Our fascinating journey, an intricate maze of hormonal fluctuations and life changes. As we traverse this path, one phase that often takes center stage in our bodies but not in our attention is perimenopause. Here we aim to shed some light on what perimenopause is, when it might start, and what symptoms to know about 🌛

What is Perimenopause?

As a reminder, menopause is a moment in time, when menstrual periods have been absent for 1 year. Perimenopause is the transitional period leading up to menopause. It's a time when the ovaries get smaller and gradually produce less estrogen.

When Does Perimenopause Start?

The average age of menopause in the US is 51. Perimenopause typically starts in a woman's mid-40s.

However, it can happen at any age—about 1 in 100 people under 40 experience symptoms of perimenopause. Onset can be triggered by surgery such as oophorectomy (ovary removal) or certain cancer treatments, but reaching menopause before 40 naturally is defined as premature and we’ll be diving into that topic in a later article.

The duration of perimenopause varies hugely, lasting anywhere from a few months to 8 years or more. It's a unique journey for each woman, influenced by factors such as genetics, lifestyle, and overall health—studies show that smokers / can reach menopause up to 2 years earlier 🚬

With life expectancy around 80, we’re spending over a third of our lives in perimenopause, menopause, and postmenopause, so let’s get educated and prepared to make the most of it! As Aviva Romm writes:

Reframing the menopause into a life and age affirming opportunity and transformation can improve women’s experiences of this time and provide a basis for the whole, wise woman.

Symptoms

🩸 VARIABLE + IRREGULAR MENSTRUAL CYCLES

One of the hallmark signs of perimenopause is menstrual irregularity or variable cycle length (7 days different from your normal). Your menstrual cycle might become shorter or longer, and you might experience unpredictable fluctuations in flow.

💦 VASOMOTOR SYMPTOMS—aka hot flashes or flushes and night sweats

The infamous hot flashes make their debut during perimenopause, leaving you feeling like you're in the midst of a tropical heatwave. They usually last 1 to 5 minutes and a cold chill might follow. Night sweats can also disrupt your peaceful slumber.

➰ MOOD SWINGS

People have described perimenopausal mood swings as much more extreme than premenstrual mood swings. Botanical therapies often include adaptogens such as ashwagandha (found in Looni’s Balance Beam).

😶‍🌫️ BRAIN FOG

Memory issues can be really alarming but may be a common symptom during perimenopause, a result of hormonal changes that might be exaggerated by insomnia and stress also experienced during this time.

🦉 SLEEP DISTURBANCES

Insomnia can be very debilitating, worsened by vasomotor symptoms and aggravating stress.

🌵 VAGINAL DRYNESS

Estrogen plays a crucial role in maintaining vaginal lubrication. As estrogen levels decline, you might notice vaginal dryness, which can be uncomfortable and result in hesitancy towards or difficulty in finding pleasure during sex.

🦴 Two changes you may not notice but might be happening inside your body are weaker bones and increased risk of heart disease. You can talk to a medical provider about getting a bone density test to see if you have a higher risk of the bone disorder, osteoporosis, and blood work to see if you have a higher chance of heart disease.

Navigating the Journey

This is a topic we’ll explore in more detail in future but understanding perimenopause is the first step towards approaching this transformative journey with intrigue and optimism.

🌿 Embracing a healthy lifestyle, including regular exercise, a balanced diet, and stress management, can help alleviate some symptoms as may acupuncture and some herbal treatments.

💊 Hormone Replacement Therapy (HRT) looks to relieve symptoms by replacing the female hormones that naturally fall during this time, but may come with difficult side effects.

It’s important for you to know your options and decide what feels right for you. While any symptoms you experience may be normal, we still emphasize that you should establish open communication with your healthcare provider to help you receive personalized guidance for your unique needs and double check your symptoms.

Perimenopause is a natural phase in our lives, ushering in changes that may be both physical and emotional. By shedding light on its nuances, we can unlock people to embrace this transition with autonomy and resilience. It's another chapter in our incredible adventure.

📚 SOURCES

Brinton, R., Yao, J., Yin, F. et al. Perimenopause as a neurological transition state. Nat Rev Endocrinol 11, 393–405 (2015). https://doi.org/10.1038/nrendo.2015.82

Burger, Henry G. MD, FRACP1; Hale, Georgina E. MBBS, PhD2; Dennerstein, Lorraine MBBS, PhD, FRANZCP3; Robertson, David M. PhD1. Cycle and hormone changes during perimenopause: the key role of ovarian function. Menopause 15(4):p 603-612, July 2008. https://doi.org/10.1097/gme.0b013e318174ea4d

Midgette, Andre S., and John A. Baron. “Cigarette Smoking and the Risk of Natural Menopause.” Epidemiology 1, no. 6 (1990): 474–80. http://www.jstor.org/stable/25759852

Nancy Fugate Woods, Ellen Sullivan Mitchell. Symptoms during the perimenopause: prevalence, severity, trajectory, and significance in women’s lives. The American Journal of Medicine,Volume 118, Issue 12, Supplement 2, 2005, Pages 14-24, ISSN 0002-9343, https://doi.org/10.1016/j.amjmed.2005.09.031.

NHS Inform

Planned Parenthood

Rebecca Hardy, Diana Kuh, Reproductive Characteristics and the Age at Inception of the Perimenopause in a British National Cohort, American Journal of Epidemiology, Volume 149, Issue 7, 1 April 1999, Pages 612–620, https://doi.org/10.1093/oxfordjournals.aje.a009861

Romm, A. Botanical Medicine For Women's Health. 485-499 (2018).

The American College of Obstetricians and Gynecologists: https://www.acog.org/

The North American Menopause Society: https://www.menopause.org/