Like birth, death and taxes, menopause is one of those guarantees in life. And like birth and death, the surprise is only in the when, not the if. Menopause is technically defined as that point in time when you have not had a period for twelve consecutive months. So what do we call all that time leading up to menopause? That is perimenopause.
The average woman experiences menopause at age 51, with anywhere from 45-58 considered normal. Indications of perimenopause can start occurring up to ten years before actual menopause, meaning even as early as 35 a woman can start having associated symptoms.
Those years of a woman’s life between 35 and 50 are hectic enough. Between raising kids, managing a career, working on marriage/partner relationships, caring for elderly parents, keeping a house and yard, or any of the many other things that take up space and time in our life, we barely have the capacity to do it all. But we do. We keep our heads above water for the most part. We make it work. But the symptoms of perimenopause can cause us to come crashing down.
Not every woman will have every symptom, some may have very few, or to a very mild degree. In some women, the symptoms are subtle, in others they are severe. They are caused by the changes in levels of hormones in our bodies, particularly estrogens, progesterone, and testosterone. Our ovaries are responsible for 90% of estrogen production in premenopause, so as the ovaries begin decrease in function, estrogen naturally decreases. Lifestyle choices can dramatically impact the symptoms though. Poor nutrition, sedentary activity level, smoking, chronic illnesses such as diabetes and autoimmune disorders, environmental toxicity, and nutrient deficiencies all contribute to our hormonal imbalances.
So, what are the symptoms of menopause anyway?
Hot flashes and night sweats – 75% of all women will experience hot flashes at some point in time during the perimenopause years. In 20% of women they will be severe. They may last for as little as a few weeks to as long a 10 years or more. They can disrupt sleep and daily life. They can destroy one’s confidence in themselves. You may feel that your temperature is never regulated, being too hot one minute and too cold the next. A simple outing to the grocery store in the winter is complicated by what to wear. If you put on a sweater to keep you warm while traveling there, you may find yourself ready to rip it off in the middle of the produce aisle when the mister comes on. Bedroom ceiling fans become a must no matter how cold it is outside, or how wrong your Feng Shui master says it is. Your partner and the cat (or dog) may have to find another place to sleep. Your relationship will surely not be affected by “I want a snuggle,” one moment, followed quickly by “do not let any part of your body touch me,” the next. Sweaty, sticky sex may have been a thing in the backseat of a car in the middle of a hot summer night when you were in college, but now you realize it was not all it was cracked up to be. You may also revel in the joy of talking to your boss with sweat dripping off your forehead, hoping she doesn’t notice. (Oh, no. I’m not having a hot flash, I just ran a mile during my coffee break.) You may also collect an assortment of handheld fans, distributed in every purse and bag you carry.
Period changes – Periods may become longer, shorter, heavier, or lighter. You may experience more irregular periods or episodes of skipped periods. All this uncertainty to look forward to before they finally fall off the cliff completely. It’s like living through those early teen years of not knowing when and where you will start all over again. Only this time, you may bleed so heavily that you soak through your clothes in a matter of minutes. That old fear of walking into a room of your peers with a huge blood spot on your ass comes crashing back. If you are one of the lucky ones whose periods actually change for the better, or whose periods simply go along as always and just stop one day, thank your lucky stars. Just remember, even if you skip for eleven months and then have one, the clock starts again.
Sleep problems – 30% of women who never had trouble sleeping before, now do. Some of this may be attributed to the hot flashes and night sweats. It is hard to sleep when you are throwing the covers off, then trying to find them again in the dark to get them back on. But some women who don’t report problems with either of those still have trouble sleeping. Either they can’t fall asleep in the first place, or they fall asleep quickly, but wake up in the middle of the night and can’t get back to sleep. Then they fall into the practice of watching the clock tick the minutes away until the alarm goes off. On the plus side, it is a good way to practice math problems, (if I fall asleep right now, I will get in this many hours and minutes. Okay, now subtract 15 from that last calculation.) Seriously though, as the days go on and sleep deprivation becomes more and more pronounced, nothing else in your life is going to get better. Weight gain, low energy, brain fog all are enhanced with poor sleep.
Vaginal dryness – As estrogen decreases, the vaginal walls thin and have less lubrication and elasticity. This can lead to painful sex. There is often a tearing or burning sensation with intercourse. Just when it should be more fun, it becomes less fun.
Urinary problems – Low estrogen can also cause a loss of tone in the muscles of the pelvic floor. This can lead to leaking of urine when doing anything that puts pressure on this area. Coughing, sneezing, laughing, running, walking, jumping, picking up something off the floor, yelling at the kids, or getting out of bed can cause anything from a little squirt to a mighty flood. Urinary tract infections also can increase due to the lack of lubrication that used to move the bacteria away. The honeymoon cystitis without the honeymoon.
Weight gain and fat redistribution – Because of the way all the hormones of our body work together, when one or two get out of whack, the others tend to follow. Cortisol and insulin get thrown off-balance as the sex hormones give way, causing more fat to be distributed around the belly. The lack of sleep and low energy doesn’t help matters any. Neither does the fact that we seem to have more and more on our plates, both the dinner plate and the life plate. Cholesterol levels seem to change as well, with increasing bad and decreasing good.
Mood changes – Is it any wonder we are in bad moods sometimes with all of the above changes going on? But, there is an increased risk of depression during perimenopause. And a feeling of always being tired doesn’t do much for your overall happiness.
Mild cognitive impairment and poor concentration – Some just refer to it as brain fog. Not remembering where you left the keys to the car more often than you used to. Forgetting to pick up the kids. Not being able to finish a cohesive thought. Jumping from one task to the next, without remembering to go back to the first one. Research shows that those who have some mild impairment during the perimenopause years are more likely to suffer from Alzheimer’s later in life.
Less hair on your head, more hair on your face, and dry skin – These are just thrown in for kicks and giggles. Could anything be more fun than a bald, flaking, bearded woman?
Conventional treatments are mostly targeted to treat specific symptoms. Synthetic and bioidentical hormone replacement therapies and progesterone creams are available but are not without risks. You can use lubricants for better, less painful sex. Sleep aids may provide more sleep, but not necessarily better sleep. Antidepressants may alleviate the mood disorder symptoms, but again, side effects are many. Weight loss aids are not usually very helpful in the long-term.
Using a balanced, whole foods diet, the right kind and amount of exercise, and getting proper sleep can keep your body and hormones in check to minimize the effects of perimenopause. Stress reducing practices such as meditation or yoga will also help. Having good support and community around you is imperative. Herbal treatments may relieve or reduce the severity of some symptoms.
The Japanese have no word for menopause. For centuries they have mostly not had the symptoms that bother us in the west. We can take some clues from their diets and lifestyles. The women who practice a mostly Mediterrainean lifestyle are similarly blessed. Both of these cultures tend to eat mostly plant based foods, supplemented with fish and grass-fed meats. They move every day, mostly walking, and enjoy strong communities and support, especially with other women with whom they develop lifelong friendships.
The fact is that the sooner earlier you delvelop lifestyle strategies to combat these symptoms, the easier your perimenopause years will be. But it is also true that it is never too late to start. Adapting your lifestyle to address better nutrition, movement, and sleep will set you on the path to feeling better every day.