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Perimenopause: Why You're Not Going Crazy

Updated: Apr 27, 2022

A large part of what I do is help women understand their hormones and help them understand that they're not going crazy. There's a reason you feel the way you feel.

Perimenopause is defined as the transition time between premenopause (where women are ovulating with frequency) and menopause (absence of menstrual cycles for 12 months).

This is a stage in a woman's life where she tends to experience more stress, has more responsibilities such as aging parents and children, as well as a time where she potentially reaches the peak of her career. This is why it becomes very easy to blame the way a woman feels during this time on her external circumstances.

There is also a massive gap in education for this population of women. Despite the fact that three quarters of the female population is likely to experience vasomotor symptoms (VMS) when they are perimenopausal, the vast majority of large-scale, definitive clinical trials targeting VMS have been limited to postmenopausal women and those very late in perimenopause (6-11 months without a cycle).

If your health care practitioner isn’t well researched in this area, it can often mean that there are other diagnoses that are being explored and this important conversation is not being had. And for the record, just because you currently have a period doesn't mean you're fine. That should not be the bar that we set for women.

In this blog post, I want to dive a little deeper into what is going on hormonally during this time so you can feel better educated and have more self-compassion for yourself.

Firstly, let's talk about what happens to a woman's menstrual cycle during this time. As you approach perimenopause, your total cycle length will begin to change. A 7-day change in either direction (shorter or longer) when you have had regular cycles before indicates the beginning stages of perimenopause. Cycles often get shorter before getting longer, but every person has a unique experience. You may also notice changes to the volume of blood lost with each period. Perimenopausal cycles can be heavier than normal or lighter than normal.

You may also notice an increase in other symptoms when you approach perimenopause. You may find you have more difficulty sleeping, hot flashes, vaginal dryness or changes to your mood. You can track these symptoms against your cycle. Sometimes they occur all month long, or they may occur only during phases of your cycle. Estrogen and progesterone are the lowest right before your period and up to day 3 of your next cycle. This may be when you sleep the worst and have the most hot flashes.

You may also notice that your PMS symptoms are absent during longer stretches without a period, or if your period arrives early. This may indicate that you did not ovulate. You must ovulate to have PMS symptoms.

Perimenopause is diagnosed clinically based on your symptoms, not blood work. However, blood work is often run to make sure nothing else might be going on. Be aware that hormonal levels during this time can fluctuate a lot and it will differ in every single woman. A lot of symptoms like migraines and hot flashes happen because of the change of hormones over time. Here are some of the hormonal changes we see:

  • Follicle Stimulating Hormone (FSH) rises progressively beginning 3-4 years before the final menstrual cycle. FSH is a hormone produced by your brain and it communicates with your ovaries. If FSH levels are high, it means your ovaries are not responding.

  • Estrogen remains relatively constant initially, or elevated relative to progesterone.

  • There is a small but significant decline in luteal progesterone in the years prior to the final menstrual cycle.

Sometimes women have a bleeding episode because those high levels of estrogen are unopposed by progesterone, and this in turn leads to really heavy bleeding. This is also why progesterone can often help treat the heavy bleeding of perimenopause.

So where do we go from here? It is really important for you to track your symptoms, including your bleeding time, cycle length, VMS and PMS symptoms. This gives your practitioner a lot of valuable information to work with and identify what factors could be leading to your concerns.

I am excited about the research that will come out in this area in the next decade. The missing piece of the puzzle is how do we help women ovulate for longer because if they do, they do better overall.

If you're interested in learning how we can work together to get to the root cause of your concerns, book a free 15 minute meet and greet here.

Medical Disclaimer: The information in this blog post is not and should not be relied upon as medical advice. None of the information provided is intended to be a substitute for professional medical advice, diagnosis or treatment. No doctor-patient relationship has been formed.

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