Chapter 1

Welcome to Perimenopause

IN THIS CHAPTER

Understanding what perimenopause is

Knowing the symptoms of perimenopause

Recognizing the difference between perimenopause and other conditions

Preparing for the physical changes

Consulting with a trusted medical professional

For women, it seems like life is all about stages. You have the childhood stage, which somehow ends around puberty, when things change and start to take a more serious turn. Then you have the reproductive stage, governed by hormonal cycles, during which the usual goals are to avoid pregnancies or to create pregnancies; also to feel well and stable emotionally. Jump over quite a few years, and you have a non-reproductive stage called menopause, when the ovaries completely shut down, all hormone levels are low, and keeping healthy and living a full life are the usual objectives.

But what about that huge gap of time between those reproductive years and the menopausal ones? You have a decade (or so) where you may still worry about a pregnancy (or you may still try to achieve one), where you experience symptoms that appear when your hormones vary widely from week to week, and even from day to day.

During these years, you may find yourself dealing with brain fog, vaginal dryness, insomnia, mood swings, and low energy at the same time that you find yourself with heavy and irregular vaginal bleeding. For these years, I’m guessing that no one ever sat you down and said, “This is what may happen between age 38 and 53.” That’s what this book is about. Welcome to perimenopause!

To get started, this chapter offers a brief overview of what causes various perimenopausal changes at this time of your life, as well as what symptoms you may have and why. You can dive deeper into all the topics mentioned here by looking into the chapters that deal specifically with each subject.

Understanding What Perimenopause Is

Perimenopause is a time, in years, of transition. It involves a move away from the regularity of hormonal release, monthly ovulation, and the menstrual cycle. Hormones cause physical and emotional changes in your body, and the more regularly your body releases these hormones, the more stable you feel. When both ovulation and hormone release start to become irregular, you’ve entered perimenopause. In general, perimenopause can start for a woman anywhere over the age of 35 and last until about age 53. (The average age of menopause is about 51.)

Between 35 and 53 years old is a very wide range, and I don’t mean everyone experiences perimenopause from the age of 35 to 53. When you start perimenopause sometimes depends on how regularly your body released hormones in your 20s and 30s. (See Chapter 6 for more on that topic.) For most women, irregularities in menstrual cycles are just one of the signs that perimenopause is approaching. Swings in moods, lack of concentration, poor energy, weight gain, and insomnia are some of the other hallmarks of aging out of your reproductive years and entering the perimenopausal transition.

Common Perimenopausal Symptoms

You can potentially attribute a laundry list of symptoms to the sudden drop in estrogen levels in your body, along with other hormonal changes that occur in perimenopause. You may not experience all of these symptoms, but if you have just a few (or sometimes even just one), we usually can assume that the hormonal changes of perimenopause are responsible. Here are the common perimenopause symptoms to watch out for:

• Interrupted sleep: The hormones estrogen and neurotransmitter serotonin act as partners in assisting deep, restful sleep; if your body doesn’t produce one of these hormones, it also may not stimulate the other.
• Hot flashes: A sudden drop in estrogen levels triggers a hot flash, a temporary rise in body temperature, enough to cause sweating and flushing of the face and usually the upper body.
• Heart palpitations: A sudden change in estrogen levels can cause heart flutters because of the hormone adrenaline that your body can release in response to changing hormone levels.
• Changes in your menstrual cycle: Although you can’t blame all menstrual irregularities on perimenopause, women commonly start to see irregular bleeding, bleeding between periods, or changes in their bleeding pattern during perimenopause.
• Irritability, anxiety, and mood changes: Often, hormonal swings can result in changes to your mood; premenstrual mood changes can now seem to occur all month long or randomly throughout the cycle.
• Brain fog and lack of concentration: Estrogen plays a role in memory and mental clarity, and changes in estrogen levels (along with poor sleep) can cause changes in cognitive function.
• Vaginal and genital discomfort: Because the vagina has many estrogen receptors, the vagina stays healthy when the body has estrogen, especially in the genital area. Women often see the result of a decrease in their estrogen levels when intercourse becomes painful.
• Urinary changes: A decrease in estrogen levels may lead to increased frequency or irritability of the bladder; bladder issues may also relate to changes in vaginal health because the vagina and the urethra (the endpoint of the urinary system) are so close together.
• Skin changes: Lower estrogen levels cause your skin to lose firmness and elasticity. Without estrogen, skin often becomes thin, loose, and droopy. You may notice hair loss and other skin changes, as well.

Although medical science doesn’t yet have a way to definitively attribute these symptoms to perimenopause, knowing that almost every perimenopausal woman has these symptoms at one time or another during her transition to menopause may make you feel a little less disturbed by the ones happening to you.

While you make your way through this book and consult with your doctor about various signs and symptoms that are causing a decrease in the quality of your life, remember that just because women commonly experience these symptoms during perimenopause doesn’t mean that you can’t do anything about them.