My Story

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I take pride in the fact that I’ve never really believed all the dumb rules about aging. It’s probably my contrarian nature, but I’ve always embraced those ever-increasing age milestones. I have been looking forward to menopause (not so much perimenopause) since the day I got my first period. I was thrilled to become “a quarter of a century” old. The day I turned 29, I started proclaiming that “I was damn near thirty”, as proof of my authority on worldly things. I’ve even aged myself up (accidentally) on many occasions because I just refuse to lean into the nonsensical belief that aging is a bad thing. I think it’s a gift that not all of us get, and I’m gonna stick with that life philosophy.

How it started…

Well, over the last few months (and by few, I mean six), I realized that I was getting increasingly scattered, and my memory turned to complete shit. I was becoming way more weepy than usual. Dumb commercials could illicit tears. And sleep—what’s that? A mythical beast that I didn’t have the magic to tame. So, yeah, something was up, and I needed to figure out what!

You’d think I would have figured this out pretty quickly, being that I’m in my mid-40s, but you would most definitely be wrong. I didn’t connect the symptoms and just figured I was overworked and burned out per usual. The reality was that my normal coping mechanisms were failing, my hormones were out of whack, and I really just needed help.

Funny enough, the IG gods must have heard my pleas. Or maybe my friends had a lot of this content in their feeds. Either way, a menopause meme popped up on my feed as I was feeding my widdle brain its daily dopamine dose…. And that little light bulb finally lit up brightly. Babes, you’re in perimenopause!

Phew, what a relief! Because, as all my control-freak friends know, you can’t fix a problem when you don’t know the cause. Welp, it was now go time; fix-it mode engaged; full speed ahead. Using my savvy research skills, coupled with my nurse brain, I’ve compiled all the latest information I could find. Here’s your perimenopause cheat sheet. Enjoy!

P.S. I’m also considering writing an article about the specific supplements I currently take and why. Let me know in the comments if that’s something you’d be interested in.

Thanks much!

 – Dewby

Perimenopause 101: What is perimenopause?

Understanding Perimenopause: Symptoms, Duration, and Holistic Solutions

Like I said before, I’ve been looking forward to menopause for a very long time. The idea of not having to deal with a period has always been appealing to me. It’s more than a touch frustrating that we learn so little about what the lead-up is like to this new chapter.

Perimenopause is the natural phase of life that is signaled by the cessation of a woman’s menstrual cycle. It is often accompanied by a wide variety of emotional and physical symptoms, so understanding what to expect and how to manage these symptoms can make a world of difference. This article covers what perimenopause is, how long it lasts, the main symptoms to expect, questions and blood tests you can ask your doctor about, as well as a few holistic approaches to symptom relief.

What is perimenopause?

Peri (before) menopause is the transitional period leading to menopause. Oh, and by the way, you won’t know that you’re actually menopausal for a whole year! That’s because menopause is defined as the point in time 12 months after a woman’s last period. So you have to wait an entire year to confirm you’re actually postmenopausal. Menopause can also be triggered by surgical removal of the ovaries or hysterectomy if hormone replacement is not immediately initiated.

“Oh and by the way, you won’t know that you’re actually menopausal for a whole year!”

During perimenopause, your body reduces its production of estrogen and progesterone, but not usually in a smooth, incremental manner. Part of the challenge is that estrogen and progesterone levels can fluctuate wildly during this time, with peaks and valleys in production that are no longer synchronized with their partner hormones. These hormonal changes affect the way many body processes function, which leads to the associated symptomology.

Perimenopause: When does it start, and how long does it last?

This less-than-glorious transition typically begins in a woman’s 40s, most often between the ages of 45-55. Early menopause happens before the age of 45, and it’s considered premature before the age of 40, so it is possible to have symptoms in your 30s. Onset is thought to be hereditary, although many factors like diet, disease, and ovarian injury can alter this. On average, perimenopause lasts about 7 years, but it can last as long as 14. According to the National Institute on Aging, factors like age of onset, race, ethnicity, and smoking can all affect duration.

