What We All Need to Know About Perimenopause

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Every person born with female reproductive organs who lives long enough, will go through menopause.

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Category

perimenopause

Date

23/08/2024

Length

19 min read

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Yet, our understanding of what that means for our overall health is minimal– which is problematic at best and dangerous at worst.

This is not okay.

With the understanding that the more we know, the stronger we are, I spent six months doing research on all things perimenopause. In addition to all the research, I happen to be a 43 year old woman in the midst of perimenopause.

So I have some things to share.

Though I’m not a doctor, and nothing I’m about to share in this article should be considered medical advice, I have done a deep dive trying to figure out what in the world is happening to us. And I have compiled it into the most important information we all need to know.

Let me say, my friends, it’s a lot.

I’d like to start with a little story.

About 6 months ago, I found myself feeling an overwhelming, all-encompassing rage brought on by trying to get dressed. The outfit I was putting together wasn’t working and I was completely livid. It’s embarrassing how angry I was; my rage was intense and utterly disproportionate to the situation.

The reaction was so extreme that I had to pause and reflect on what was happening. I knew that this was not OK, and I also knew that this was more than PMS.

On the other side of things, I was also crying for reasons I couldn’t figure out. Was it grief? Depression? Maybe both? Maybe neither?

Once I was curled up in a ball on my bed, crying so hard I was shaking. And I couldn’t identify a reason why.

It scared me.

My third big emotional symptom (I’ll talk about the physical symptoms later in this post) was a feeling of “who fucking cares” about almost everything in my life.

I felt no motivation to do anything in my personal life or work. I was ready to walk away from it all.

So I decided to do some research and came across the word “perimenopause,” something I knew nothing about. From that moment on, I felt so validated and understood that I (can you guess?) — cried.

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"This time it was tears of joy. Joy at finally knowing that I was not losing my mind, I was not depressed, and I was not alone."

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So let’s start by defining perimenopause.

“Menopause” is actually just one day— the day that marks one year since your last period or, a more accurate definition according to Dr. Mary Claire Haver, board-certified OB/GYN and menopause specialist, is the day we no longer have any eggs left and therefore very little sex hormones produced from the ovaries- and everything leading to that date, it could be up to 10 years before that date, is called perimenopause.

Perimenopause can cause a very long list of symptoms brought on by the loss of estrogen and this loss can lead to significant health problems later in life if not addressed.

According to Dr. Haver, while women tend to live longer, our quality of life in the final 10 years tends to be much less than men, and researchers are discovering now that the loss of hormones is a very big part of that.

I made it my mission to read 3 books, countless articles, watch at least 10 videos, listen to podcasts, and dig through too many Instagram posts from various experts in order to distill it down to what I think is the most important information to share with you.

Information that can arm you with the knowledge to speak to your doctor, or find one, who can help you navigate this very important, but also very misunderstood, time in our lives.

This excerpt from peri menopause power. said it best:

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“There is an intensity to perimenopause that we are rarely prepared for, but desperately need to be, because rather than it being something that happens to us, we can have a state of agency over our experience and find our power."

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So let’s dive in. To begin, here are the three books I used in my research.

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Important Data And Statistics

In an effort to make this post digestible and truly helpful, rather than going into every single detail of what I read, I will share data points and a link to the sources they come from so that you can dive into anything you’d like to learn more about.

  • Only 20 percent of doctor residencies offer menopause training

    .

  • Medical students specializing as

    OBGYNs receive little to no training on menopause

    . Read that again.

  • Consider the impact of this when we, women entering into perimenopause, visit our doctors with a list of symptoms and a lot of questions and they really have minimal idea how to help.

  • It is incredibly common to be completely dismissed or misdiagnosed during these visits. All three books I read share true accounts of women struggling to get help because their doctors don’t have enough education about menopause.

  • In 2021,

    the National Institutes of Health reported that $5 billion in federal funds would go towards women’s health

    . However, only .003 percent will go towards menopause research.

  • According to Dr. Mary Claire Haver, “by the year 2030, the world population of menopausal and postmenopausal women is projected to increase to 1.2 billion, with 47 million new entrants each year. Can you imagine the power of a population this size if we can unite to demand continued improvements in the standard of care for women at this stage of our lives?”

