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How do I know if I’m in perimenopause?
13 Aug 2024
In today’s world, the word ‘perimenopause’ has a lot of emotion, judgment, and misinformation tied to it. The vocabulary used to describe this life transition is that of a medical condition that needs to be ‘treated’, as opposed to a natural transition in a woman’s (or a person with ovaries) life where they should feel well supported, educated and informed. It is currently associated with symptoms that can differ from person to person, but most will report an overall decrease in their quality of life. Generations before us didn’t have the access to resources or education to discuss their experience and decided to ‘live’ with their symptoms and push through. Now, we can get excited about this phase of life where we can use it as an opportunity to determine current health status, act preventatively and to provide support for the patient’s menopause experience and overall long term health.
Our Role as Naturopathic Doctor’s
As integrative health care practitioners, we have the knowledge and resources to help patients understand and become aware of the changes they are experiencing or may experience in the future in their transition to menopause. We can provide recommendations and a strategic plan for lifestyle changes and supplemental support to address symptoms, improve quality of life, but also to reduce future health risks. We do not need to ‘regulate’ your cycle. We do not want to impose on this natural phase of life, we just don’t want one of the longest hormonal influential times to reduce your quality and enjoyment of your health. We can help you set health goals for the next stage of your lives, which may involve informed consent conversations around contraception and indication for the use of hormone therapy, counseling patients on the risks and benefits of all scenarios.
How do I know if I’m in perimenopause?
As you approach perimenopause, your total cycle length will begin to change. A seven-day change in either direction (shorter or longer) when you have had regular cycles before indicates the beginning stages of perimenopause. Cycles often get shorter before getting longer, but every person has a unique experience. You may also notice changes in the volume of blood lost with each period; perimenopausal cycles can be both heavier or lighter than normal. It is important to remember that every woman experiences this transition differently.
Perimenopause is diagnosed clinically, so if you’re speaking to your healthcare provider you want to make sure they are asking you about the following aspects of your health:
-New onset of symptoms you may be noticing and changes
-Menstrual cycle history
-Past medical history
-Family history
A lot of people aren’t aware that signs of perimenopause can present themselves in their 40s, way before we start to notice changes in the menstrual cycle. We can start noticing changes in sleep and mood (reported insomnia and low mood) well before changes in our cycle. Some common symptoms include but are not limited to:
-Vasomotor symptoms (hot flashes, night sweats)
-Vaginal dryness, pain or itching
-Trouble sleeping
-Low mood, feeling anxious
-Brain fog/change in cognitive function
-Bladder changes and recurrent UTIs
-Joint pain
-Fatigue/lack of energy
-Reduced libido
-Weight gain/loss of muscle
-Irregular cycles
When we start to see changes in our menstrual cycle, we may notice:
-Shorter or longer cycles
-Reduction in bleeding OR heavier bleeding
-Different pattern every month
Please remember that even if you are experiencing changes in cycle length with no other signs of menopause, other health factors need to be ruled out before we can use the perimenopause stamp. This applies to women below the age of 45.
How long can I be in perimenopause for?
The length of perimenopause can vary, but can range anywhere from 4-8 years. Menopause occurs once we have gone 12 months without a menstrual cycle at all. Then, the person is considered to be postmenopausal.
This is a crucial time to not only address symptoms, but to be preventative for long-term health. A variety of treatment options are available to help reduce cardiovascular risk, bone density issues, cognitive health, and many more. The role of estrogen is protective on these aspects of health, so as estrogen declines we need to enforce our foundations of health to support these long term risk factors.
Am I still fertile in perimenopause?
It is important to note that just because perimenopause is occurring, does not mean that you are no longer fertile. With the changes in cycle length, the predictability of ovulation becomes harder and harder which is why contraception is a key piece of the puzzle that must be discussed during this time.
Tracking Your Cycle in Perimenopause
It is important to follow the same principles of cycle tracking as we approach perimenopause. Over the age of 40, a woman’s menstrual cycle becomes less consistent. An egg may not be released every single month, and this interferes with the production of hormones like estrogen and progesterone. The initial changes in perimenopausal cycles may be subtle. Knowing if ovulation is occurring can help us monitor cycle length changes, bleeding changes, and PMS symptoms. It can also help your healthcare practitioner review your best treatment options, as hormonal fluctuations can influence symptoms and how you feel. You may also notice an increase in other symptoms when you approach perimenopause as discussed above.
You can track these symptoms against your cycle, as sometimes they occur all month long, or they may occur only during cycle phases. Drastic hormonal fluctuations can influence your symptoms and may be why a patient experiences poor sleep and the hottest flashes at a certain time of the month. You may also notice that your PMS symptoms are absent during longer stretches without a period, or if your period arrives early. This may indicate that you did not ovulate, meaning changes in mood, breast tenderness, bloating, etc. cannot be explained by premenstrual fluctuations any longer.
Can I get a lab test to confirm if I am in perimenopause?
The short is answer is that this is not necessary. Testing our hormones through blood will not indicate anything about where you are in your perimenopausal journey, and doesn’t explain your symptoms or your experience. The only indication it will tell us is if your body is able to ovulate or not, which can vary from cycle to cycle especially during this stage. We would be looking for FSH to be high and estradiol to be on the lower end, but this would only be accurate if we tested it consecutively and does not change or guide us in our treatment plan. So don’t waste your money on testing!
What You Can Do
This transition doesn’t have to be confusing or overwhelming. With the proper assessment, you can have support to improve your sleep, mood, PMS experience, reduce severity of vasomotor symptoms, vaginal and bladder changes, libido changes, and heavy menstrual bleeding. Due to the loss of estrogen, we also want to consider standard of care treatments that can help reduce your risk of bone mineral density loss and cardiovascular changes/disease. Your quality of life can improve with the right support and we can become excited about this transition in life.
Here are some things you can start doing TODAY if you suspect you might be perimenopausal:
- Eat a Mediterranean style diet: a diet high in protein (1.2-1.5 grams of protein per kilogram of body weight, our metabolism changes and increasing protein intake will reduce caloric intake overall and avoid weight gain that is common), fruits and vegetables, healthy fats (olive oil, nuts and seeds), 2-3 servings of fish per week, and low in processed/packaged foods will be supportive of your hormonal health
- Exercise a minimum of 150 minutes per week
- Limit alcohol and caffeine, especially in the two weeks before you expected period
- Prioritize sleep and stress management strategies
- Track your cycle to collect data
As always, ask your practitioner which method of tracking and testing your cycle is right for you. Education about your menstrual cycle leads to empowerment and will bring you a step closer to accomplishing your health goals.
Conclusion
If you’re curious if you’re in perimenopause and want to get a head start on being preventative, book an initial appointment with me at Natural Choice Medical Clinic in Guelph!
Dr. Annaleeza Caputi, Naturopathic Doctor
This article was originally published by EcoParent magazine.
