All about perimenopause

Perimenopause means “around menopause” and is when your menstrual cycles and hormone levels start to change as you transition to menopause. Your cycles may get shorter or more irregular, and you may experience symptoms like night sweats or headaches due to the change in hormones¹. Perimenopause isn’t always a walk in the park, but there are good options to help ease the symptoms.

Read on to learn more about perimenopause, why it happens, its symptoms, and more.

Why does perimenopause happen?

Menopause (and hence, perimenopause) is a natural part of aging for all women. As your body makes the transition to menopause, hormone levels begin to change. Your ovaries produce declining amounts of estrogen and progesterone, and you’ll release fewer and fewer eggs until you stop ovulating altogether and your periods stop. Fun fact, in the 18th and 19th centuries, perimenopause was called “the dodge” or “dodging” because women were dodging between periods².

These hormonal changes can make your menstrual cycle³:

• longer
• shorter
• heavier
• lighter
• more frequent
• less frequent

Essentially, if you find your body “dodging” a relatively regular period, it could be one of the first big signs of perimenopause, especially if you’ve had regular periods up until now.

Symptoms of perimenopause

Other than changes to your menstrual cycle, you may also notice some of the following symptoms during perimenopause^3,4:

Vasomotor symptoms - these are symptoms that occur due to the constriction or dilation of blood vessels, like:

• Hot flashes - sudden and short bursts of heat usually occurring in the face, neck, and chest, which can also make your skin red and sweaty
• Night sweats - the only real difference here is that night sweats are hot flashes that happen at night, which can be a drag as you sweat so much your night clothes and bedding can get soaking wet
• Palpitations - you may notice your heartbeat sometimes flutters or becomes too hard or too fast
• Sleeping difficulties - you may be kept awake by hot flashes, night sweats, or just have trouble sleeping, which could cause you to feel tired and irritable during the day

Sexual symptoms:

• Vaginal dryness - this may also be accompanied by pain, itching, or discomfort during sex
• Reduced sex drive

Psychological symptoms:

• Anxiety
• Mood changes

Cognitive symptoms:

• Memory problems
• Concentration problems
• “Brain fog”

Physical symptoms:

• Headaches
• Joint stiffness, aches, and pains
• Hair loss and brittle nails
• Weight gain and slowed metabolism

It’s a long and daunting list of potential symptoms, but some good news is that it’s not a given that you’ll have all of them, or indeed any of them! Genetics, lifestyle, diet, and other factors can be in your favor. Plus, your healthcare provider can help you find treatment options that are best for you to ease symptoms.

Early and late perimenopause

You can also think of perimenopause as having two stages^3,5:

• Early perimenopause - you’re likely to be in early perimenopause when you notice that over the last year your menstrual cycles have often varied in length by 7 days or more. In early perimenopause, you have a variable follicular phase - which is the phase in your menstrual cycle when the egg begins to mature - thanks to changing levels of the follicle stimulating hormone (FSH)
•  Late perimenopause - this is the stage in which you have a space of 60 days or more between your periods and can typically last between one and three years. During late perimenopause, your menstrual cycles become more irregular in length, your hormonal levels go through extreme changes. You also have more cycles when you don’t release an egg at all (anovulation). You also have elevated FSH levels at this stage and are more likely to suffer from vasomotor symptoms

How is perimenopause diagnosed?

It can be sometimes hard to tell if you’re in perimenopause. Your healthcare provider may be able to diagnose it from⁶:

• Your symptoms - which could point to perimenopause
• Your menstrual cycle - if your periods are irregular or unusually long or short, it’s often a first sign of perimenopause
• Your hormone levels - your healthcare provider may test for changes in your hormone levels, like FSH, the hormone responsible for helping your eggs mature. You can also buy FSH tests to take at home

Ultimately, if you’re experiencing troublesome perimenopause symptoms, with or without a formal diagnosis, talk to your healthcare provider. Many women know that the not-so-subtle symptoms of perimenopause can have a rough impact on your quality of life, but even though you may not be able to entirely stop all of your symptoms, there’s hope to help reduce them⁷.