  • “As your body produces less estrogen….your risks for developing serious medical conditions – including diabetes, dementia, Alzheimer’s, osteoporosis, and cardiovascular disease- go up.” – The New Menopause

  • A study published in the journal Menopause reported that a woman starting estrogen at fifty can expect to live up to two years longer than women who don’t.

  • “The dip in estrogen during the menopause transition literally changes the female brain.”-

    based on a study by Dr. Lisa Masconi

  • A central feature of menopause is the decline in the body’s production of estrogens. This leads to various bodily changes including the cessation of menstruation, but also to neuropsychiatric effects such as “brain fog,” depression and anxiety.-

    Weill Cornell Medicine Study

  • 1 in 5 women will quit their jobs because of menopause symptoms. -Dr. Haver.

  • Women are living longer than men, but 20-25% of that life is in poor health. – Dr. Haver.

And while a lot of this data is focused on the U.S., my research shows that these stats are a global issue with women worldwide feeling the impact of a lack of knowledge and education about women’s health.

According to the World Health Organization, “perimenopausal women need access to quality health services and communities and systems that can support them. Unfortunately, both awareness and access to menopause-related information and services remain a significant challenge in most countries.”

Why am I not surprised?

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(Not So) Common Symptoms

It’s important to understand that there are estrogen receptors throughout your body, which means that every part of your body is used to functioning with estrogen. And as hormones drop, cells begin to lose their ability to assist in maintaining your health. Your heart, your bones, your blood sugar, all can become impacted.

And when you think about that, you likely won’t be surprised by the long list of symptoms that 30-50% of women experience that impacts their quality of life.

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I also loved this skit that shows some of the more bizarre & unsettling menopause symptoms. I have totally felt the sensation of bugs crawling on me as a symptom!

I know, it’s a lot to take in. Not everyone will experience all of these symptoms but it’s important to know what the symptoms could be because, honestly, things start to fall into place when you realize that you’re not falling apart, you’re in perimenopause.

The a-ha moment I had was when I realized that I didn’t develop bad knees at the age of 43, it was the joint pain caused by perimenopause. #lifechanging

If you identify with some of these symptoms, it is worth talking to your doctor about whether you could be in perimenopause.

According to Dr. Newson inThe Definitive Guide to the Perimenopause and Menopause, “as a general rule, the perimenopause begins in the early to mid forties- though it can happen later or much earlier for reasons including genetics or due to surgery or treatment.”

Something important to note, the average age of menopause in American women is 51, which means that many women hit menopause as young as 45 and perimenopause as young as 35.

Watch this video:I’m sharing the video to reinforce the idea that this article isn’t just for my 40+ ladies. If you’re in your mid to late thirties, you should keep reading too.

Honestly, no matter what age you are, YOU NEED TO KNOW THIS STUFF!

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(HRT Also Known As MHT)

I know there has been a lot said about hormone replacement therapy or menopausal hormone therapy over the years.

Back in 1998, the Women’s Health Initiative launched a study on menopausal hormone therapy and what happened with this study had a massive impact on women’s health, not for the positive.

So let’s get a snapshot of what this study did.

It studied post-menopausal women (they were in their 60s) with a focus on prevention of chronic diseases through hormone therapy (estrogen and progestin).

Read any one of the 3 books I shared to get a much better understanding of what this study was all about, but suffice it to say that what was supposed to be an 8.5 year study was abruptly stopped in 2002 because there was found to be a slight increase in breast cancer risk found in some of these women.

Once this came out, a massive percentage of women who were on hormone therapy stopped receiving it and very few women were offered it moving forward.

According to The New Menopause, “all the public got at the time was drama in the form of inaccurate reporting and alarming headlines that was reduced to: estrogen causes cancer.”

Here’s what’s important to know about the “risk” of breast cancer from estrogen, as clarified by Dr. Haver:

In the WHI study, the chance that a woman would develop breast cancer was four out of one thousand per year on placebo. When estrogen and progestin were added, that risk increased to five out of one thousand women per year. That increased risk is 0.08 percent.

I’m not telling you to go on hormones. I’m just clarifying what this study is about so that you aren’t holding on to false information perpetuated by the media and scaring you into completely disregarding a treatment that could be a life-changing option for you. (It has been for me).

