Meet Jessica, a 41-year-old mother of two. She visits her clinician describing heavier
periods, increased fatigue, trouble sleeping, and sometimes feeling hot at night. Jessica
attributes her symptoms to stress from her job, her kids, and forgetting to turn down the
thermostat at night. She’s also noticed some weight gain and feels frustrated by her
struggle to find time for exercise. She’s tired of feeling tired and wonders if it’s possible
she could be in perimenopause or facing something worse. More importantly, she just
wants to feel better.
Like many women her age, Jessica may be navigating the journey of perimenopause.
This natural phase marks the transition from the reproductive years to menopause and
typically begins in a woman’s 40s, although it can start as early as the mid-30s!
According to the Menopause Society, perimenopause is divided into two stages:
Early Perimenopause: This stage begins when menstrual cycles start to become irregular. The intervals between periods may change, with cycles being shorter or longer than usual. Hormonal fluctuations, particularly in estrogen levels, start to occur, leading to symptoms such as hot flashes, night sweats, and mood swings.
Late Perimenopause: This stage is characterized by more pronounced irregularities in the menstrual cycle. Periods may occur more than 60 days apart. Symptoms such as hot flashes, sleep disturbances, and vaginal dryness can become more severe. This phase ends when menopause begins. Menopause is technically the day after 12 consecutive months without a menstrual period.
The average duration of perimenopause varies widely, lasting from a few months to more than ten years, though typically lasts somewhere between 4-10 years and most often occurs between the ages of 40-58!
Perimenopause doesn’t come with a playbook and is a unique journey for each woman, marked by a smorgasbord of physical and emotional changes. Here are a dozen of the more common symptoms:
1.) Changes in Menstrual Cycle
Changes in the menstrual cycle are often the first signs. Periods may become longer, shorter, heavier, or lighter, and cycles may be more or less frequent due to fluctuating hormone levels.
2) Hot Flashes and Night Sweats
These sudden feelings of intense heat, often with sweating and a flushed face, can disrupt daily life and sleep. Night sweats are particularly challenging as they occur during sleep, leading to significant sleep disturbances.
3) Sleep Disturbances
Many women have trouble falling asleep, frequent awakenings, and early morning waking. Night sweats and the competing priorities in life can exacerbate these issues, making consistent restful sleep a challenge.
4) Mood Changes
Hormonal fluctuations can cause mood swings, irritability, anxiety, and depression. Emotional changes can be frustratingly unpredictable and vary in intensity, affecting daily life and relationships.
5) Vaginal Dryness and Discomfort
Decreased estrogen levels can lead to thinner, drier, and less elastic vaginal tissues, causing discomfort during intercourse and itching or irritation.
6) Decreased Libido
A reduced interest in sex is common and can result from physical discomfort, emotional factors like mood changes and stress, and life in general.
7) Cognitive Changes
Many women report occasional and sometimes cyclical difficulties with memory, concentration, and mental clarity, often referred to as “brain fog”; These cognitive changes can be irritating and impact daily functioning.
8) Weight Gain and Changes in Body Composition
These changes can occur due to a combination of hormonal changes, reduced muscle mass and lifestyle factors.
9) Breast Tenderness
Fluctuating hormone levels can cause breast tenderness or swelling, like premenstrual syndrome (PMS) discomfort but potentially more persistent.
10) Hair and Skin Changes
Estrogen plays a role in maintaining healthy hair and skin. During perimenopause, hair may become thinner or more prone to shedding, and skin may become drier and less elastic.
11) Headaches
Hormonal changes can trigger more frequent or severe headaches, resembling migraines or tension headaches.
12) Joint and Muscle Pain
The decrease in estrogen can contribute to joint and muscle pain. Estrogen has anti-inflammatory properties and helps maintain joint and muscle health. It also plays a role in collagen production, which is essential for maintaining healthy connective tissue.
Recognizing and understanding the more common symptoms associated with perimenopause, as well as so many others, can empower you to take proactive steps in managing your health. There are various strategies to help you navigate these challenges. While some strategies are more effective than others, there is still a need for more research to determine the best approaches in certain areas.
To help Jessica, several strategies can be recommended:
First, Jessica can schedule a thorough medical evaluation. This should include blood tests to check her hormone levels and rule out other potential conditions. Jessica can also keep a symptom diary to track the frequency, severity, and triggers of her symptoms. This can help identify patterns and tailor her treatment plan effectively.
Strength training is particularly crucial for perimenopausal women. Engaging in strength training exercises two to three times a week can significantly help maintain muscle mass, improve bone density, and boost overall metabolic health. These exercises should include a mix of weight-bearing activities like lifting weights, resistance band exercises, and body-weight movements such as squats and push-ups. Strength training not only combats the natural muscle loss that occurs with aging but also helps in reducing the risk of osteoporosis, improving posture, and enhancing daily functional Strength.
In addition to strength training, Jessica can try to aim for at least 150 minutes of moderate-intensity aerobic exercise per week. Activities such as walking, swimming, cycling, or dancing are excellent choices. Aerobic exercise helps improve cardiovascular health, increase energy levels, and manage weight.
Including activities that improve flexibility and balance is also beneficial. Yoga, Pilates, and stretching exercises can enhance flexibility, reduce stress, and promote relaxation. Balance exercises, such as tai chi or simple balance drills, can help prevent falls and improve overall stability.
From a nutrition perspective, Jessica can emphasize a diet rich in whole, unprocessed foods, including a variety of vegetables, fruits, whole grains, lean proteins, and healthy fats. Ensuring adequate protein intake is crucial to support muscle mass and overall metabolic health.
Improving sleep hygiene can be achieved by creating a comfortable sleep environment—keeping the bedroom cool, dark, and quiet. Establishing a consistent bedtime routine and avoiding screens at least an hour before bed can help improve
sleep quality. Limiting caffeine and alcohol intake, especially in the evening, is also important.
To manage stress, Jessica can incorporate mindfulness practices such as meditation, deep breathing exercises, or progressive muscle relaxation. Finding ways to manage her time more effectively, balancing work, family, and self-care, is another key recommendation.
The possibility of hormone replacement therapy (HRT) or the potential use of other supplements can be discussed with her health care professional.
Jessica can lean on her support system, including friends, family, or support groups. If needed, she could consider seeing a mental health professional to address any emotional or psychological concerns.
Finally, Jessica can advocate for her health and work closely with her healthcare provider to find the best solutions for her needs.
As you transition through perimenopause and into menopause, remember that your accumulated wisdom and life experience are invaluable tools. Leveraging your strengths, along with strategies such as regular exercise, maintaining a balanced diet, and seeking support, can help you navigate this transition with greater ease and well- being. Engage with your health care professional, be open about your symptoms, and work together to find a proactive approach.
Remember, you are not alone. Embrace this stage of life with the confidence that you have the tools and experience to handle it. Continue to build on your strong foundation and move forward with strength and resilience.
Dr. Jen Burke, MD
thePause Board of Medical Advisors