Do I Have Perimenopause?

By Bethany Bryant, PA

Maybe. Maybe not.

Perimenopause is very common - more so than you may even realize. But it is also something that many women can mistake for other health conditions. The reason for this is that a lot of the symptoms of perimenopause are symptoms of other issues, and without working with your provider directly, it can be hard to diagnose.

Seriously, do not go down the WebMD search hole - it will just create more confusion.

How to figure out if you have perimenopause

Let’s start with the basics first - figuring out if you even are entering perimenopause.

At what age can you get perimenopause?

Perimenopause can begin in your 30s, 40s, or 50s. It’s a transitional phase and can last for years. It ends when you officially hit menopause, which is the point at which you have not had a period for 12 months.

Symptoms of perimenopause can include:

• Irregular periods - they can become shorter, longer, heavier, or you may skip some months

• Hot flashes and/or night sweats - this is a hallmark sign of perimenopause (and menopause, which is possibly why you are worried)

• Issues falling or staying asleep

• Mood changes - you may feel more irritable, depressed, or anxious

• Lower sex drive - yep, that lower libido isn’t about your partner not doing the dishes, it’s possible it’s due to perimenopause

• Brain fog and difficulty concentrating

• Vaginal dryness and discomfort

• Joint pain and muscle aches

• Weight gain, especially around the midsection

• Tender breasts

• Heart palpitations

• Skin changes - dryness, itching, acne, etc.

• Hair loss or thinning

• Increased need to pee or more frequent bladder infections

If you’re thinking, “But isn’t that also a sign of___?” you’re on the right track.

Perimenopause can be hard to pinpoint for three main reasons.

1. Not every woman experiences ALL the symptoms or the same combination of them. You could have only one of the above symptoms or multiple, or all of them.

2. These symptoms are also the same that can arise with other conditions.

3. Some symptoms are not as widely known as being connected to perimenopause

Examples of other conditions that can cause symptoms similar to perimenopause:

1. Anxiety and depression - both can significantly impact your mood, make your heart palpitate, lead to brain fog, cause insomnia, and lead to weight gain, hair loss, decreased libido, and irregular periods. Especially for women, when your body is in constant “fight or flight” mode, it can lead to a cascade of other issues. So, before thinking it’s perimenopause, take a moment to be honest about how stressful your life is and if you have been feeling anxious or depressed for a while.

2. Hormonal changes - Just like when your hormones have changed in your teenage years or pregnancy, they can still change now. Changes in cortisol (stress hormone), for example, can lead to weight gain, especially in the middle area, hair loss, insomnia, anxiety, gastrointestinal issues, and joint and muscle aches. This is because your body’s stress response is always on, and your nervous system is on overdrive. 
   
   Other hormonal changes that can lead to mimicking symptoms are when your body has too little estrogen, too much testosterone, or your thyroid is not working like it should.
   
   
   
   

3. Weight and muscle loss -  If you’ve ever talked with performance athletes, runners, or bikini body competitors, they may tell you they’ve lost hair and not had a period for months (or years). For women, our bodies are supposed to carry a higher percentage of fat, and when our bodies lose fat and muscle, or gain fat or muscle, it can cause our hormones to fluctuate in different ways.

These are just some of the conditions that can mimic perimenopause symptoms. So, how do you definitively determine a perimenopause diagnosis?

Diagnosing Perimenopause

Since perimenopause can vary in how it displays from person to person, working with your primary care provider is key. Partly to ensure you’re really entering perimenopause, but also to ensure nothing else is going on. As women age, the risk for osteoporosis, heart disease, diabetes, and other diseases increases. Identifying perimenopause is key, but the same symptoms may be due to another issue, too.

 Your provider will determine perimenopause based on a physical exam, your existing symptoms, age, and medical history. They may also choose to perform hormone tests (such as testing your FSH (follicle-stimulating hormone) levels). A consistently high level of FSH could indicate perimenopause.

 If you’re nervous about perimenopause right now, please come talk with us. We’re here to answer questions and talk about how to handle changes that perimenopause may be causing. Book an appointment with us online here.]

What Can I Do about Perimenopause?

There isn’t any treatment to stop perimenopause once it starts, but we can help you manage the changes it may be causing to your body.

For example, the biggest question we get is “How can I stop gaining weight?” because we see a lot of our patients with perimenopause telling us they’ve gained weight around their bellies and hips, and it won’t go away. Other women tell us about struggles with anxiety or depression, or hot flashes.

Some people may not need treatment at all, but for those that do there are options we’re happy to talk through you. See below for some potential recommended options:

1. Hormone replacement therapy (HRT) to help with rebalancing hormone levels

2. Hormone therapy (HT) to help increase hormone levels (often testosterone)

3. Therapeutic devices such as those that leverage cranial electrical stimulation therapy (CES) to treat anxiety or insomnia

4. Medications to help with hot flashes, stabilize your hormone levels, stabilize your mood, or treat symptomatic bladder infections

5. Vaginal creams if you’re struggling with vaginal dryness

Again, this is not a comprehensive list, as we like to make a plan that works uniquely for you and the specific perimenopause symptoms you have, as well as any other existing health conditions or concerns.  

The biggest recommendations we can make though, are what to avoid, because these behaviors can make perimenopause worse:

What makes perimenopause worse?

• Excessive drinking of alcohol

• Smoking or using other tobacco products

• Avoiding exercise and weight lifting

• Staying sedentary

• Eating too many sugar drinks, foods high in saturated fat, or overly processed foods

• Not managing your stress levels

• Not maintaining a regular and healthy sleep routine

Perimenopause is common. Approximately 75% of women experience perimenopause symptoms, according to the North American Menopause Society (NAMS), so know you are not alone. Set up an appointment today and alleviate any uncertainty today.