How Do I Know I’m in Perimenopause? And What Should I Do About It?
Perimenopause and menopause are finally getting more attention, which is a good start to helping more women through it. There’s a lot of information out there, but it’s not always easy to know what to make of it. Keep reading for what I think is most important to know, and some concrete things you can do.
What is it?
Perimenopause: Time of transition characterized by fluctuating hormones
Can occur as early as the late 30’s, but most often occurs in the 40’s
Can begin 10 years prior to menopause
Best time time to make lifestyle changes to ease the transition
Menopause: The single day one year after your last menstrual period
Average age is 51
Under 45 is considered early menopause
Postmenopause: The rest of a person’s life after menopause
Hormone levels settle, but estrogen and progesterone remain low without supplementation
What are the Symptoms?
Lack of estrogen
Night sweats
Hot flashes
Sleep disturbances
Vaginal dryness
Painful intercourse
Brain fog
Weight gain - particularly abdominal
Heart palpitations
Joint pain - estrogen is anti-inflammatory
Tendonitis and frozen shoulder - estrogen promotes collagen and reduces stiffness
Lack of progesterone
Increased anxiety
Breast tenderness and/or lumpy breasts
Decreased libido
Period irregularities - changes in flow or cycle duration/frequency
How Is Perimenopause Diagnosed?
Diagnosis is often made based on a combination of age, multiple symptoms, and ruling out other issues like PCOS or thyroid conditions. Hormone testing is not always used in diagnosing perimenopause because of the fluctuations that characterize this transition. Because hormone levels become a moving target, they aren’t always reliable for diagnosis.
Diagnostic Symptoms:
New menstrual changes
Heavier or longer flow
Shorter cycles
New onset night waking or night sweats
New sore, swollen, or lumpy breasts
New or increased migraine headaches
Weight gain without eating/exercise changes
New worsening of PMS symptoms
What Should I Do About It?
If you’re in your late 30’s to 40’s and have been experiencing the above symptoms, you should talk with your primary care physician or gynecologist to consider a diagnosis of perimenopause, rule out any other possible causes, and discuss treatment options. If your doctor doesn’t have a lot of experience with perimenopause and menopause, you can find a practitioner who does in this directory.
Your doctor is the one who can discuss if hormone replacement therapy is a good option for you. Current evidence supports hormone replacement therapy as a safe and effective treatment for symptoms related to perimenopause and menopause when it is started before age 60 or within 10 years of menopause. However, your individual health and risk profile will determine if this is right for you.
If you’re experiencing genitourinary symptoms like painful sex, vaginal dryness, urinary incontinence, or frequent UTI’s, discuss this with your doctor but also consider seeing a pelvic floor physical therapist (like me!). Read more about Genitourinary Syndrome of Menopause and treatment options here.
How Can I Help Myself?
Lifestyle modifications can also be extremely helpful during perimenopause and menopause. These can help promote heart health, brain health, bone density, healthy weight, and maintenance of muscle mass. Not all of these lifestyle changes are easy, but even working on one to start is moving you in the right direction. The sooner the better!
Promoting good sleep practices
Limiting caffeine later in the day
Reducing screen time before bed
Reducing alcohol intake
Alcohol is inflammatory
Disrupts sleep
Feeding yourself well
Balance of quality carbohydrates, good fats, and protein
Promoting whole foods when possible
Increasing protein to meet 0.5 - 1 gram per pound of body weight
Exercising
A mix of cardio, strength training, and flexibility
Make sure weight-bearing exercise is in the mix
Most important is consistency
Strength training is often overlooked but is essential for maintaining muscle mass and bone density
Strength training basic formula
Pick 4-5 different resistance exercises
Start at 3 sets of 8-12 reps, can progress to 4-5 sets
Focus on good form with lower load, then add more
The last 2 reps of each exercise should be hard but manageable
Perform 3x/week
Sample:
Side plank (full or modified)
Weighted squats
Bent over rows
Push up or modified push up (knees down or at wall)
Weighted lateral lunges
Optional: squat jumps
The most important thing to know is that you have resources at your disposal to help you through this transition. Get in touch if you have more specific questions or would like help from an orthopedic and pelvic floor physical therapist.