How do I know if I’m in perimenopause?
Do you find yourself wondering if you are entering The Change, that ‘Time of Life’? And how do you know you are getting reliable information?
There are quite a few unspoken signs that you are entering this important stage in a woman’s life. You may be shocked by some of the surprising signs of perimenopause! And the fact that NOBODY has ever mentioned these to you before.
I will post in a later article (probably quite a few actually, it’s a bit of a passion of mine) about how you can support yourself through these changes.
*I use the term woman and female throughout this article, but I recognise that not everyone who menstruate identifies as a woman.
One thing you may notice as you enter perimenopause is that you are becoming more sensitive to sounds, smells, and sights than you were before. Finding that your tolerance for pretty much everything is becoming more narrow! (Hence the noise cancelling earphones).
A Bit of Science
When people talk about perimenopause and menopause, they quite often talk about hot flushes/flashes and irregular cycles. But these are actually some of the least likely symptoms for some women, especially in the first few years. (I actually get quite cross when hot flushes are talked about as if that is ONLY challenge we face!)
To understand why this is, we need to go into a bit of science. But first, just a quick word on terminology. Menopause occurs when you haven’t had a period for 12 months. Perimenopause is the transitional stage between fertility and your monthly bleed ending. And can last 7-10 years.
You read that right.
The rise and fall of oestrogen and progesterone through puberty and perimenopause.
The transition to menopause can take 10 years. And it isn’t a linear process either. It is fraught with challenges because it is so unpredictable. Your hormones can fluctuate from month to month, week by week, even day to day. So while the general trend is that key hormones are on their way down, they don’t do this in a beautiful, graceful arc. But in a haphazard messy way that can be very difficult for women to cope with.
The graphic above only shows oestrogen and progesterone, but in reality it is all of our sex hormones that are affected including testosterone.
The reason this causes so many problems is that oestrogen plays a crucial role in almost all functions in our body. And progesterone has a special relationship with other neurotransmitters that affect mood. Testosterone, while found in only small quantities in female bodies, impacts our energy levels as well as our libido.
So as we enter perimenopause, we can experience changes in every single part of our body and brain, our mood, and in our energy levels.
And recent research has also shown that women today are experiencing far higher levels of changes compared with women a generation or two ago. A study has been published that showed that women are twice as likely to experience hot flushes than earlier generations. And, to add insult to injury, women can still experience them over 10 years after their last period.
(Yes, I know I complained about hot flushes a scant minute ago - but sadly, research on women is still lagging, and perimenopause and menopause is still focused on this particular aspect. So that is the evidence I have to draw upon.)
As a menopause coach this concerns me deeply. The reasons why we are all experiencing harsher menopause are unclear, but in the main are thought to include environmental toxins, greater stress, and changes to our diet and lifestyle.
Signs of Perimenopause
Here are a summary of the key signs that you are entering perimenopause. Sadly, menopause can happen very early in life, but generally speaking we start to enter this stage from around the age of 35 onwards. With the average age of menopause occurring at around 51.
You can get any of these signs in any order, but I have broadly listed them in order of likelihood from the start of perimenopause to post menopause.
Weight gain: particularly around the abdomen as cortisol levels fluctuate alongside changes in oestrogen and progesterone.
Skin and Hair: getting dry skin can be an early sign of perimenopause. Some women also report changes in hair thickness, finding that they get thinner hair strands as well as fewer hair follicles. This is down to the role that oestrogen plays in stimulating production of collagen, hyaluronic acid, and lipids.
Urination and Bladder: we have oestrogen receptors in our muscles, connective tissue, joints, and tendons. So changing oestrogen levels can affect the tone of our muscles including those that control urination. Leaking when we sneeze, cough, or jump after the age of 35 is likely to be related to fluctuating oestrogen levels.
Aches and Pains: as mentioned, oestrogen receptors are found throughout our body, including the muscles and connective tissue. As oestrogen levels decrease, we are more susceptible to inflammation in the joints causing pain in the surrounding tissues and muscles.
