When women reach their 40s, it feels like menopause is still a far-off destination. But perimenopause symptoms can occur for years (sometimes over a decade) before you reach menopause. With a wide variety of symptoms and a lack of public awareness around the mysteries of perimenopause, this can leave women wondering, how do I know if what I’m going through is normal for perimenopause?
As we’ve discussed before, the list of symptoms associated with perimenopause is extensive. But just because a symptom is related to perimenopause, does that mean it’s normal or does it indicate there’s a deeper issue going on?
Let’s start with one main symptom that would be considered normal and expected in perimenopause through a holistic lens.
The most logical perimenopause symptom is change in your menses. Typically, periods start changing by becoming more frequent and heavier. This can last for months to years before your period starts becoming less frequent and lighter, and then ultimately ceasing all together.
The next set of symptoms would be considered normal for perimenopause but also normal with aging in general. In other words, we can’t expect our bodies to function like they did at twenty. It doesn’t mean there aren’t things that can be done to address them if they’re a concern but to some extent, they can be normal as we age.
These symptoms include decreased libido or sex drive, vaginal dryness, changes in skin texture, changes in hair texture or thickness, less energy (though you should still be able to function), and mild changes in memory. As hard as it is to feel our bodies change as we age, I like to take the perspective that we’re lucky to get older since not everyone has that opportunity.
Then we have symptoms that are commonly thought of as due to perimenopause but from a holistic perspective, they actually indicate there’s another underlying dysfunction occurring. That could be due to hormone imbalances like cortisol or insulin, a nutritional deficiency, or larger issues at play such as gut dysfunction or needing to set better boundaries with families and work.
First, we have hot flashes and night sweats. While yes, hot flashes and night sweats are one of the most disruptive symptoms, they usually indicate there’s an underlying hormone imbalance occurring, usually cortisol.
Weight gain is also common in perimenopause, with over 80% of women gaining weight at this time of life. It has been thought for years that weight gain in perimenopause, especially around the abdomen, is due to waning levels of estrogen since adipose (fat cells) can make estrogen. However, newer research suggests that weight gain is associated with aging, not necessarily perimenopause.
We frequently associate periods with PMS symptoms, as though it’s normal and expected. In reality, it’s a sign that there’s a deeper dysfunction occurring. The same is true in perimenopause when those symptoms of PMS can worsen or occur for weeks instead of a few days. This can include changes in mood like irritability, sadness, or anxiety, or breast tenderness.
Other symptoms common in perimenopause are changes in sleep, fatigue, brain fog, abnormal hair growth (chest, face, or back), joint pain, and new or worsening of headaches and migraines. These symptoms can have several potential root causes unrelated to perimenopause.
And even though urinary incontinence and pain with intercourse can occur as we get older, things like pelvic floor physical therapy can make a profound difference, especially when addressed sooner rather than later. Pain and incontinence are not things you need to grin and bear, there are treatments that can help.
Other symptoms that can indicate there are larger issues at play such as a gastrointestinal condition, immune system dysfunction, or adrenal fatigue include increased frequency of urinary tract infections, bloating, increased or new allergies, and digestive disturbances like diarrhea or constipation.
Lastly, we have the stranger perimenopause symptoms that are usually associated with nutritional deficiencies or sometimes immune system dysfunction. These include burning mouth syndrome, increase itching of skin, feeling like insects crawling, or feeling of tingling or burning in your hands or feet.
Just because something is common or expected, doesn’t mean it is normal. Normal can depend on culture, the average health of our population, and many other factors. It may be hard to believe, but there are some countries where women have extremely low rates of hot flashes and night sweats so it’s neither a normal nor common symptom of perimenopause.
Our society has historically been dismissive towards women’s health concerns. If anything, know that you don’t need to suffer from these symptoms just because they’re common. Not all perimenopause symptoms can or should be blamed on a hormone imbalance. It’s important for your doctor to do their due diligence to dig deeper and figure out the underlying root cause of your concerns.