What is Perimenopause?
Perimenopause is a hot topic these days, and understandably, women have many questions. The truth is, there isn’t a single diagnostic test or pattern of symptoms; each woman’s perimenopause experience is unique. And I see it all in my practice.
In this article, I’ll cover the basics of perimenopause. We’ll get into the terminology, symptoms, and timeline of what to expect, all while understanding that your experience will be your own. Luckily, you don’t have to go through it by yourself or live with uncomfortable symptoms. I’m here to answer all your questions and offer the functional medicine tools so perimenopause isn’t just something you have to survive, but an opportunity to thrive.
Perimenopause Definition
Perimenopause is the gradual loss of ovarian function, the transition to menopause. Often considered “reverse puberty,” perimenopause is marked by erratic, and usually higher estrogen levels in the early phases, paired with declining progesterone levels. Eventually, ovulation stops, and both hormones remain low.
Menopause is the one-year anniversary of your last period, an arbitrary single-day event. Post-menopause includes all the time after menopause. Women may spend 30% of their lives or more in the post-menopausal phase.
While we often think of menopause as associated with symptoms, many menopausal symptoms actually begin in perimenopause, this time of wild hormone changes. Think of it this way: your whole body is calibrated to a predictable monthly pattern, and perimenopause forces it to adapt to a new hormonal landscape. This recalibration has some glitches, which show up as symptoms.
Perimenopause Symptoms
There are dozens of symptoms associated with perimenopause, even weird ones like itchy ears or electric shock sensations. If something new arises, be sure to speak with your provider to determine if it’s perimenopause-related or something else. Some of the more common perimenopausal symptoms include:
Mood changes
Cognitive problems, such as memory changes
Decreased libido
Hot flashes
Night sweats
Heavy periods
Increased PMS
Muscle and joint pain
Sleep disturbances
Vaginal dryness
Urinary tract infections
Weight gain
Headaches
Irregular menstrual cycles
Some symptoms, such as hot flashes, may resolve in the first few years after menopause, but other symptoms, like genitourinary syndrome of menopause, persist and may exacerbate with age.
Further, perimenopause is a time of increased and worsening metabolic health, which gives rise to post-menopause chronic disease risk. The long-term risks of low hormones include bone loss, heart disease, and poor quality of life.
Perimenopause Timeline
Perimenopause may last a few years or more than a decade. Perimenopause typically begins in a woman’s 40s but may start in the 30s for some women.
The average age of menopause in the U.S. is 51, but anywhere from age 45 to 55 is considered normal. Because estrogen and progesterone are so beneficial beyond reproduction and nourish the entire body, we want to optimize and support the menstrual cycle for as long as naturally possible.
There is still some debate about when perimenopause starts. Some say that the onset of perimenopause is when the menstrual cycle becomes irregular. However, it is very common to start having perimenopausal symptoms while the cycle remains regular, such as insomnia or night sweats. Remember that the transition is gradual, and for some it’s more gradual than others.
Functional Medicine for Perimenopause
The goal with functional medicine in perimenopause is to manage symptoms and improve quality of life, while preventing chronic disease and promoting long-term health. I see how all body systems are interconnected and the influence of perimenopausal changes on multiple body systems.
I’ve discussed how your perimenopausal journey will likely differ from your friends, so a personalized approach is key. What makes you feel your best and addresses your concerns will be unique. Still, there are some tools that everyone can draw from. These include:
Comprehensive lab work and monitoring – Let’s look at your labs, get a good baseline view of your hormones, identify nutrient deficiencies, etc. We can consider advanced functional medicine testing as necessary.
Nutrition – The diet you’ve been eating in your 20s and 30s may no longer support you in your 40s, as you may have new needs and more metabolic upheaval to support. I’d argue that nutrition becomes even more important in perimenopause, and optimizing nutrition can make perimenopause run more smoothly.
Sleep – Everything is worse when you aren’t sleeping well, including perimenopausal symptoms. But perimenopause often makes sleep more challenging. I can help you figure out the root cause and offer strategies to improve sleep. You’ll also have to prioritize sleep in your schedule.
Stress management – Stress management in perimenopause is non-negotiable. Hormonal changes will leave you more vulnerable to the adverse effects of stress, and at the same time, you may be facing a period of higher stress. Many practices, boundaries, and habits help, and these will be part of your protocol.
Exercise – Like nutrition, the way you’ve always exercised might need an update in perimenopause. For example, you will likely need to prioritize strength training to maintain muscle mass, bone strength, and a healthy body composition. Exercise is essential for mental and physical health in perimenopause and beyond.
Supplements – With foundations like sleep, nutrition, and exercise in place, we can layer on targeted supplements to address nutrient insufficiencies, support hormonal systems, help build muscle, and more.
Bioidentical hormones – Hormone replacement therapy is an incredible tool for symptom management and long-term health optimization. Again, it needs to be tailored to the individual and put in the context of the entire health picture. In my practice, I use bioidentical hormones, which are chemically the same as the hormones your body produces, including estradiol (estrogen), progesterone, and testosterone.
The good news is that you don’t need to wait until menopause to begin bioidentical hormones and can start in perimenopause as needed, while adjusting over time.
Perimenopause often feels overwhelming and scary. You may not want to face aging or the loss of fertility. But understanding what’s happening to your hormones and what to expect is empowering. While you can’t stop menopause from coming, you can lovingly support your body through this tumultuous time with many of the strategies mentioned here. I’m here to help.
References
Prior, J. C., Hitchcock, C. L., Shirin, S., Hale, G., & Goshtasebi, A. (2023). Don't ignore perimenopause. CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, 195(29), E987.
Metcalf, C. A., Duffy, K. A., Page, C. E., & Novick, A. M. (2023). Cognitive Problems in Perimenopause: A Review of Recent Evidence. Current psychiatry reports, 25(10), 501–511.
Lega, I. C., & Jacobson, M. (2024). Perimenopause. CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, 196(34), E1169.
Santoro, N., Roeca, C., Peters, B. A., & Neal-Perry, G. (2021). The Menopause Transition: Signs, Symptoms, and Management Options. The Journal of clinical endocrinology and metabolism, 106(1), 1–15.
Erdélyi, A., Pálfi, E., Tűű, L., Nas, K., Szűcs, Z., Török, M., Jakab, A., & Várbíró, S. (2023). The Importance of Nutrition in Menopause and Perimenopause-A Review. Nutrients, 16(1), 27. https://doi.org/10.3390/nu16010027
