Mood changes; anxiety, depression, irritability and sadness
• Worsening recovery from intense workouts and difficulty building muscle
• Immune system changes
• Increase in cholesterol
• Unhealthy blood sugar
• Breast health issues

The typical Stages of Perimenopause:

• Stage 1: The first stage starts with declining progesterone – one of the main sex hormones. Periods will still be regular but they may be heavier with an increase in anxiety, breast pain and tenderness, heart palpitations and migraines.
• Stage 2: This stage is high and fluctuating estrogen. You may experience very heavy periods, hot flushes, night sweats, irritability. Estrogen can be 3 times higher than you have ever experienced and then very low which can cause hot flushes and mood changes.
• Stage 3:  The final stage is low estrogen and low progesterone. Periods come every few months, and can switch between being very heavy with or without clots, to being very light and gone within a few days. The above symptoms may worsen as well as brain fog, memory recall, joint pain and inflammation, hair and skin changes and more insulin resistance with difficulty losing weight and building muscle.  You may also experience more insomnia, night waking and vaginal dryness
• Menopause Stage 4: Menopause is the one day in time that marks 12 months since your last period. Symptoms can vary quite a lot for women with more of the above as well as some genitourinary symptoms.

The perimenopause transition to menopause for a woman depends on a lot of factors – the health of your adrenal system, brain health, stress response, your circadian rhythm, metabolic health and how strong, nourished and fit you are. All of these factors will determine your transition and long term health.

Its important during this phase that women seek support from friends and loved ones as well as an experienced health practitioner. It can be an isolating time with so many changes and symptoms occurring that can be unexpected and sometimes debilitating. Every woman’s experience is individual and can be supported with personalised diet, exercise, stress management, health care and supplements.

The more you know about your body and the changes Perimenopause can bring, the better prepared you will be and the more ease and confidence you can have as you move towards menopause.