How Do I Know If It’s Perimenopause?
By: Dr. Alyssa Dweck
So, you think you’re starting your journey towards menopause. After all, this is an inevitable right of passage for women. I find it best to arm yourself with knowledge and preparation for this natural transition.
What is peri-menopause anyway and how can you be sure?
First, lets get some semantics out of the way. Menopause is defined as 12 consecutive months without menstruation for no other identifiable reason; yes, even pregnancy can be mistaken for menopause! Trust me. The average age of menopause in the US in 51 years old, but age range of 40-58 is fair game. The age of onset is in part genetic and may very well mirror your moms or your sisters experience; but lifestyle habits also play a role. Postmenopause specifically refers to time from menopause forward; 12 months plus a day after your last menstrual period to be exact. It’s important to note that menopause doesn’t just happen from one day to the next, but rather it is a transition that may take 4-8 years. These years are termed perimenopause.
What’s happening during peri-menopause?
In general, ovulation and the carefully orchestrated hormonal peaks and valleys that occur with ovulation, becomes irregular and eventually ceases. As such, estrogen, progesterone and testosterone become highly variable and eventually plummet. For some, it’s obvious when these changes start. Others are often caught off guard.
Irregular or skipped menses are the hallmark of perimenopause. Some women will intermittently skip a month or two, or even longer, while others will bleed more frequently. One important point about missed menses: if you are peri-menopausal and having sex, contraception is still needed if pregnancy is a concern. What about erratic menses? When should one be concerned? In general, bleeding more often than every 3 weeks, very heavy bleeding or bleeding in between cycles warrants a check-in with your gynecologist.
Hot flashes and night sweats are not uncommon. They may wax and wane. Sleep interruption and mood volatility are also frequent complaints during peri-menopause. Women often note less tolerance and patience, fatigue, irritability, and heightened emotions as well as a feeling of “going crazy” and “not recognizing themselves”. While concerns of this nature are often multifactorial due to life stresses that coincide with age, hormonal variation is surely to blame, in part. I often recommend SerenolTM for those patients who are distraught with these PMS type symptoms.
Is there a blood test to diagnose peri-menopause?
In fact, FSH (Follicle-Stimulating Hormones) and estradiol blood levels might be helpful to suggest hormonal changes, however, they are not diagnostic. In addition, these tests are limited since they are cycle dependent and most accurate on day two of the menstrual cycle and/or during the pill free/placebo week of oral contraceptive pills. This blood work is also just a quick window in time and may vary significantly during the peri-menopausal transition. A comprehensive “well woman” blood panel can help rule out other medical issues, including anemia and thyroid disorder, and can be help diagnose other medical issues that may cause similar symptoms. Realistically, reassurance that you’re not “going crazy” is often all that is needed.
Here’s the good news: Peri-menopause is gradual and lifestyle modifications with diet, exercise, stress reduction and supplements can be super helpful. Some women even report a heightened libido during peri-menopause. Go for it! All in all, knowledge and preparation are key to making the perimenopause journey a more positive experience overall.
Alyssa Dweck, MS, MD, FACOG, Bonafide Medical Advisor, is a practicing gynecologist at CareMount Medical in Westchester County, New York. She provides care to women of all ages and has delivered thousands of babies. A graduate of Barnard College, she has a Master’s Degree in Human Nutrition from Columbia University and her Medical Degree from Hahnemann University School of Medicine in Philadelphia, now named Drexel University. Dr. Dweck currently practices in Mount Kisco, NY and Carmel, NY and admits to Northern Westchester Hospital in Mount Kisco, NY. She has been voted “Top Doctor” in New York Magazine and in Westchester County and has authored three books to date: “The Complete A to Z for your V,” “The Sexual Spark,” and “V is for Vagina.”