Navigating Perimenopause: A Friendly Guide to Understanding Perimenopause

What is perimenopause?

Perimenopause is the phase leading up to menopause, the point at which a woman’s menstrual cycle comes to an end. It can last anywhere from 2 to 10 years and can cause physical and emotional symptoms. During perimenopause, your body:

• Ovulates less frequently
• Produces lower amounts of estrogen and other hormones
• Becomes less fertile
• Experiences shorter and more irregular menstrual cycles

Why perimenopause happens

Perimenopause is a natural change that occurs as your ovaries gradually stop functioning. Ovulation may become inconsistent and eventually stop. Your menstrual cycle may lengthen, and your flow may become irregular before your final period.

The symptoms of perimenopause are caused by fluctuating hormone levels within the body. When estrogen levels are high, you might experience PMS-like symptoms, while lower estrogen levels can lead to hot flashes and night sweats. These hormonal fluctuations may coincide with your regular cycles.

Common Perimenopause Symptoms

Common symptoms include:

• Mood fluctuations
• Changes in libido
• Difficulty concentrating
• Headaches
• Night sweats
• Hot flashes
• Vaginal dryness
• Sleep disturbances
• Joint and muscle pain
• Profuse sweating
• Frequent urination
• PMS-like symptoms

See a clinician because perimenopause symptoms can resemble those of other conditions.

Diagnosing Perimenopause

To diagnose perimenopause, your healthcare provider may consider your symptoms, medical history, age and a physical examination. Blood tests to measure hormone levels might also be recommended.

Decoding Hormonal Changes: FSH and AMH Levels

Hormone testing may be used to assess how close you are to menopause. Two hormones are often measured:

Follicle Stimulating Hormone (FSH): This hormone’s level is a key indicator of menopause. A test for FSH is usually conducted on day three of the menstrual cycle if menstruating, or any day if menstruation has ceased. An FSH level above 25 suggests that menopause could commence within one to three years.

Anti-Müllerian Hormone (AMH): AMH levels inversely correlate with FSH levels. An AMH level under one, coupled with an FSH level above 25, suggests menopause is approaching.

More than one FSH reading may be needed because levels can fluctuate monthly.

Perimenopause Treatment Options

Perimenopause does not require treatment unless symptoms are causing discomfort. Possible treatments include:

• Hormone therapy with estrogen or a combination of estrogen and progestins to balance hormone levels
• Antidepressants to manage mood fluctuations

Your healthcare provider may also recommend lifestyle changes:

• Consume a balanced diet rich in fruits, vegetables, and whole grains
• Aim for 1,000-1,200 mg of calcium daily from food or supplements
• Exercise regularly
• Identify and avoid hot flash triggers (e.g., alcohol, coffee, tea) by keeping a journal
• Consult with your healthcare provider about alternative treatments for symptom relief

Some herbal supplements claim to help manage hot flashes, but the FDA does not review supplements for effectiveness before they are sold. They have not undergone the same testing as conventional medications to establish their effectiveness and safety. Talk with your healthcare provider before using any herbal supplements.

Perimenopause: Key Takeaways

• Perimenopause is a natural transition leading up to menopause, during which your ovaries gradually stop functioning
• This phase can cause physical and emotional symptoms
• Treatment is not necessary but can help alleviate symptoms
• Treatment options include hormones, antidepressants, and lifestyle changes

Preparing for a healthcare provider visit

Before your healthcare provider visit, consider the following:

• Know why you are going and what you want help with
• Write down questions you’d like answered beforehand
• Bring a companion to help with asking questions and remembering information
• Take notes during the appointment, including new diagnoses, medications, treatments, or tests, as well as any instructions provided
• Understand the reasons for new medications or treatments and their potential side effects
• Inquire about alternative treatment options
• Know the rationale behind recommended tests or procedures and what the results may indicate
• Understand the implications if you choose not to take prescribed medication or undergo the suggested test or procedure
• Note the date, time, and purpose of any follow-up appointments
• Make sure you know how to contact your provider if you have further questions

Taking Control of Perimenopause Symptoms

If perimenopause symptoms are affecting your daily life, Bioidentical Hormone Replacement Therapy (BHRT) may ease symptoms for many women. Your provider can help you weigh its benefits and risks for your situation.

Video: Dr. Alexis deep dive on Perimenopause

Dr. Alexis explains the hormonal changes, symptoms and practical ways to manage perimenopause in the video below.

Summary and Key Takeaways of the Video