3 Perimenopause Symptoms That You’ll Know When You Get Them
tl;dr (1) really heavy periods (they call it "flooding" for a reason) (2) shorter cycles ("every two weeks?! for real?!) (3) high anxiety (hang on. it's gonna be a wild ride)
Perimenopause symptoms often don’t get the attention they need. They kinda sneak up on most women. In fact, most women have been taught that perimenopause is a thing, that it's the first phase of menopause and that everyone woman will go through it.
The reason why perimenopause symptoms sneak up on women is that they often show up as wonky periods. Top symptoms to pay attention to are heavy bleeding (and clotting), irregular cycles (usually getting closer together before they get further apart), worsening PMS and mood swings like really high anxiety, anger/easily triggered and depression.
Menopause is challenging enough. The language used to describe it shouldn’t make it harder. So, let’s clear it up.
Menopause. Menopause is derived from two roots from Greek, men or meno for month and pausis meaning to pause or cease.
Menopause is technically a point in time. That point in time is when a woman has gone 12 consecutive months without a menstrual cycle. Common uses are “hit menopause, reach menopause, through menopause”. For all women, puberty is marked by the first menstrual cycle. Menopause is marked by its cessation.
This is an important point. Menopause is also used to describe the entire multi-year transition through which a woman’s hormonal profile shifts from one to another. It lumps in all the stages of menopause into one term.
And throughout the transition, hormones are fluctuating on their way to a new normal. Through that transition there are terms for the different phases or stages of menopause: pre-, peri-, early post-, late post-. Pre and peri- get confused. Early post- and later post- get lumped conceptually into one thing. Let’s sort that out.
Pre-menopause. Anything before you hit menopause could technically be considered “pre” and generally refers to the time in your 40s leading up to menopause (the average age is 51 in the US and UK). For example, a woman in her 30s is technically pre-menopause but is not that relevant to her so it’s not really used to describe her situation.
Perimenopause. The prefix “peri” means “around” so perimenopause technically means the time around menopause. However, its common usage refers to the time before menopause when symptoms arise due to hormonal changes. It’s used in phrases such as “in perimenopause”, “experiencing perimenopause” or “I am perimenopause”. If you’re still having periods without noticeable changes and you’re in your 40s, you’d be pre-menopause. If your periods are changing (typically cycles shorten and get heavier) or you’re starting to experience symptoms (more emotional volatility and other symptoms like hot flashes), you are technically still in pre-menopause (because you are still menstruating) but you are now also in perimenopause. Hormones start to get out of whack and cause perimenopause symptoms.
To go a little deeper, perimenopause symptoms are different early perimenopause vs later perimenopause. Mostly it’s changes to menstruation. In early perimenopause, periods get heavier, clot-ier and closer together. Later on, they start to get light and more infrequent.
Post-menopause. Post is any time after you’ve marked those 12 consecutive months without a period. The time after can be separated into two stages: early post-menopause and late post-menopause.
Early post-menopause is when your body is working towards its new normal, ovaries have ceased ovulation and estrogen levels are falling (but not necessarily smoothly!).
Late post-menopause is when your body has found a new normal with essentially no estrogen production and generally (generally!) symptoms go away. Late post-menopause is what commonly think of when we talk about menopause.
The distinction between peri, early post- and later post- is a not a matter of linguistic gymnastics. They are distinct because the underlying hormonal profiles are distinct through the different stages of menopause. It is an essential categorization that will help foster self-awareness and guide treatment of perimenopause and menopause symptoms. The more consistent we get, the better we all are.
Let’s talk perimenopause. And, perimenopause symptoms.
First, let’s just clarify again. Menopause is the cessation of menstruation. Pre-menopause is the span of years leading up to that. Post-menopause is the time after that. That’s it. I mean, it’s kinda complicated but it’s also kinda simple.
Second, remember that hormones are always in flux – hour by hour, day by day, month by month, year by year, phase by phase. As women age, our hormonal profiles change during pre-menopause in a fairly predictable way – moving our bodies toward menopause. Yes, all women are different but we are all kind of the same.
In colloquial terms, perimenopause is when things start to go haywire - estrogen levels rise but are unpredictable and volatile and progesterone production wanes throwing everything off balance, which can cause symptoms. Perimenopause symptoms can be further exacerbated not only because individual levels are important but the ratio of estrogen to progesterone is also an important factor to hormonal balance.
It is imperative to highlight that in perimenopause, estrogen levels are on average higher than during the reproductive years. Yes, higher. Common understanding is that menopause (and all its variations) equates to diminishing and/or very low estrogen. That is the case for early post- and later-post menopause. But not with perimenopause. And it’s worth repeating. In perimenopause, estrogen levels can get really high - not low. So, we have to keep this in mind when assessing perimenopause symptoms.
Perimenopause is often identified once symptoms arise. Currently there is no “perimenopause test”. So, we rely on women to pay attention and notices the changes.
The 3 most easily identified perimenopause symptoms are changes to the menstrual cycle and, of course, emotional volatility.
Heavier cycles (they call it “flooding” for a reason”. Commonly, the cycle will get heavier because estrogen (specifically estradiol) levels are increasing (and fluctuating. Remembering that estrogen triggers the building of the endometrium during the first half of the cycle, more estrogen means more building of the endometrium which means heavier flow. They don’t make it easy, do they?
Cycles get irregular – commonly they get closer together. Even better, right? One hormone change is tied to this is lower progesterone production. Progesterone is produced during the second half of the cycle and helps regulate the cycle. Less progesterone shortens the cycle.
High (like really high) anxiety. You may think you’re going insane. You aren’t, really. From the emotional side, estrogen influences feelings of anxiety. And, research studies that looked at anxiety and estrogen levels (and estrogen treatment) are conflicting and point to quite a complex relationship between estrogen and anxiety because some mechanisms (i.e., certain receptors) increase anxiety and some decrease anxiety. Sometimes high levels of estrogen helped, sometimes low levels help. It’s pretty safe to say, it is the fluctuation of estrogen that causes problems. In perimenopause, estrogen levels are volatile so pay attention to increasing levels of anxiety.
In fact, it’s important to pay close attention to all of these things. Remember, women often confuse these changes to be just “another wonky period” because they have all had something like this happen before. During a women’s 40s, these changes are a sign that perimenopause, the first stage of menopause, is happening.
What’s to do about perimenopause symptoms?
So, then what’s a woman to do? One way to address heavy bleeding and anxiety is to get rid of excess estrogen. So, eat kale or brussel sprouts! Why? There’s a phytochemical in those types of veggies (I3C and DIM) that metabolize estrogen (you can also get these as a separate supplement). It is one of the key ingredients we use in our own supplement. (link here?)
For shorter periods, try Chasteberry which research shows helps to normalize cycle length.
For period management, get some period underwear and always carry pads, tampons and extra undies.
For the emotional roller coaster, try slow, steady breathing through the nose. We created this audio track to take you through 12 rounds of breath. It's less than 3 mins and it will calm the nervous system.