Signs and Symptoms of Peri-me-no-pause

Perimenopause is characterized by a wide range of emotional and physical symptoms that can change rapidly over time. The main symptoms include:

1. Irregular Periods: Menstrual cycles may become shorter or longer, and the flow can vary from lighter to very heavy. My cycles got closer together and heavier on the heaviest day but one day shorter as well.
2. Hot Flashes/Night Sweats: Sudden, intense heat sensations often accompanied by sweating. No to hot flashes Yes, to occasional night sweats.
3. Mood Swings: Emotional fluctuations, including irritability and moodiness. Just call me a Power RAGER… Get it?  I love corny jokes; don’t judge me.
4. Sleep Disturbances: Difficulty falling asleep or staying asleep. What is sleep? I actually fall asleep with no problem but can’t STAY asleep for very long; this is the opposite of how I was pre-peri.
5. Vaginal Changes: Thinning and dryness of the vaginal tissue, leading to discomfort or pain during intercourse. Again, grateful no issues here, but I hear there are good fixes available.
6. Changes in Libido: Reduced interest in sexual activity. Not yet :o)
7. Weight Gain: Some women may notice weight gain, particularly around the abdomen. Small flux but improved with supplementation & consistent physical activity.
8. Urinary Incontinence: Occasional leaks or urgency. No changes here, but it is a story for another time.
9. Bone Density Loss: The risk of osteoporosis increases as estrogen levels decrease. My Calcium was wicked low. I started taking vitamin D and increased my sun exposure a bit. I need to recheck my numbers post-intervention, but I’m optimistic.

Which brings us to…

What’s up, Doc? Questions to ask about perimenopause

1. How can I confirm if I’m in perimenopause?
2. What are my treatment options for managing symptoms?
3. What specific health risks should I be aware of based on my medical history during perimenopause?
4. How do I know if hormone therapy is right for me, and what are the potential benefits and risks?
5. What lifestyle changes or holistic approaches can best help alleviate my symptoms?

Blood Tests You Can Request

Here are a few labs you can request to assess your hormone levels and overall health during this time.

1. CBC with electrolytes: You’re getting older, and it’s really important to have a baseline to compare future labs to. While there are normal lab ranges, what’s normal for you can be outside of that “normal” range. This range also varies by institution, so it’s more of a general guide than a hard-and-fast rule.
2. Hormone Levels: Measuring estradiol (a form of estrogen) and FSH (follicle-stimulating hormone) can provide insights into hormonal changes. You can go one step further and ask for an anti-mullerian hormone (AMH) level so they can determine ovarian reserve, which can give insight as to how soon you could transition. Also, keep in mind that these tests may need to be completed on a specific day of your cycle, so be sure to get those details from your doc!
3. Thyroid Function: Checking thyroid hormones is important, as thyroid imbalances can mimic perimenopausal symptoms. If you think you may have thyroid dysfunction, be sure to ask for a full thyroid panel that includes the following tests: TSH, Total & Free T4, Total & Free T3, Reverse T3, Anti-TPO, and Anti-Thyroglobulin. This will give you the most accurate picture of what’s happening with your thyroid hormones.
4. Lipid Profile: Monitoring cholesterol levels is crucial for assessing heart health, which can be affected during perimenopause. Your lipid profile should include your total cholesterol, LDL, HDLs, and triglycerides.
5. Bone Density Testing: A DEXA scan can evaluate bone health and assess the risk of osteoporosis. Also, be sure to monitor calcium and vitamin D levels.

Perimenopause is usually diagnosed based on patient history, age, symptoms, more-so than blood tests. Hormones during this time fluctuate erratically, so your bloodwork may not show the true story, but it can rule out other potential causes for your symptoms.

A Holistic Approach to “The Change” (insert eye roll)

Our journey through perimenopause is as unique as each of us. It’s crucial to tune in and listen to our bodies, especially as we age. A balanced approach to health typically has the best outcomes. It’s important to consult with your healthcare provider prior to starting any new exercise programs, diet regimens, or herbal supplements that could interfere with your current medications or diagnoses.

Lifestyle changes that can make a big impact…

Consider making changes to the following to help manage your perimenopause symptoms:

1. Diet: A well-balanced diet rich in fruits, vegetables, dark leafy greens, whole grains, and lean proteins can support overall health. Incorporate foods with phytoestrogens like soy and flaxseeds. Think: less processed is best.
2. Exercise: Regular physical activity can help with mood, weight management, and bone health. Make it as easy as possible; walking is an amazing way to start. Sometimes my only goal is just to put on my sneakers and walk to the corner, cuz I know if I do, I’ll go a little farther, and I ALWAYS feel better after a workout, no matter how easy!
3. Stress Reduction: Mindfulness practices, yoga, and meditation can reduce stress and improve mood. Yoga has been a GAME CHANGER for me. I’m still not very flexible, but my joints feel great, and my range of motion has dramatically improved.
4. Vitamin Supplements & Herbal Remedies: Some women find relief from perimenopausal symptoms with supplements like black cohosh, soy isoflavones, and omega-3 fatty acids. Herbs such as sage and evening primrose oil may offer relief from specific symptoms. The right supplements can make ALL the difference, it has for me!!
5. Acupuncture: Some women experience relief from hot flashes and mood swings through acupuncture.
6. Sleep Hygiene: Most of us need to do a better job in this category. Establishing a consistent sleep routine and creating a comfortable sleeping environment can help with sleep disturbances. I’m still working on this.

