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Published on May 24, 2022

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Perimenopause 101: Signs, Symptoms & Treatments

Perimenopause. That magical time in a women’s life when her body starts going through “the change.” Meaning: her ovaries don’t produce as many hormones as they did while she eases into — perhaps somewhat uncomfortably — menopause.

While some women can be frustrated when perimenopause symptoms begin in their early 40s or younger, Jessica Morrell, CNP, IFMCP, with Avera Medical Group Functional Medicine, said they usually aren’t surprised.

“These symptoms blend into menopause,” she said, “so many of the symptoms of perimenopause are the same as menopause.”

What is Perimenopause?

Perimenopause has been variously defined, but experts generally agree that it begins with irregular menstrual cycles — courtesy of declining ovarian function — and ends a year after the last menstrual period.

Although some women start developing symptoms in their 30s, it’s common for perimenopause to start in a woman’s mid-40s and can last two to 10 years. While some studies have shown that perimenopause is starting earlier in women and menopause is starting later, Morrell says that’s not necessarily the case.

“It is possible,” she said, “but may also be just as likely that we are addressing it sooner or are more aware of the connection of hormones than we have been in the past.”

Perimenopause isn’t the same for everyone. For example:

  • The average duration is three to four years, although it can last just a few months or extend as long as a decade.
  • Some women feel pummeled by hot flashes and wiped out by heavy periods.
  • Many have no bothersome symptoms.
  • Periods may end more abruptly for some, while others may menstruate erratically for years.

Fortunately, as knowledge about reproductive aging has grown, so have the options for treating some of its more distressing features.

Perimenopause Symptoms

By a woman’s late 30s, she doesn't produce as much progesterone. The number and quality of follicles in her ovaries also diminishes, causing a decline in estrogen production and fewer ovulations. As a result, by her 40s, cycle length and menstrual flow may vary and periods may become irregular. Estrogen may drop steeply or spike higher than normal.

Symptoms can include:

  • Trouble sleeping
  • Night sweats
  • Hot flashes
  • Irritability/depression, anxiety
  • Irregular periods
  • Change in menstrual flow
  • Weight gain
  • Fatigue
  • Loss of muscle mass
  • Headaches
  • Skin changes
  • PMS changes
  • Joint aches
  • Foggy thinking
  • Decreased libido
  • Vaginal dryness
  • Heart palpitations

Hormone therapy given in the right doses can drastically improve the symptoms of this transition. Lack of estrogen affects so many areas in the body – cognition, cardiovascular, musculoskeletal. The rapid decline in hormones with then an occasional surge of hormones contributes to the symptoms.

What to do About Perimenopause Symptoms

While perimenopause is typically symptom-based, Morrell said hormone testing can give insight into where the imbalances are to direct interventions. But it involves more than just hormones.

For example, if the GI system and metabolic systems are not healthy, symptoms are more likely to be pronounced. Doctors often must dig a bit deeper than just hormone testing.

A few things to know about perimenopause symptoms include:

  • It’s important to focus on a healthy lifestyle. This can involve increasing dietary fiber, decreasing sugar and processed foods, increasing cruciferous vegetables (broccoli, cauliflower, kale, cabbage, Brussels sprouts), exercise, mindfulness.
  • Typically, symptoms are worse for people who have other imbalances going on in their bodies. There are treatments depending on where the imbalances are. Morrell recommends talking with a provider who will test hormones, take a dive into adrenal function, and look at thyroid function.
  • When hormones start changing it can affect thyroid function as well.
  • Hormone therapy, acupuncture, and herbal therapies are some of treatment options available.

“When women say they feel crazy, it is because their hormone patterns are crazy,” Morrell said. “It’s important to know that they are not alone.”

Talk to your provider if you’re interested in hormonal testing or treatments related to perimenopause.


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