Recognizing Perimenopause: What You Need to Know

Let's be clear about perimenopause. It's the lead-up to menopause, that phase where your hormones start their decline and your body begins a significant transition. It's not menopause itself – that's a specific point in time. Perimenopause is the *phase* of change, and it can span several years. Understanding its signs is crucial, because while each woman's journey is individual, there are common indicators that this shift is underway.

Often, the first concrete sign you're entering perimenopause involves noticeable changes to your menstrual cycle. Your formerly predictable rhythm may start to waver. According to established sources like the Mayo Clinic, these changes can manifest as:

• Irregularity in Cycle Length: Periods might become longer or shorter than what you're used to.
• Variations in Flow: You could experience periods that are significantly lighter or unexpectedly heavier.
• Skipped Periods: It's not uncommon to miss periods entirely. The Mayo Clinic notes that a persistent change of seven days or more in your cycle length can be an early sign of perimenopause. If you find yourself going 60 days or more between periods, you're likely in a later stage of this transition.

However, perimenopause is more than just erratic periods. The fluctuations in your hormone levels, chiefly estrogen, trigger a cascade of other potential symptoms. Many reputable sources, including the Cleveland Clinic and WebMD, outline these common experiences:

• Hot flashes and Night Sweats: That sudden, intense feeling of heat, often most noticeable in the upper body and face, sometimes leading to perspiration and then chills. When these occur during sleep, they're termed night sweats and can significantly disrupt rest.
• Sleep Disturbances: You might find it difficult to fall asleep, stay asleep, or you may wake earlier than desired. This can be a direct result of night sweats or other hormonal shifts impacting sleep regulation.
• Mood Fluctuations: Increased irritability, mood swings, heightened anxiety, or even a greater susceptibility to depression can occur. Sleep disruption can exacerbate these changes.
• Vaginal and Bladder Changes: As estrogen declines, vaginal tissues can become thinner, drier, and less elastic. This may lead to discomfort, itching, or pain during sexual intercourse (dyspareunia). You might also experience increased urinary urgency, a higher frequency of urinary tract infections (UTIs), or issues with incontinence.
• Shifts in Sexual Function: Changes in libido or overall sexual desire are commonly reported.
• Cognitive Issues (Brain Fog): Difficulty concentrating, memory lapses, or struggling to find the right words are often grouped under the term "brain fog" and can be a frustrating aspect of perimenopause.
• Other Physical Symptoms:
  • Breast tenderness, similar to premenstrual symptoms but potentially more frequent or intense.
  • An exacerbation of premenstrual syndrome (PMS).
  • Persistent fatigue that isn't alleviated by rest.
  • New or worsening joint and muscle aches or stiffness.
  • An increase in headaches or changes in headache patterns.
  • Noticeable changes to skin (dryness, loss of elasticity) and hair (thinning).
  • Weight gain, often around the midsection, can occur as metabolic rates may slow. Information from resources like Riverside Health System also highlights this.
• Reduced Fertility: Ovulation becomes irregular, making conception more difficult, though pregnancy is still possible.
• Cholesterol Level Adjustments: The decline in estrogen can lead to less favorable changes in blood cholesterol profiles.
• Accelerated Bone Loss: The rate of bone density loss can increase during perimenopause, which is a precursor to the increased risk of osteoporosis in post-menopause.

Confirming Perimenopause

A diagnosis of perimenopause is generally made based on a combination of your reported symptoms, your age, and your menstrual history, as outlined by the Mayo Clinic. It's important to understand that there isn't a single blood test that definitively diagnoses perimenopause. Hormone levels, such as follicle-stimulating hormone (FSH), can be measured, but these levels fluctuate so erratically during this transition that such tests are not consistently reliable for diagnosis. They are more often used to rule out other conditions, like thyroid dysfunction, which can mimic some perimenopausal symptoms (Cleveland Clinic; Medical News Today).

A consultation with your doctor will typically involve a discussion of your overall health and may include a physical and pelvic exam. Tracking your menstrual cycles and any associated symptoms can provide valuable information for this assessment.

Consulting A Doctor

Perimenopause is a natural biological process. However, if your symptoms are significantly impacting your quality of life, try to get treatment. Furthermore, certain patterns of bleeding necessitate a consultation to rule out other potential underlying conditions. The Mayo Clinic advises seeing a doctor if you experience:

• Particularly heavy bleeding (e.g., requiring a change of tampons or pads every hour or two for several hours).
• Bleeding that persists for longer than seven days.
• Any bleeding or spotting that occurs between your periods.
• Bleeding following sexual intercourse.
• Menstrual cycles that consistently occur less than 21 days apart.

If I could turn back time, I wish I visited my doctor during perimenopause. Frankly, I was relieved to no longer have a period and not eager to discuss it with anyone. It would have helped to start the charting process then, during the transition..