The tables below show 20 of the best perimenopause supplements, organized by symptom type. If you are currently taking prescription medications, it’s super important to consult a healthcare provider before using supplements or herbs. Some supplements can interact with your meds and change their potency or efficacy.

Supplements for Hot Flashes:

Supplement Name	Recommended Daily Dosage	Scientific Data	Contraindications
Black Cohosh	20-40 mg	Limited evidence NCCIH	Caution for liver disorders
Soy Isoflavones	40-80 mg	Contains phytoestrogens NIH	None known
Vitamin E	400-800 IU	Limited evidence ODS	Caution with blood-thinning medications
Red Clover	40-80 mg	Contains isoflavones NCCIH	Caution for hormone-sensitive conditions
Sage	Varies	Limited evidence NCCIH	Generally considered safe
Evening Primrose Oil	Varies	Limited evidence NCCIH	Caution, especially for those with epilepsy
Dong Quai	Varies	Limited scientific evidence	Avoid during pregnancy and with bleeding disorders

Supplements for Mood Swings:

Supplement Name	Recommended Daily Dosage	Scientific Data	Contraindications
Soy Isoflavones	40-80 mg	Contains phytoestrogens NIH	None known
Vitamin E	400-800 IU	Limited evidence ODS	Caution with blood-thinning medications
B Vitamins (B6, B12, Folate)	Varies	Essential for overall well-being, limited evidence for menopausal symptoms	Generally safe within recommended daily allowances
Rhodiola Rosea	Varies	May help with mood and stress NCCIH	Consult a healthcare provider if you have bipolar disorder
Maca Root	Varies	Limited evidence for mood and energy	Generally considered safe, consult with healthcare provider if needed
Ashwagandha	Varies	May help with stress and mood NCCIH	Consult a healthcare provider, especially if you have thyroid issues

Supplements for Bone Health:

Supplement Name	Recommended Daily Dosage	Scientific Data	Contraindications
Vitamin D	Varies	Essential for bone health ODS	Consult a healthcare provider for appropriate dosage
Calcium	Varies	Essential for maintaining bone health ODS	High doses may lead to kidney stones in susceptible individuals

Supplements for Other Perimenopause Symptoms:

Supplement Name	Recommended Daily Dosage	Symptoms it Treats	Scientific Data	Contraindications
Magnesium	Varies	Mood swings, insomnia, muscle cramps	May help with mood, sleep disturbances, and muscle cramps ODS	Consult a healthcare provider, especially if you have kidney or heart conditions
Omega-3 Fatty Acids (Fish Oil)	Varies	Mood swings, joint pain, heart health	May help with mood, joint pain, and heart health ODS	High doses can interact with blood-thinning medications
Probiotics	Varies (1-10 billion CFUs)	Digestive issues, mood swings, overall well-being	May support gut health and improve mood PubMed	Generally safe, consult with a healthcare provider for specific recommendations
Ginkgo Biloba	120-240 mg	Cognitive function, memory	May improve cognitive function NCCIH	Consult a healthcare provider, especially if taking blood-thinning medications
Chasteberry/Vitex	Varies	Hormone-related symptoms	May help with hormone-related estrogen dominance symptoms NCCIH	Avoid use during pregnancy and when taking certain medications

Please note that these tables provide a general overview and cannot replace professional medical advice. Always consult with a trusted healthcare provider for personalized recommendations.

Final Thoughts

Perimenopause is just another transitional phase in a woman’s life. We will all go through it at some point, but it’s a lot easier to manage when you know what to expect and how to cope with all those changes. Keep in mind that what works for me may not be what works for you. There will likely be some trial and error required to find your optimal regime. That being said, you are not alone, and you are not crazy. Let’s change the narrative of how we view ourselves and these changes.

What’s your experience with perimenopause?

What’s your biggest fear about the changes you are or will go through?

I think perimenopause is just another phase of womanhood. What are your thoughts?

More Resources

1. Mayo Clinic – Perimenopause: Mayo Clinic – Perimenopause
2. The North American Menopause Society (NAMS): NAMS
3. WebMD: Perimenopause: WebMD – Perimenopause
4. National Institute on Aging – Menopause: NIA – Menopause
5. American College of Obstetricians and Gynecologists (ACOG) – Menopause: ACOG – Menopause

Thanks for the read! This article is a generalized compilation of current knowledge and doesn’t cite specific sources unless indicated. It is, by no means, an exhaustive resource.