Why don't I feel like myself? It may be perimenopause.

• Perimenopause is the years leading up to your final menstrual period, when your hormone levels begin to fluctuate. It typically starts in your 40’s but can start in your 30’s or 50’s as well.
• Premature menopause occurs before the age of 40 and can happen due to surgery (if both ovaries are surgically removed), chemotherapy or radiation therapy.
• Menopause is when you’ve gone 12 months without having a menstrual period. The average age of menopause in the US is 51, though it can happen in your 40’s or later than age 51. 

Perimenopause is more than just hot flashes!

At its core, perimenopause is triggered by decreasing estrogen hormone levels, which affect all organ systems (your brain, heart, blood vessels, bones, reproductive organs, and skin). Hot flashes are a possibility, but there are a lot of other symptoms to watch for that can signal perimenopause is beginning. Below are some of the main ones. You can learn about these and other common symptoms through some of the resources listed at the end of this blog. 

Period changes

Some of the first signs you may notice are changes to your periods (they may become shorter, longer, heavier, or lighter; you may have shorter/longer periods of time between bleeding episodes). This is caused by fluctuations in your estrogen levels. However, if you’re on birth control pills or have a hormonal IUD, you may not notice any changes. 

Sleep issues

You may have trouble falling asleep, wake during the night, or have trouble falling back to sleep. You may also start having night sweats (which are hot flashes at night), that may contribute to these sleep challenges. Sleep issues are common for more than half the people who go through perimenopause.

Genitourinary changes

You might have signs and symptoms associated with lack of estrogen that can involve changes to your labia, vaginal opening and vagina, clitoris, bladder, and urethra. This typically involves feelings of dryness, irritation, and burning, sexual symptoms like pain with vaginal penetration, and urinary symptoms. They can be mild to debilitating. 

Brain fog

You may have trouble focusing, become forgetful, and struggle to find the word you want to say. Because this can be especially noticeable at work, you may worry about your job. This is a result of declining estrogen and if you experience this, you’re not alone. It affects 60% of people during perimenopause. 

Mood issues

As your estrogen drops in perimenopause, so does serotonin, a brain chemical that helps you feel happy. Progesterone, a hormone that helps calm you, is also declining. The result? You may experience:

• Irritability
• Crying more than usual
• Increased worry or anxiety
• Difficulty concentrating
• Not feeling like yourself
• Mood swings
• Feeling overwhelmed
• Low motivation or energy

Know the risk factors for a mood issue interfering with your life during this phase:

• History of depression
• Having hot flashes and/or night sweats
• Adverse life events: people with a history of abuse/neglect, family problems, and low childhood socio-economic status, poverty, and unsafe environments have an increased risk of depression during perimenopause and menopause. 

Even if you don’t have these risk factors, no one should try to "tough it out." Talk to your provider if your symptoms are bothersome and affecting your quality of life.

Studies show women of color experience perimenopause differently than white women

Perimenopause and menopause haven’t been studied as much as they should. And much of what we do know about perimenopause and menopause is based on white people. But, according to the New York Times, “research has found that the duration, the frequency, the severity and even the types of symptoms can look different across races.” Because of this, women of color especially should advocate strongly for themselves when talking with their healthcare provider about their symptoms. 

Start the conversation now with your healthcare provider

No matter if you’re just starting perimenopause or have been in it a while, it’s good to talk to your healthcare provider about your current health status and any risk of long-term health issues after you’ve reached menopause. And as we said before, if you’re not feeling like yourself, whether it’s your mental or physical health, don’t try to tough it out! Talk with your healthcare provider about how you’re feeling and what they can do to help you. 

Help is available!

Depending on what you’re experiencing, they may recommend hormone therapy, antidepressants, vaginal creams, behavioral therapy, or more. You may need to be referred to a gynecologist or menopause specialist who knows more about this topic than your current provider. Here’s some great advice on how to start the conversation. Perimenopause lasts a while, and menopause lasts forever! Keep the discussion going at each visit. 

You've got this!

Knowledge is power and so is breaking down the mystery behind something that is a natural, normal part of life. Be kind to yourself through your perimenopause journey and connect with friends at the same stage of life as you for support and community. 

Resources that may help you

Perimenopause and menopause are broad topics and difficult to sum up in a blog post! Here are some resources that may help you.

Websites

• Menopause.org, The Menopause Society
• Hot Flash Substack
• Menopause and your health, Office on Women’s Health
• Menopause and sexuality, Office on Women’s Health
• Menopause basics, Office on Women’s Health
• Menopause, Office on Women’s Health
• Let’s Talk Menopause!
• What Every Black Woman Should Know About Navigating Menopause, Alloy
• How FOLX can support you through perimenopause and menopause, FOLX