Let’s look at what studies are now saying about hormone therapy.

  • Studies show that women who are given hormone therapy in their perimenopause have a lower incidence of depression.

  • Studies show that hormone therapy lowers heart disease and heart attacks.

  • Studies show that hormone therapy protects the bones from weakening and breaking. (Side note, it’s astonishing how many people don’t survive long after breaking a hip in old age)

  • Studies show that hormone therapy lowers the risk of type 2 diabetes

  • Studies show that hormone therapy decreases your risk of death from any cause. Meaning, if you’re diagnosed with something, you have a better chance of beating it when you’re on hormone therapy.

  • Studies show that the earlier a woman starts hormone therapy, the better her future health.

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It’s important to understand that there really isn’t a test to determine what your hormones are doing. Because hormone levels can change through a single day, a blood test isn’t an accurate representation of your levels.

Instead, doctors who understand menopause tend to ask about your symptoms, do tests to rule out other health issues, and then if all are negative, talk to you about perimenopause and menopause. The knowledgeable ones will tell you about your hormone therapy options.

DO NOT listen if their response to you is “you’re aging, so exercise more, eat less, and toughen up”. Advocate for yourself.

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Nutrition + Exercise

MHT alone is not enough to minimize the symptoms and improve our health during perimenopause and menopause.

I have found that making changes to my nutrition and exercise routines, in addition to taking hormones, has made a huge difference in my symptoms and my overall wellbeing.

I was blown away when I learned about the difference between subcutaneous fat and visceral fat.

Visceral fat is the fat that wraps around our organs and is a harbinger of chronic disease.

Subcutaneous fat is what we see, it stresses people out because society has told us it isn’t “attractive”, but it doesn’t bring the level of risk to our health that visceral fat brings.

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"8% of our fat is visceral fat when we are premenopausal, it goes up to 23% when we are perimenopausal. -Dr. Haver

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Up until recently, the “cardio queen” approach to exercise was all the rage and strength training was something too many women put out of their minds for fear of bulking up and not being “skinny”.

According to The Menopause Society, "There are many physical activities that have been shown to help protect and strengthen the heart, bones, and muscles, as well as maintain and improve balance, body weight, mood, and one’s overall sense of well-being. Here are a few activities to introduce variety into your routine:

  • Brisk walking

  • Jogging

  • Biking or spinning

  • Aerobics

  • Dancing

  • Tennis

  • Weight training

  • Interval training

I think for so long, we were trained to focus on burning calories. So hours spent on the peloton or running seemed to be the most important. But that’s not enough. It has to be a balance of cardio, strength training, and stretching.

With weight training, we should think about increasing resistance. The goal is to increase the weight each time our muscles stop fatiguing around 12-15 repetitions.

With stretching, it’s important to build a habit of stretching every day because honestly, losing flexibility as we age just sucks.

I really like that Movement Living offers up free exercise classes each week that are on rotation based on a theme. Personally, I’ve learned to think about exercise and nutrition not to “get skinny” but to get strong.

And in general, I’ve kept these things in mind in terms of diet:

  • The more protein we consume, the less likely we are to be frail as we age. So eat a lot of protein throughout the day.

  • We start to process alcohol differently in perimenopause so I have started introducing

    non-alcoholic drinks

    into my social situations.

  • We need to make sure we’re getting enough vitamins like calcium, vitamin D, and iron. We should get as much as we can from food and then go with supplements to reach the recommended numbers if need be.

  • Fiber is a big deal, don’t ignore it.

I don’t like to think about things that I’m removing from my diet. I love food, almost all food, and I don’t intend to stop enjoying it.

Instead, I’ve approached it a few ways:

  • The 80/20 rule.

    Try not to feel guilty when you enjoy treats. Life is too short for that.

  • Look at your meal

    . By this I mean, whatever you have on your plate, see if there is anything you can add to boost it. Like a hard boiled egg or a banana or berries or an avocado, or cottage cheese, whatever!

  • Probiotics.

    I try to have a probiotic every day. Sourdough bread, kombucha, yogurt, kimchi, miso, etc.

  • Curb sugar intake.

    Just pay attention to how much added sugar you have. The daily recommended amount is 28 grams.

Just remember that when it comes to exercise and nutrition, it’s not about being perfect. It’s about feeling strong, energized, and satiated, prioritizing your needs, and finding balance and enjoyment.

