Perimenopause refers to the time leading up to the cessation of menstruation, or as most of us know it, menopause.
As is true about most things regarding the female body, it is widely experienced by roughly 50% of the world’s population, yet it is rarely talked about. That in itself is a problem, although one of the most perplexing problems with perimenopause is how ambiguous many of the symptoms are. Because of this, and other reasons, many women delay seeking care for perimenopause.
Perimenopause typically begins in the mid-thirties or forties. The individual experiencing perimenopause may or may not experience symptoms. Symptoms could last for one year or up to ten years. They may be consistent or sporadic. Symptoms may go away on their own, or they may require treatment. Treatment recommendations range from simple lifestyle changes to risky medical interventions with a myriad of possible side effects. Wait, what?
A scary truth about the wide variety of symptoms involved is that they often mimic other ailments. This could send a person into a barrage of medical appointments and tests, only to find out that it’s just a normal part of life that no one told us about.
The laundry list of perimenopause problems include, but are not limited to – hot flashes, frequent headaches, heart palpitations, vertigo, ringing in the ear, body odor, excessive sweating, thinning hair, brittle nails, digestive issues, depression, brain fog, fatigue, anxiety, rage, breast soreness, loss of libido, cycle variation, vaginal dryness, joint pain, change in body shape, weight fluctuation, burning mouth, urinary dysfunction and discontinence, dry eyes, electric shock sensations… Yikes!
Among the myriad of common perimenopause problems, there are some lesser known symptoms that might leave you scratching your head (or elsewhere)…
Cold flashes – what?
Hot flashes and night sweats are the most common perimenopause problems you hear about, so imagine my surprise when I started to experience cold flashes. Cue the doctor’s appointment where we check for anemia. Nope, just another perimenopause problem brought on by fluctuating hormones. Sometimes cold flashes occur after a hot flash, but sometimes they happen on their own.
Dry nostrils? That’s an odd and sometimes painful one. Speaking of your sniffer – have you ever heard of phantosmia? Probably not until you started having your own olfactory hallucinations, where you think you’re smelling smoke or burning chemicals when in fact there is no such smell present.
Whether common or not, none of these symptoms are fun. Many of them are embarrassing. All of them are perimenopause problems that will go away. Maybe. In one to ten years. Or not. Good luck!
Kidding! Sort of.
It is absurd that some doctors don’t even mention perimenopause until the patient inquires about it. It should be a topic that all providers talk about with patients before it even happens. In not knowing what to expect, we get confused by ambiguous symptoms, seek treatment for one thing, and later find out it’s something entirely different that is completely common and manageable in an entirely different way.
In Hot and Bothered, Jancee Dunn explains that there are twenty-four main symptoms a person may experience throughout perimenopause. Health journalist Jessica Migala suggests there are over one hundred symptoms a woman might experience throughout her journey into menopause! These symptoms might be in relation to one another, or not. They might be severe, or not. They might need treatment, or not. Some women are so confused about this new bodily change that early perimenopause symptoms can make us wonder, “Is it menopause or am I pregnant?”
The problem with perimenopause is that we just don’t know what to expect. This is not a typical virus or a broken bone that you can identify and treat in the same way for every person who experiences it. Every single person who goes through perimenopause will endure it differently. Some don’t even know they’re in perimenopause at all! How nice would that be?
Living in a female body feels kind of like being in a constant state of metamorphosis. From puberty to childbirth to postnatal to perimenopause and menopause, then finally post menopause. I feel so fortunate to have close friends to talk to about what in bloody hell is going on with my body.
It took me six months to write this because my brain is foggier than Cheech and Chong’s Love Machine. (If you’re old enough to get that reference, you might be in perimenopause.) People probably think I’m not paying attention to them because I get distracted mid-sentence and am still catching up on a previous thought by the time they’ve moved on to the next.
Exercise helps, but who has the energy for that? The need to rest became so real that I had my thyroid checked. It turns out it wasn’t my thyroid, just another perimenopause problem – extreme fatigue.
Anxiety is a constant companion, coupled with inexplicable bouts of rage. (Sorry, family. It’s not you. It’s me.) Some days I feel like a fairly normal, even-keeled, fully functional adult. Other days, there is not enough ashwagandha in the world to manage my mood swings and emotions.
Writing can be therapeutic when my brain isn’t playing a constant game of Boggle, but the only thing I can focus on at length is all the changes going on in my body.
As women around the world reach the age where we have fewer Fs left to give, we are finally talking about it. Menopause is no longer viewed as a disease or psychoailment, as explained in What Fresh Hell is This? by Heather Corinna. We are learning more and more about symptoms and, thankfully, about relief from those symptoms.
While this is not intended as medical advice, it’s important to review the solutions that are being touted. Some natural perimenopause remedies include black cohosh, phytoestrogens, and dehydroepiandrosterone, or DHEA. These are supplements that can be found over the counter at a pharmacy or health food store. Alternate therapies suggested are acupuncture, hypnosis, and cognitive behavior therapy. You might also choose to supply yourself with a perimenopause starter pack.
The Mayo Clinic offers the following suggestions: lifestyle changes and home treatments include eating a healthy diet, being active, getting enough sleep, and using OTC vaginal creams as needed.
If your symptoms become unmanageable, you can talk to your doctor about Hormone Replacement Therapy, commonly known as HRT. Naomi Watts does a fantastic job of breaking down HRT in her informative and witty book Dare I Say It. Dr. Jen Gunter’s Menopause Manifesto is another deeply informative read.
Primary care doctors are simply not experts in perimenopause, and neither are gynecologists. For this reason, many women are now turning to online providers for women in midlife. One website has a wealth of information about symptoms at every age and stage. You can also find a local doctor who specializes in menopause management through the North American Menopause Society.
Among all the perimenopause problems there are, the one I struggle with most is the fact that there are so very many perimenopause problems. They vary based on age, genetics, lifestyle, and even ethnicity. Nearly all of the perimenopause problems require individual diagnoses, and there are different management recommendations for each. It feels like a trial-and-error game in which there is no winner.
The light at the end of the dried-up vaginal tunnel is that we are talking about these things. Women are now more informed than ever before, and we’re not backing down from these uncomfortable conversations.
There is hope. The “change,” the “big M,” the “second spring,” or whatever you want to call it, ends with menopause – the cessation of menstruation. The natural end to reproductive life can be a natural beginning to an exciting next phase of life. I look forward to the freedom this will allow and to the coming of an age that we can embrace. As Dame Helen Mirren says, “Life doesn’t end with menopause; it’s the beginning of a new adventure. Strap in and enjoy the ride!”
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