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So... What's Perimenopause?

Updated: Jan 8, 2023

We've all heard the word Menopause and often think older women, hot flashes, mood swings, and no longer having a menstrual cycle. But what many women (and especially men) don't realize is that in order to get to Menopause, we must first get through Perimenopause. So let's start with a few main points here:


Perimenopause can start at any point after the age of 35

I see it a lot in my practice. Women come to me, late 30s - early 40s, complaining of their periods getting heavier, cycles are shorter than they used to be, constant fatigue, more migraine headaches, and a variety of other symptoms. Their doctors have blown them off, told them to just go on birth control (which is more often a band aid, not a problem fixer), and said their labs "look fine." Yet, they don't feel fine! What they, and many doctors, don't realize is that those are all symptoms of the very early stages of perimenopause. Now, I will note that this isn't always the case, and I have plenty of clients who the cause of their symptoms is related to other issues that show up in labs not traditionally run by GPs.

But, if you have at least 5 of any of the below symptoms it might be time to run more comprehensive lab work and consider the possibility that perimenopause is on it's way and/or has begun:

Symptoms of Perimenopause

  • Irregular Periods

  • New or increased Stress Incontinence (Urinating involuntarily when you sneeze, laugh, cough, jump, run, etc.)

  • New or increased Urge Incontinence (Urinating involuntarily when you get and urge to urinate)

  • Vaginal Dryness

  • Depression

  • Hot Flashes

  • Cold flashes

  • Sleep Problems (can be fatigue to insomnia)

  • Extreme Mood Swings

  • Short Term Memory loss and other cognitive impairments

  • Weight Gain- maybe specifically around the mid-section

  • Loss of Breast fullness OR Increased Breast fullness

  • Night Sweats

  • Migraines and severe headaches

  • Fatigue

  • Anxiety

  • Loss of sex drive OR increased sex drive

  • Bloating and flatulence

  • New or Additional Food sensitivities

  • Psychological changes such as loss of self-confidence, feelings of invisibility, and/or isolation

  • Hearing Problems

  • Worsening Allergies

  • Tingling in extremities

  • Palpitations

  • Breast Pain

  • Hair loss

How many of the above symptoms are you experiencing?

  • 0-5

  • 5-10

  • 10+


It takes up to 15 years (yes you read that right, YEARS) to get through Perimenopause, hit menopause, and thus become post menopausal

This is probably one of the most misunderstood points about women's bodies and how hormones work. We don't just magically get our first period at age 10-15ish (some earlier and later than that because NO ONE is textbook) and then somewhere between the ages of 50-60 it magically stops. Our body's take time to do the things it does. For example, when thinking about the body how long does our hair or our nails to grow? Neither of them grow overnight, it takes time. So now take that idea into the context of internal function and hormones, it takes a lot more time. After the first period it takes many years for a young woman's body to actually regulate her hormones. This is one of the many reasons why we shouldn't be giving young women hormonal birth control (a subject for another time). Without those fake hormones their bodies are able to learn to regulate correctly and have better control over their hormonal function over all. This same concept applies to women going through perimenopause. The process of perimenopause starts with minor hormone fluctuations outside of the norm and over many years the hormone levels will start to lower to menopause levels.

The 4 stages of perimenopause that happen over a 10-15 year period


Perimenopause and it's symptoms are a culmination of highly fluctuating estrogen and continually lowering progesterone - NOT low estrogen, like is often suggested

Hormone fluctuations in perimenopause are another thing that is often very incorrectly talked about. Many women are told that their perimenopause symptoms are caused by low estrogen which is very much not the case. As discussed above, the process to becoming post menopausal takes time. And during that time women's estrogen numbers will actually fluctuate significantly going from very high highs to some low lows but it isn't consistent and definitely isn't the main cause of many of the symptoms experienced. What DOES happen is that progesterone drops, significantly. This drop in progesterone and highly volatile estrogen is why women have symptoms like heavy periods, increased breast pain, hot flashed, and many more. The below graph can give you a more visual idea of what I am trying to explain here.

From "Perimenopause lost - Reframing the end of menstruation" - Jerilynn C Prior DOI:10.1080/02646830600974071


If you have ovaries you WILL go through perimenopause (ahem... this one is for my ladies who have had hysterectomies)

I will make my discussion on this last point short and sweet, since it is fairly self explanatory. Just because a woman doesn't have a uterus it does not omit them from going through the same hormone changes that other women go through. As long as a woman has functioning ovaries, which is often the case in this day in age when women get hysterectomies, her body will still go through all of the above mentioned processes. The only difference is that there is no period to gauge where she is at in the process. That being the case, these women need to be more in tune with their bodies, their symptoms, and need to get regular hormone labs done to keep an eye on where everything is at. If you have had a hysterectomy and aren't sure where you are at in the process or want to know more please reach out!


Want to Know More??

Here are two great opportunities to learn more about hormones, nutrition, your body, and how to be Powerful Through Perimenopause. Register today!

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