Mental Health

Before I get into sharing how to find menopause specialists and other logistical things, there is one last area I want to cover. And that’s mental health. I started this article with a story about my mental health. I didn’t know what was happening to me or why. I wondered if I was depressed, I wondered if the grief I had been experiencing was the cause. But since starting HRT, I have been blown away by how my mental health has improved. Here are a few mental health facts shared by Dr. Newson,

  • Feeling down, sad and upset can be very common symptoms of the menopause and perimenopause. Other psychological symptoms include feelings of low self-esteem, reduced motivation or interest in things, anxiety and panic attacks, irritability and mood swings.

  • Fluctuating hormones can have an immense impact on mental health. Previously rock-solid relationships can begin to falter, work may seem insurmountable, and activities you previously took pleasure in now feel like a chore.

  • Women are two to four times more likely to experience major depression during the perimenopausal or early postmenopausal phase.

Dr. Newson also shares this in her book: “…if you feel your moods have become more extreme…it is worth asking yourself the questions below to see if hormones are the cause.

  • Am I feeling more down/worried/irritable/angry than usual?

  • If you are still having periods, do these mood changes happen around my period?

  • Have these feelings become more intense?

  • Are my moods affecting my life in terms of motivation, sleep, eating, exercise?

  • Are these moods affecting work and home relationships- are these changes affecting those close to me more than usual?

  • Have these mood changes lasted for a few weeks?”

If the majority of your answers are “yes”, talk to your doctor.

And as an important note, people can have two things. Mental health should be taken seriously; we cannot attribute everything to menopause. If you’re experiencing depression, talk to your doctor.

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How To Find Specialists

Before finding your menopause specialist, it’s a great idea to create a daily symptoms journal.In your daily symptoms journal, record everything you are experiencing — the common, the weird — all of it. And also the intensity. I did this and created a 0-3 star scale so that every day, I would list my symptoms in a note on my phone and add a number of stars next to each symptom.

I did this for almost two months while I waited for my appointment with my doctor. It was a very big help at my appointment. She was able to see what I had been experiencing, for how long, and how extreme. She was very happy I had that.

Now, as for finding a doctor, you may find that your current doctor is great and ready to talk to you about perimenopause. But if that’s not the case, and your doctor dismisses you or makes you feel silly for asking or tells you that “you’re too young for menopause” or has any response other than a willingness to talk about what you’re experiencing, then it’s time to move on.

You deserve better than that.

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Below is a list of resources for finding doctors who are menopause specialists.

  • The North American Menopause Society

    : these are certified Menopause Practitioners

  • The Pause Life:

    started by Dr. Mary Claire Haver, it’s a database of doctors submitted by women across the US..

  • Gennev:

    menopause-trained doctors and registered dietitian nutritionists

  • Midi:

    clinicians specializing in menopause care

  • Menopause Care:

    Britain’s largest team of British Menopause Society-accredited doctors and healthcare professionals

  • FemPoli

    : independent clinic located in The Netherlands

  • Newson Health Menopause Society

    – U.K.-based resource founded by menopause specialist Dr. Louise Newson

Also, I highly recommend listening to this podcast episode: At the risk of causing a lot of eye rolls, I actually teared up listening to Dr. Haver in this Huberman Lab podcast episode. The combination of the infuriating data she shares and the passion with which she talks about what we as women deserve for our health and our lives is really, really moving.

I hope that if there is one thing you take away from this article, it’s the importance of educating ourselves and advocating for ourselves in a system that has never been set up to prioritize women’s health.

Pay attention to how you’re feeling, trust your instincts, and speak up so that you can get the care you deserve and thrive in life as you continue through the second act and make your way into the third.

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Nicole Giordano is the founder of Revel + Verve, a newsletter and community creating closeness, understanding, inspiration, and joy for women 40+ who see this time as just the beginning and who are reclaiming and redefining what life after forty looks like.

This post has been adapted from an original piece titled Everything You Need To Know About Perimenopause.

You can read more of her work on topics such as Navigating Friendships in Midlife and What it means to be Living in the Liminal Space.

Or follow her on Instagram at @revelandvervesi. Nulla quis sem at nibh elementum imperdiet.

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