What is Perimenopause
Are My Symptoms Related to Menopause?
There is so much confusion around the topic of menopause these days, for women and physicians alike. The title of this article is a question I get asked nearly every day. Menopause is not a disease, but a stage of life not unlike puberty, and like other times of transition, some women may experience symptoms that can be troublesome while others do not experience any issues at all.
Menopause by definition is one year since last spontaneous menstrual period, typically around age 50-51, but anything between age 40-60 is considered normal.
In 1920, the average life expectancy for women was 55, in 2020 it was 81…we are basically outliving our ovaries. As women are living longer, we are living more years in relative estrogen deficiency, and this may cause significant issues in some women.
Perimenopause is literally “around menopause” and is the time during which the body makes the natural transition to menopause. Unfortunately, this transition is not like a light switch, quite the opposite in fact: erratic hormone production fluctuates from day to day and month to month, thereby causing changeable and varied symptoms. These symptoms can start up to 15 years (yes, YEARS) before the last menstrual period, so for some women that can be as early as the mid-30s. Perimenopause is a clinical diagnosis meaning, due to the hormone variability, labs often do not help in determining whether the symptoms you are experiencing are related to hormonal fluctuations associated with menopause.
Common perimenopausal symptoms may include:
Hot flashes/night sweats
Mood issues, anxiety, worsening PMS
Menstrual irregularity, heavier, more painful menses
Unplanned pregnancy vs infertility (what is goal?)
Vaginal dryness, painful intercourse, low libido
Frequent urination, urgency, incontinence
Attention, memory, concentration issues
Insomnia, fatigue
Quality of life issues like fatigue, low motivation, poor memory, body composition and skin changes.
Maybe you wouldn’t use such clinical terms as "depression" or “anxiety" or “insomnia”, but do you find yourself weeping at commercials? Being testy with your kids or partner for no reason? Losing your car in the parking lot? Waking frequently at 1-3 am, unable to fall back to sleep due to the mind racing with worries? Feeling tired or anti-social? Many women simply, often tearfully, describe just not feeling like themselves.
Even in the absence of perimenopausal symptoms, this transition is an opportunity to refocus attention and energy on a woman’s physical health and wellbeing with a special emphasis on the prevention of chronic diseases, like osteoporosis and cardiovascular disease.
Labs may be useful in that they can can identify other causes of issues that mimic or worsen the symptoms of perimenopause, like thyroid disease or vitamin deficiencies, and diseases that can increase during perimenopause, such as cardiovascular disease and diabetes. It is also important for women in their 40’s to start screening for breast & colon cancer, depending on personal risk factors. Some hormone tests, like testosterone, may be useful in determining if replacement is safe and possibly helpful.
Not all women will need hormone replacement therapy (HRT) in perimenopause: CDC estimates that 44% of post-menopausal women ever tried hormones. Treatment decisions should be based on detailed conversation between a woman and her physician.
Depending on the severity of presenting problems and woman's preference, several treatment options are available and therapies with less associated risk should be tried first. Studies confirm the positive impact of diet, exercise, acupuncture, stress management, meditation, therapy, and lifestyle changes for women with mild menopausal symptoms. Vitamin and herbal supplements may be helpful in some women, but research is mixed and appropriate dosing and use of high-quality products is necessary to know if these may be effective.
There is good evidence that non-hormonal prescription medications may do double-duty in decreasing menopausal symptoms while treating other conditions, such as depression, anxiety, and insomnia.
If these strategies do not help, assessment of a woman’s potential benefits vs. risks should be conducted. HRT can play an important role in managing symptoms during the menopause transition, preventing bone fractures, lowering risk of CVD & DM2 if hormones are started early.
There often is much confusion regarding bio-identical hormones. “Bio-identical” hormones are chemically identical to those made by a woman’s body. There are studies that suggest bio-identical hormones seem to be somewhat safer than synthetic, but they are not risk-free and are available as custom-compounded and FDA-approved pharmaceutical preparations. Compounded hormones may be necessary when there is not an equivalent FDA option (i.e. testosterone) or when allergy to a component of a commercially-produced product. Compounded products are often not covered by insurance and are not supervised as closely as the FDA-approved products and there is no evidence that custom-compounded bioidentical hormone therapy is any safer or more effective than FDA-approved hormone therapies. In some cases, like pellets, the delivery method may actually “over-dose” women, causing more risks and side effects than benefits according to new research.
As a physician who has been credentialed by the North American Menopause Society, I can help you find the right combination of treatments and referrals to help you get started on the road to wellness today. Contact me with any questions.
Menopause Learning & Resources
Hormone Replacement Therapy (HRT) and Menopause (podcast) Please listen to this great podcast on the current evidence on HRT.
The North American Menopause Society is an excellent resource for high quality information.
Leigh Lewis ND, LAc
AZ State Board Certified Women's Health Specialist
Fellow American Board of Oriental Reproductive Medicine
Nationally Certified Menopause Practitioner
Certified Perinatal Mental Health Prescriber
info@drleighlewis.com
Instagram @dr_leigh_lewis