Picture your hormonal cycles during your reproductive years as a kiddie-roller-coaster. You have predictable peaks and valleys, generally in regular intervals. If you track your periods during this time, they are usually the same length of days from the start of one cycle to the next.
Enter perimenopause. Your adorable kiddie coaster is now one of those heart-stopping, stomach-dropping loop-de-loops. At one time, you could predict that one week out of the month when you had to pack your bags and move to a deserted island with a stockpile of tampons. Now, it’s as random as the wheel of fortune spinner with no polite warning!
If you were to have your hormone levels checked during this time, you would find values that swing from one extreme to the other daily—or even hourly. This could manifest in a number of disturbing physical and emotional symptoms such as hot flashes, night sweats, brain fog, memory problems, achy joints, erratic cycles, trouble sleeping, low libido, hair thinning, depression, anxiety, and vaginal dryness.
Combine this with the life of a typical middle-aged woman who is already juggling a ton of competing priorities. Most women enter perimenopause at a time when they are hitting their stride in what are often very demanding careers. If you have children, you could be in the throes of parenting challenges and even be at the start of your pregnancy journey as the number of women having children in midlife is growing steadily. Or you may be caring for aging parents with serious health concerns.
Life at this stage is beyond overwhelming, and if you’ve set your biological clock to auto-pilot, the sudden onset of all of these symptoms while still having periods will leave you frazzled, confused, and questioning your own sanity. Well, you’ll be relieved to know that what feels like puberty part two means you’re not unraveling at the seams but likely going through perimenopause. And with over 1 billion women worldwide expected to go through perimenopause in 2025, you are not alone.
Why We Feel Crazed & Off Our Game
The average onset of menopause is between 45-55 years old, with North American women, on average, entering menopause at 51. This means by that age, women have gone a full twelve months without a period. Most women don’t realize that perimenopause can start a full decade before that. If you currently land in that age group, you belong to Generation X and will surely remember the Magic School Bus. Well, here’s the menopause edition:
Ms. Frizzle will tell you our bodies are rife with hormone receptors. We have them, among other places, in our brains, joints, gastrointestinal system, and vaginal walls. During perimenopause, the extreme variations in our hormone levels can cause a variety of physical symptoms. Specifically, they can affect how our brain cells and the blood vessels surrounding them function. It’s not the overall decrease of hormones that seems to be the issue, but the alternating and unpredictable amounts of estrogen and progesterone.
Some women are more vulnerable to these hormonal swings than others. Certain problems that may have been lying dormant for years may make a reappearance. If, for example, you’re among the 1 in 5 women to experience post-partum depression or the 1 in 10 who suffered post-partum anxiety, be on the lookout for worsening moods during perimenopause. The same type of hormonal fluctuations that occur during post-partum can also trigger anxiety and depression in perimenopause.
For many of us Generation X women who pride ourselves on being resourceful, independent self-starters, anything that slows us down can be extremely distressing. We’ve turned the baby boomer mentality of family vs. career on its head and somehow found ways to balance both (most of the time!). When you’re killing it at home and work, it can be wildly disorienting when perimenopause suddenly throws you into a hormonal tsunami. One minute, you’re in the driver’s seat, and the next, you’re pulling over to catch your breath.
Make A Plan & Get Back in the Game
If you are under 40 or still having monthly periods, one of the first things you can do is to start tracking your period. This is only an option for those of us who are not on hormonal birth control. The period you get on the pill is not a result of your naturally occurring hormones. Your natural cycle lengths can give you some insight that you’re nearing this transition, then you can be on the lookout for the grab bag of symptoms coming your way. This can also decrease the chances of you being blindsided by them. You don’t have to get ready if you stay ready, as a good friend of mine likes to say.
Midlife can be an opportune time to grab the bull by the horns and achieve your best health. One of the great things about living in these times is that we are surrounded by a bevy of highly successful women rocking their midlife experience. Many women are coming into their fitness primes, and there’s no reason you should have to grit your teeth and bear any of the unsettling symptoms that often come with this transition. Experts have found tremendous benefits from making important lifestyle modifications:
“These include maintaining an extensive social network, remaining physically and mentally active, increasing dietary intake of omega-3 fatty acids and certain vitamins from natural foods, following a Mediterranean diet, not smoking, consuming alcohol in moderation, and reducing cardiovascular risk factors such as hypertension, diabetes mellitus, and high cholesterol. Evidence is perhaps strongest for the role of regular exercise in preventing cognitive decline.”
The most important of these changes are regular exercise and social networks. One study found that women who were part of a group that met at least once a month were less likely to have uncomfortable symptoms of menopause and depression. Regularly moving your body to increase your heart rate at least 150 minutes a week and doing strength training 2-3 times a week has been shown to slow some of the physiological changes of aging, improve your bone health, decrease your cardiovascular risk, and improve mental well-being. So start that amateur tennis team! Join that book club!
Lastly, write down a list of questions to bring up to your ob-gyn, or better yet, find a North American Menopause Society (NAMS) certified practitioner and sit down for a chat. They can explain what treatment options are appropriate for your situation. They can also tell you what metaphorical ducks you need to get into a row as you approach the transition to decrease your risks of depression, anxiety, heart disease, or cancer. They can also share what symptoms can and cannot improve with the addition of hormone therapy or other medications.
Final Thoughts
It’s important to remember three things: you are not alone, you are not going crazy, and there are options to help ease your symptoms and get you back in the game. Thankfully as menopause becomes more mainstream, we have celebrities from the likes of Oprah, Drew Barrymore, Halle Berry, and Michelle Obama talking about their menopause experience. You don’t have to be a celebrity to share your journey. Talk to your friends, talk to the checkout clerk, talk to your neighbors, talk to your daughters and sons. Perimenopause is a normal part of life, and there is nothing to gain by suffering in silence.
Alexandra Sherman is a board-certified Women’s Health Practitioner with over ten years of experience. She has been a North American Certified Menopause Practitioner since 2017. She’s lived in Massachusetts, California, and today calls the suburbs of Atlanta her home. When she’s not helping her patients navigate the trials and tribulations of womanhood, she enjoys spending time with her husband, three kids, a dorky dog, and a chunky cat. She loves travel, baking, and any time outdoors, especially by the water.