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Perimenopause

It's basically puberty, in reverse. 

Rather than the gradual ramp-up of hormones leading to menstruation, it’s the decrease of hormones (namely estrogen) that ends at menopause.* This process can last as long as10 years. The first sign is typically changes in your menstrual cycle. Then it’s night sweats, hot flashes, trouble sleeping, changes in mood (rage, anxiety, depression) – and doesn't stop there. Estrogen impacts every system, organ, and cell in your body – so the physical, mental, and emotional impact can be huge.

Check out what’s happening in your body, and the symptoms of those changes.
 

*Menopause the day you’ve officially gone 12 straight months without a period. Before that day, you’re perimenopausal, after that day you’re postmenopausal.

What happens to your body during perimenopause?

See how every system in your body is effected

See if you meet the criteria fora Perimenopause diagnoses?

It's so much more hot flashes and missed periods!

Perimenopause Symptoms

Feeling off? Have less patience? More rage? No moisture in your skin, eyes, hair, vagina? Can't remember why you walked into a room? Gaining weight but have no energy to do anything about it?

    • Irregular menstrual cycles (shorter, longer, skipped)

    • Heavier or lighter bleeding

    • Spotting between periods

    • New or worsening PMS or PMDD

    • Breast tenderness

    • Hot flashes

    • Night sweats

    • Chills following hot flashes

    • Flushing

    • Difficulty falling asleep

    • Waking up in the middle of the night

    • Waking up too early

    • Disrupted sleep from night sweats

    • Non-restorative sleep

    • New or worsening sleep apnea

    • Mood swings

    • Irritability

    • Anxiety

    • Depressive symptoms

    • Increased emotional reactivity

    • Reduced stress tolerance

    • Rage

    • “Brain fog”

    • Difficulty concentrating

    • Memory lapses

    • Trouble finding words

    • Slower processing speed

    • New or worsening ADHD symptoms

    • Vaginal dryness

    • Burning or irritation

    • Pain during sex (dyspareunia)

    • Decreased libido

    • Urinary urgency or frequency

    • Increased frequency of UTIs, yeast infections,  and vaginosis

    • Fatigue

    • Joint and muscle aches

    • Headaches or migraines

    • Weight gain or redistribution of fat

    • Changes in body odor

    • Dry skin

    • Dry eyes

    • Dry mouth

    • Hair thinning or hair loss

    • New or increasing skin growths (cherry angiomas, skin tags, seborrheic keratoses)

    • Skin discoloration (redness, dark spots)

    • Palpitations

    • Dizziness

    • Increased cholesterol levels

    • Changes in blood pressure

    • Increased insulin resistance

How is perimenopause diagnosed?

The most widely accepted diagnostic criteria come from the Stages of Reproductive Aging Workshop (STRAW) and its update STRAW+10¹

The STRAW criteria was first published in 2001. It established the first standardized framework for diagnosing the transition to menopause. Ten years later, with a decade’s more information the STRAW+10 was published.

menstruation

The Primary Criteria (STRAW)
Perimenopause is diagnosed when a woman (with ovaries) experiences changes in her menstrual timing or flow,


Early Perimenopause =
cycle length becomes consistently different by ≥7 days from baseline cycles may shorten or lengthen unpredictably ovulation becomes irregular


Late perimenopause =
No period for 60 days or more Skipped cycles are often skipped bleeding may be heavy, prolonged, or erratic

hormone levels

What about hormone levels?
“No single hormonal marker is sufficiently reliable for diagnostic purposes.”
— STRAW+10¹
In other words, there is too much fluctuation in hormone levels from day to day, for hormones to be a reliable diagnostic tool. That means that “normal labs" do not rule out perimenopause.

​

“Perimenopause is diagnosed clinically based on menstrual cycle changes and symptoms; laboratory testing is rarely required.” - North American Menopause Society (NAMS)⁴ 

 

The American College of Obstetricians and Gynecologists (ACOG) recommends taking into consideration a woman’s “history of cycle irregularity, symptom pattern, and ruling out pregnancy, thyroid disease, or structural causes when indicated.”⁵

symptoms

What about symptoms?Symptoms aren’t required for a perimenopausal diagnosis, but they do support it, if you’re also having changes in your cycle. (3)The most reported symptoms are:hot flashes or night sweatssleep disruptionmood changes or anxietybrain fog or memory complaintscycle-linked migrainesworsening PMS or new mid-cycle symptoms

age

What about age?Perimenopause typically starts between ages 40-55, with the average start being between 45 and 47 years. (2)age alone cannot confirm or exclude perimenopause

1. Harlow, S. D., et al. (2012). Executive summary of the Stages of Reproductive Aging Workshop +10. Menopause, 19(4), 387–395. https://doi.org/10.1097/gme.0b013e31824d8f40
2.Santoro, N., et al. (2015). The menopausal transition. Endocrine Reviews, 36(3), 275–312.https://doi.org/10.1210/er.2015-1012
3. Greene, J. G. (1998). Constructing a standard climacteric scale. Maturitas, 29(1), 25–31
4. The North American Menopause Society (2022). The 2022 hormone therapy position statement. Menopause, 29(7), 767–794
5. ACOG Practice Bulletin No. 141 (2014, reaffirmed). Management of menopausal symptoms. Obstetrics & Gynecology

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