No one told you it was going to be like this in your 40's. You thought by now you'd have it together, would know what to expect, would know where you going with your life. Instead, in your 40's all of your prior choices and life experiences come together to create a crushing set of expectations from every direction. If you delayed making a lifetime commitment to a partner or having children, you're knee deep in the throes of parenting. Parents who are still alive are showing signs of age and needing more support. Your career is likely reaching a zenith, with your role carrying greater responsibility to colleagues and third parties. And then there's your partner, looking for their slice of your precious time and energy.
In the midst of this swirl of everyday activity, you begin noticing your monthly period is different. It's late, then it's early. It's heavier or lighter when it does come. Perhaps even more infuriating, your emotions are all over the place anticipating its arrival. You're just so moody. It's like PMS on steroids. You may be asking yourself: Is this my imagination? Am I just tired? Could this perimenopause?
The reality is that most women never know for sure. Defining the start of perimenopause is elusive. What we do know is that, for most women, sometime in their mid to late 40's, hormone levels begin to vary more widely. But there are exceptions. For some women, hormone fluctuations begin as early as age 35, which is considered premature perimenopause. While for other women, these hormone fluctuations do not begin until they are in their 50's. This wishy-washiness about when perimenopause starts adds to women's confusion. And, in many cases, it means women do not receive medical treatment. We are only beginning to understand how not receiving proper treatment during perimenopause and menopause, or even delaying it, changes the course of women's future lives.
Typically women present to their provider reporting symptoms that do not seem to be explained by anything else. In this way a diagnosis of perimenopause may be seen as a diagnosis of exclusion. Here are some of the common symptoms that women report: irregular (ie. missed, heavier, lighter, longer) periods, menstrual cycles that vary in length more than seven days, hot flashes and night sweats. Other symptoms that are often ignored or less commonly connected to perimenopause include insomnia, middle of the night waking, irritability, mood swings, anxiety, depression, painful sex, reduced libido, weight gain, cortisol belly, slowed metabolism, headaches, brain fog, difficulty concentrating, forgetfulness, joint pain and thinning hair.
Perimenopause, in short, is a full body experience. Certainly obtaining treatment for many of these symptoms may be beneficial and improve quality of life for many women. It's essential to seek care when these symptoms are interfering with daily life, when bleeding is particularly heavy (ie. soaking through a sanitary pad in an hour) or when there is a threat to life.
Medical treatment during perimenopause can include prescription of medications. The most widely recognized of these are hormone replacement therapy and hormone therapy, which both help to increase levels of estrogen and progesterone in the body. Other common medications include antidepressants to address mental health symptoms, birth control pills to stabilize hormones and vaginal creams to reduce pain during sex.
Your provider may also suggest lifestyle changes which may include dietary changes such as eating more protein, whole grains, fruits and vegetables, performing weight-bearing exercises like weight lifting, hiking or strength training, dressing in layers, keeping your environments cooler, limiting alcohol and caffeine, improving sleep hygiene and doing relaxing activities before bedtime, and practicing meditation as well other stress management techniques.