I hear it all the time. A woman in her 40s comes to me feeling like she’s going through puberty again. She’s irritable at the smallest things and feels like she’s PMS-ing half the month. Her sleep and energy are all over the place and she’s having a hard time concentrating at work.
Like any concerned individual, she goes to her doctor to see if they can figure out what’s going on. After a quick visit, she leaves feeling disappointed and discouraged.
Her doctor says she’s “just getting older” and needs to “relax more”. They may order some labs (sometimes they don’t) which come back showing everything is “normal” and leaving her with no answers.
Less than 7% of doctors feel comfortable treating perimenopause and I suspect not many more are great at even diagnosing it.
In my practice, it seems like most women don’t know they’re in perimenopause even though they’ve been experiencing symptoms for years. So what exactly is perimenopause?
Perimenopause is the time leading up to menopause, when your period comes to an end. It lasts anywhere from 2-8 years on average and can start as early as age 40.
By definition, perimenopause is changes in your menstrual cycle, which makes sense since your period is closing up shop, but there are dozens of other symptoms that can occur at the same time. Symptoms that may be missed, dismissed, or even misdiagnosed.
If you’re a woman (or a person with a uterus and ovaries), over 40 years old, and having some of these symptoms, you may consider perimenopause as a cause:
-hot flashes or night sweats
-insomnia (either difficulty falling asleep, staying asleep, or waking up too early)
-fatigue
-weight gain, especially in the abdomen
-hair loss or abnormal hair growth (chin, chest, back)
-joint pain
-mood changes (irritability, anxiety, depression)
-impaired memory or brain fog
-irregular menstrual cycle (unpredictable cycles or even missing a period)
-heavier bleeding during your period
-increased PMS (lasting for longer or more intense symptoms)
-skin changes (dryness or changes in texture)
-headache and migraines (either new or worsening of existing headaches and migraines)
-urinary incontinence
-pain with intercourse (also known as dyspareunia)
-increased frequency of urinary tract infections
-vaginal dryness
-low libido
-bloating
-breast tenderness
-burning mouth syndrome
-increase itching of skin
-feeling like insects crawling (called formication)
-feeling of tingling or burning in your hands or feet (paresthesia)
-increased or new allergies
-digestive disturbances like diarrhea or constipation
While there are some lab tests that can help clue you in, perimenopause is what’s called a clinical diagnosis, which means there is no definitive test that can be run so it’s diagnosed based on your symptoms as well as ruling out other reasons that your symptoms may be occurring, such as low thyroid function, anemia, or PCOS.
If you haven’t been already, it’s important to start tracking your cycle so you can better tell when your period starts changing. Thanks to technology, tracking your cycle is easier than ever.
Just download a period tracking app (there are tons of free options) and start marking when your period starts and ends. Most apps also allow you to track symptoms as well, which can help you notice any patterns such as symptoms worsening a week or two before your next period should start.
Another helpful clue can be to ask your female relatives about their experience. When did your mom, aunts, older cousins and siblings start perimenopause and ultimately menopause?
It’s much easier to have solutions when we know what the problem is. If you suspect perimenopause may be the root cause of your disruptive symptoms, talk to an expert. Getting diagnosed can be half the battle.