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Perimenopause 101

  • Signs of Perimenopause

  • Thanks to evolving and well-documented research, we now know that women can begin to experience the effects of the menopause-related changes as early as their 30s in a phase known as perimenopause. By the early 40s, a number of physical changes may in fact be signs of perimenopause. 

    A woman officially enters menopause when she has not had a period for a full year. The average age of menopause in the U.S. is 52, which means that half of women enter menopause before the age of 52, and half at older than 52. Perimenopause can begin up to eight years before menopause. Given the variation of ages at which menopause begins, perimenopause follows suit with women seeing changes anywhere from their late 30s to mid-40s.

    Although menopause is associated with a drop in estrogen, perimenopause is characterized by drops in progesterone, leading to signs of estrogen overload rather than deficiency. During this phase, some women notice a number of changes, including:

    • Trouble sleeping
    • Exaggerated PMS (increased breast tenderness, water retention)
    • Nervous system irritability
    • Fatigue
    • Hot flashes

    In fact, insomnia tends to be worse during perimenopause than menopause itself, says sleep expert Lydia Wytrzes, M.D., a neurologist and director of the Sutter Sleep Disorders Center in Sacramento. Women in perimenopause may also begin to experience irregular periods, since progesterone is the hormone that “organizes and sheds” the uterine lining.

    Later, as menopause nears, estrogen drops and women start to notice menopausal signs like:

    • Hot flashes
    • Night sweats
    • Vaginal dryness
    • Insomnia
    • Lighter or skipping menses
    • Depression and anxiety

    Not all women notice changes leading up to menopause, but some struggle daily to manage their changing bodies. During perimenopause, hormones can shift dramatically from day to day. Still this process is a normal and natural part of mid- life, not necessarily a “hormone imbalance,” says internist Meg Durbin, M.D. of Palo Alto Medical Foundation.

    “We have to be careful not to medicalize normal life transitions,” says Durbin. The phrase "hormone imbalance" implies that something is wrong. I like to say that these are changes.”

    Durbin encourage women to work closely with their doctors to explore other common medical conditions that may contribute to the severity of perimenopausal symptoms such as depression, iron deficiency, obesity and thyroid imbalance. When any of these conditions are present, perimenopause may exaggerate their impact.

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