What is Perimenopause?
When it comes to menopause, there is a common misconception that all of a sudden one day you become menopausal – you were premenopausal and then just like that, you’re in menopause.
The reality is that your body goes through a menopausal transition – PERIMENOPAUSE – over the 4-8 years prior to officially reaching menopause. The median age of menopause is 51 years old, which means that menstruating people deserve to be educated about perimenopause (what is happening during this hormonal transition, what symptoms to expect, discussions around how they want to be supported, etc.) starting in their early 40s.
So let’s clarify some terms!
Menopause – The permanent loss of menstrual periods, determined after 12 consecutive months without a period.
Perimenopause – The transition between the reproductive years and menopause, identified by a change in menstrual cycle length of 7 days or more. Therefore, if you typically have a 28 day menstrual cycle, and now your cycle is 21 days long or 35 days long, this may mean that you are in perimenopause.
What Hormonal Changes are Happening in Perimenopause?
We can expect that people with a uterus who do not have a menstrual cycle disorder will ovulate every (or nearly every) menstrual cycle in their reproductive years. And if you don’t know what ovulate means, that is completely okay! Ovulation is when an oocyte (egg) is released from its follicle in the ovary. The oocyte then travels along the fallopian tube to the uterus, where it can be fertilized by sperm (so ovulation is important for fertility). Ovulation actually provides many benefits beyond fertility though! After the oocyte is released, its follicle in the ovary becomes a corpus luteum, and the corpus luteum produces progesterone and estrogen. Therefore, the healthy production of progesterone and estrogen hinges on ovulation.
So going back to the beginning… In their reproductive years people with a uterus will ovulate predictably each menstrual cycle. In PERIMENOPAUSE however, ovulation becomes more haphazard, and as a person gets closer and closer to menopause, they ovulate less and less often until eventually they stop ovulating altogether (menopause). Because the ovulations in perimenopause are haphazard, hormone production through these years is haphazard, and so it’s no wonder people may feel unwell during this transition.
Symptoms that you may experience in perimenopause include:
- Menstrual cycle irregularity
- Heavy menstrual bleeding
- Hot flashes, night sweats
- Mood changes such as depression
- Changes in body composition (loss of lean mass and gain of fat mass)
- Vaginal dryness, pain with intercourse
Tracking Your Menstrual Cycle in Perimenopause
Menstrual cycle tracking can be very empowering and informative, and I recommend it for all my menstruating patients. It’s a really important step when it comes to the assessment and treatment of perimenopause. What can tracking help us identify?
- Changes in menstrual cycle length and bleeding
- Ovulatory cycles from anovulatory cycles (when you did not ovulate)
- Patterns in symptoms (e.g. symptoms that always occur during a particular phase of your cycle)
- Changes in symptoms with treatment (e.g. changes in frequency, intensity, and duration of hot flashes before and after initiating treatment)
There are lots of great ways to track your menstrual cycle. I typically recommend either the Balance app, Clue app, or the Daily Record of Severity of Problems (a paper tracking sheet), but it’s all about finding the tracking method that is best for you!
A couple of tips for tracking:
- Day 1 is the first day of your period
- It’s not always easy to know whether or not you ovulated (so try not to get frustrated, it’s all part of the learning process!). One way is by noting a change in your cervical mucus to the consistency of a raw egg white (clear and slippery).
Perimenopause – How Naturopathic Medicine Can Help
I truly believe naturopathic medicine has so much to offer patients in perimenopause. Two of the greatest assets of naturopathic medicine are TIME and a PREVENTATIVE MINDSET.
With more TIME to spend with patients, we can:
- Learn the full scope of your health story
- Thoroughly assess for other health conditions that may be mimicking or exacerbating your perimenopause experience
- Provide education on what to expect as you move through perimenopause and into menopause
- Discuss all of your treatment options in an unbiased manner
- Discuss a preventative health strategy as you move into your 50s
When we approach your case with a PREVENTATIVE MINDSET, we can:
- Discuss how to mitigate the increased cardiovascular disease risk in late perimenopause into menopause
- Discuss how to mitigate the accelerated bone loss in late perimenopause into menopause
- Discuss how to mitigate changes in body composition that accelerate in late perimenopause into menopause
- Build a schedule for important health screening (cervical cancer screening, breast cancer screening, colon cancer screening, cardiovascular screening, diabetes screening)
If you suspect you may be in perimenopause, and would like more knowledge and support through this transition, please book an appointment today! I offer both in-office and telemedicine appointments. Supporting women through perimenopause is one of my greatest passions in clinical practice.
**Please remember that this article is meant for educational purposes only and should not be viewed as medical advice.
Photo Credit: Artem Beliaikin