Could it be Perimenopause?
Sometimes I catch patients off guard by mentioning perimenopause as a potential underlying cause of their symptoms. In some cases, this is because the woman didn’t realize the menopause transition could cause more than hot flashes and night sweats. At other times, it’s because the person doesn’t realize that perimenopause can occur at their age.
Normal menopause occurs between 45 and 55 (51 on average in the United States), and perimenopause can precede this by up to 7 years (as young as late 30s). We cannot predict when a woman will stop menstruating or how long she will have symptoms related to menopause, but talking to female relatives about their menopause transition and reflecting on personal experience going through puberty can be helpful.
Below are some of the lesser known symptoms of perimenopause. You may experience any number of these symptoms or none of them. Provided the underlying hormonal issue is identified, these complaints are all treatable with interventions ranging from lifestyle to nutrient and herbal supplements to pharmaceutical medications.
Menstrual Irregularities
Counterintuitively, perimenopause often starts with heavier and more frequent periods. The reason being that progesterone declines before estrogen in the menopause transition, and progesterone is the hormone that helps extend our cycles and keep them lighter. There are lots of interventions available to help slow bleeding; consult your naturopathic doctor.
Women can also skip periods, sometimes for months at a time. This is usually monitored but not treated if laboratory tests indicate there’s no hidden cause. It’s generally not harmful to skip periods, but it’s possible that the period following will be heavier than normal. Menopause (rather than perimenopause) is when you’ve had no spontaneous periods for 12 consecutive months, and until reaching that threshold, there’s always the possibility for more periods. Prepare accordingly.
Mood Changes
Irritability, anxiety, and insomnia are all common mood changes in perimenopause. Progesterone binds GABA receptors in the brain, which provides a calming effect; as progesterone drops, anxiety and insomnia can crop up or worsen due to decreased GABA stimulation. Irritability and sleep disruptions can be a result of the hormone fluctuations that occur during perimenopause.
Energy & Weight
Decline in estrogen can also trigger fatigue and brain fog due to the complex interplay between hormones and whole body functioning. The thought is that it takes time for the mind and body to adjust and adapt to the new hormonal milieu, although in some women these symptoms can persist.
Perimenopausal weight gain is a nice illustration of the complex interplay happening in the body when hormone levels shift. Estrogen helps the body be sensitive to insulin. As estrogen declines, women tend to become more insulin resistant. This can lead to an increase in blood sugar as well as the tendency to gain weight in the abdomen.
Sexual Function
Finally, perimenopause can affect sexual functioning. This can be a result of vaginal dryness causing pain during intercourse. Sometimes there is an emotional component, related to irritability affecting the relationship or challenges with self-confidence related to weight gain. Hormone decline can also lead to low libido, slow arousal, and/or decrease in orgasms. These issues are all treatable, but it is important to reflect where the issue resides (lack of desire, discomfort, relationship challenges, etc.), so the treatment can be targeted to be most effective.
