Am I in Perimenopause? What is perimenopause?
Perimenopause is the transition time leading up to the last menstrual period. This transition can last between 2-12 years, with an average of 7 years. This time can begin in the mid-30s or as late as the early 50s. Most women begin the perimenopause time in their early-mid 40s. Perimenopause ends 12 months after the last menstrual period.
What are the 4 stages of perimenopause?
The First Phase of Perimenopause
The very early stage of perimenopause is characterized by slowly decreasing progesterone levels, which can be associated with worsening PMS symptoms like crying earlier, fatigue, headaches, depression, insomnia, and anxiety. In this stage, cycles may still be regular but with fluctuating levels of hormones. Heavier menstrual bleeding during this time can result in anemia in perimenopause.
Second Phase: Early Perimenopause
Early perimenopause begins with the onset of irregular periods. Irregular periods are defined as a greater than 7-day variation in the overall cycle length. This phase lasts approximately 2-5 years.
Third Phase: Middle-Late Perimenopause
The late transition of perimenopause is characterized by the first cycle of greater than 60 days. Women often refer to this as a “skipped period.” This occurs because ovulation did not happen in that cycle but the endometrial lining builds up and results in “breakthrough bleeding.” This stage lasts approximately three years.
Fourth Phase: Very Late Perimenopause
Late perimenopause is the 12-month time frame following the final period. If you go six months without a period, and then have another period, the 12-month count would restart.
Menopause is the life phase beginning 1 year after the last period.
How to tell if I’m in Perimenopause if I’ve had a hysterectomy?
If a woman had a partial hysterectomy (removal of the uterus) but retained ovaries, she would still go through the 4 phases of natural perimenopause and have years of hidden cycling, but with no bleeding to signal what’s going on. This may be confusing. However, with the use of Creighton Model FertilityCare™ System, a woman can still monitor her cervical mucus changes to aid in understanding where she is in her cycle, which can be very beneficial when using bio-identical progesterone supplementation.
What are perimenopause symptoms?
There are 100s of symptoms associated with the complex hormonal changes of perimenopause. These are unrelated to the mere fact of “aging,” as they occur at different times for different women, but are all characterized by the unique hormonal shifts associated with this transition.
In perimenopause, the brain is recalibrating to new levels of hormones. Estrogen and progesterone influence other hormones like thyroid, insulin, and cortisol, as well as neurotransmitters like serotonin and dopamine.
25% of women have severe symptoms. Many women have mild symptoms, however, they are still in a critical window for long-term health factors like thyroid disease, heart disease, insulin resistance, and neurological conditions
The most common symptoms of perimenopause include new onset heavy bleeding or scanty bleeding, irregular cycles, anxiety, insomnia, fatigue, hot flashes, night sweats, and vaginal dryness. Other common symptoms include bloating, digestive issues, brain fog, memory issues, heart palpitations, dizziness, dry skin, and increased urinary frequency. Check out my other two blog posts on Anemia in Perimenopause and Herbs for Heavy Menstrual Bleeding.
Due to the gradually decreasing progesterone levels, women may experience worsening of Premenstrual syndrome symptoms such as insomnia, anxiety, crying easily, fatigue, headaches, and depression.
What causes perimenopause symptoms?
In perimenopause, the brain is recalibrating to new levels of hormones. Estrogen and progesterone influence other hormones like thyroid, insulin, and cortisol, as well as neurotransmitters like serotonin and dopamine.
During perimenopause, women experience estrogen levels up to three times higher than she’s ever experienced but they will also have times of lower estrogen than ever before. These wildly fluctuating estrogen levels may cause symptoms such as irritability, breast tenderness, insomnia, heavy periods, and hot flashes.
Eventually, a new normal baseline level of lower estrogen is established in menopause, which is essential for lifelong brain, bone, and cardiovascular health.
Also, due to gradually decreasing progesterone levels, women may experience worsening premenstrual syndrome symptoms such as insomnia, anxiety, crying easily, fatigue, headaches, and depression.
25% of women have severe symptoms. Many women have mild symptoms, however, they are still in a critical window for long-term health factors like thyroid disease, heart disease, insulin resistance, and neurological conditions
Are there lab tests to tell if I’m in perimenopause?
Conventionally, the FSH – follicle stimulating hormone – test can help tell if you are in post-menopause. FSH levels can fluctuate widely, especially in late perimenopause. However, conventionally FSH levels over 30 generally indicate post-menopause.
How else can I tell if I’m in perimenopause?
A great way to transition through perimenopause is to chart your ovulation and cycles with the Creighton Model FertilityCare™System. With this System, you will know if and when you ovulate. You will know if you are fertile or infertile every day of your cycle.
When the shortest cycle is 42 days less than the longest cycle, there are less than 20 menstrual cycles left. For example, in the past year or so, if you have a 63-day cycle on cycle and a 21-day cycle in another cycle, those are 42 days apart, so you would expect to have less than 20 cycles left.
Perimenopause vs Post-partum
Many women conceive and birth babies during the perimenopause years. Post-partum symptoms are very similar to those of perimenopause. Again, by charting with Creighton Model FertilityCare™System, you will be able to know when you ovulate and understand what’s going on in your body each day, each week, and each cycle.
Can I conceive during perimenopause?
Yes!
It is actually healthy to ovulate as long as naturally possible because that’s how the body makes progesterone – which is great for building strong bones, a strong immune system, healthy cognition, and cardiovascular health.
Women’s reproductive life span is pretty incredible – ranging from early adolescence through menopause.
For women with PCOS, they may find that their fertility improves during perimenopause due to the naturally decreasing androgens.
Cultural variations in the experience of perimenopause
It’s interesting to note that women in various cultures have greatly differing experiences of the perimenopause transition, with some cultures reporting no associated symptoms other than the gradual cessation of periods. In some cultures, where elders are revered, menopause is seen as a lifting of the “veil of hormones” – which can be liberating and new – and women are seen as sources of wisdom in their community. Many women report a newfound “zest” and energy for life during menopause.
In Conclusion:
Perimenopause is a time of great hormonal, emotional, and spiritual transition. It begins anytime between the late 30s and early 50s. The perimenopause transition, from very early stages through late stages, generally lasts 5-10 years.
While there are many symptoms associated with this hormonal shift, it does not have to be your norm. Help is available through doctors specializing in this unique time period. You can thrive, not just survive, perimenopause and emerge as your healthiest, most vibrant version of you in the post-menopause phase.
Get a doctor who listens to your unique needs. Book a Breakthrough Session with Dr. Jessica Whelan
About Dr. Jessica Whelan
Dr. Whelan is a highly regarded licensed naturopathic doctor (N.D.) and Creighton Model FertilityCare™ Medical Consultant, based in Vermont. She is renowned for her expertise in treating women’s reproductive hormone disorders. Her practice specializes in lifestyle medicine, nutritional counseling, botanical medicine, and bioidentical hormone replacement therapy.
Dr. Whelan’s main focus addresses hormone imbalances related to conditions such as PCOS, Hashimoto’s, heavy menstrual bleeding, PMS, perimenopause symptoms – (including insomnia, brain fog, fatigue, anxiety, depression, digestive issues), insulin resistance, adrenal dysfunction, fertility issues, irregular menstrual cycles, endometriosis.
She earned her Doctor of Naturopathic Medicine (ND) degree from the National University of Natural Medicine. She completed additional training as a Creighton Model FertilityCare™ Practitioner and NaPro Medical Consultant from the St Paul VI Institute in Omaha, NE.