Dental problems: even our teeth aren’t safe! Due to the role that oestrogen plays in our soft tissue, gum problems are very common through perimenopause. Dental hygiene is therefore very important through this time.
Exhaustion: decreasing levels of testosterone alongside depleted oestrogen affects sleep and energy levels. Chronic fatigue, mood disorders, concentration difficulties, and a decrease in productivity all impact through this stage of our life, but yet we’re expected to carry on as if nothing has changed.
Memory and Concentration Issues: Cognitive changes, such as forgetfulness or difficulty concentrating, can occur during perimenopause, often referred to as “brain fog”. This is due to the relationship between oestrogen and dopamine, a key neurotransmitter in cognitive function including memory, planning, and recall.
Mood Changes: You may notice changes in your emotional state, such as increased irritability, anxiety, or mood swings. These fluctuations can be attributed to changes in progesterone as it helps us synthesise serotonin.
Breast Changes: Changes in breast tenderness or size can occur as oestrogen and other hormones fluctuate.
Sleep Disturbances: Difficulty falling asleep or staying asleep is common during perimenopause, often exacerbated by night sweats and hormonal imbalances. Nearly 60% of women report difficulties falling asleep, frequent night awakenings, and non-restorative sleep during perimenopause, through and post menopause.
Irregular Menstrual Cycles: Changes in your menstrual cycle, including fluctuations in cycle length and flow, are often one of the last signs of perimenopause. Periods may become shorter or longer, heavier or lighter. And may change from month to month.
Hot Flashes and Night Sweats: Some women experience sudden feelings of warmth radiating throughout the body, often accompanied by sweating, known as hot flushes. Night sweats disrupt sleep and may leave you feeling uncomfortable and exhausted. This is another symptom that is referenced a lot but actually happens later in the process and isn’t experienced by all women.
Changes in Sexual Function: You may experience vaginal dryness or discomfort during intercourse due to decreased oestrogen levels. This, alongside changes in testosterone levels, can also lead to a decrease in libido for some women.
Osteoporosis: the link with bone health is well documented, alongside hot flushes. Oestrogens play a crucial role in maintaining bone health, by stimulating the activity cells that build bone and inhibiting cells that absorb bone. Their decrease causes an imbalance in bone remodelling, with bone loss that can reach 2 to 5% per year in the first years following menopause.
Cardiovascular health and cholesterol: perimenopause is accompanied by significant changes in our lipid (fats) profile, which can increase the risk of cardiovascular diseases in women. Oestrogen plays an important role is how fats are metabolised. As levels fall, our cholesterol balance can be affected.
Changes in blood pressure: Oestrogens play a key role in blood pressure regulation, acting on several mechanisms. With the fluctuation and eventual drop in oestrogens at through perimenopause and at menopause, these protective effects gradually disappear. This leads to an increase in arterial stiffness and a rise in blood pressure.
If you are experiencing several of these symptoms, it may indicate that you are entering perimenopause. Unfortunately, no blood test currently, reliably informs whether we are in perimenopause, because hormones can fluctuate so drastically.
When you speak to your GP (in the UK) they will take a detailed medical history and examine the signs you are experiencing. And it is now a little easier to get HRT or at least be taken seriously. When I first went to my GP around 10 years ago with some of these signs, my bloods showed nothing and that was the end of my journey. That has changed as more science is available to back up claims by women that they are experiencing far more problems than hot flushes.
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Exercise also has proven benefits for perimenopausal and menopausal women. Weight bearing exercise, stretching, and balancing all have positive impacts on our health. If you like cardio exercise, don’t stop doing it, but it isn’t always as effective as reducing stress, changing eating habits, or lifting weights for perimenopausal people.
If you live in Cambridgeshire and would like a heart-centred exercise practice that supports you in perimenopause to balance cortisol as well as tone, increase flexibility, improve bone health, and help with mood regulation, then check out my page on somatic movement.
