Snapshot
The subtle changes of perimenopause typically start in our 40s
Perimenopause often begins with subtle, seemingly unrelated symptoms like brain fog, joint pain, and weight changes; recognizing these early signs empowers women to proactively manage their health through lifestyle adjustments and informed conversations with healthcare providers.
Have you been feeling a bit off lately, but can’t quite put your finger on why?
It often starts with small changes. You may feel unusually tired, your joints might ache, or your once-sharp memory may be clouded by brain fog. At first, it’s easy to attribute these symptoms to life’s demands. But as they accumulate—unexpected weight gain, trouble concentrating, sudden bouts of fatigue, dry skin, even hair thinning—you might start to wonder, “Is my body falling apart, or is this perimenopause?”
Perimenopause, the stage before menopause, often begins quietly. These subtle symptoms can feel disconnected, making it hard to realize what’s actually happening. It’s important to recognize that you’re not alone in experiencing this. Many women begin to notice changes in their 40s, though it can start earlier. The key is connecting the dots: these shifts are usually the result of fluctuating hormone levels.
Declining estrogen impacts almost every system in our bodies
Many of the more subtle symptoms of perimenopause are less talked about but just as significant. These can include:
- Brain fog: A noticeable decline in focus or memory is common, affecting work and daily life.
- Aches and pains: As estrogen levels drop, joint and muscle aches can become more pronounced. Many women report feeling like they’re aging overnight.
- Unexplained weight gain: Even if diet and exercise remain the same, hormonal shifts can lead to fat redistribution, especially around the belly.
- Dry, itchy skin: Lower estrogen levels can affect the skin’s ability to retain moisture, leading to dryness and irritation.
- Changes in hair and nails: Thinning hair and brittle nails can be early indicators of hormonal imbalance.
It’s these quieter, more gradual changes that often leave women feeling as if they’re falling apart when, in reality, it’s the body’s way of adapting to fluctuating hormones.
From perimenopause to postmenopause
Perimenopause can last several years—up to a decade for some women. During this time, periods may become irregular, symptoms intensify, and eventually, menopause (when periods have stopped for 12 consecutive months) sets in. After menopause, the postmenopausal phase begins, where symptoms may ease, but women continue to adjust to life with lower hormone levels.
What can we do to manage perimenopause?
While lifestyle adjustments are helpful, sometimes the symptoms of perimenopause can feel overwhelming. If you’re struggling with sleep, anxiety, or severe hot flashes, you don’t have to suffer in silence. Hormone replacement therapy (HRT) is one option that some women find beneficial (speak to your healthcare provider about this), but natural alternatives like black cohosh or evening primrose oil can also be explored.
Other steps for self-care include:
- Regular exercise: Helps manage weight gain, improves mood, and supports joint health.
- Balanced diet: Focus on whole foods, lean protein, healthy fats, and phytoestrogen-rich foods (like flaxseed and soy) to support hormone balance.
- Hydration and skincare: Keeping skin hydrated, inside and out, can reduce dryness and irritation.
- Sleep hygiene: Creating a bedtime routine can help manage the sleep disturbances that often come with perimenopause.
Is there a test for perimenopause?
The short answer is: it’s complicated. Unlike pregnancy, there’s no single, straightforward test for perimenopause. Here’s what you need to know:
Hormone tests
While blood tests can measure hormone levels, these aren’t always reliable indicators of perimenopause because:
- Hormone levels fluctuate greatly during perimenopause, even from day to day. A single test only provides a snapshot of your hormone levels at that moment. Some women may have normal hormone levels but still experience perimenopausal symptoms.
Follicle stimulating hormone (FSH) test
This is sometimes used, but it’s not definitive:
- An elevated FSH level can suggest you’re nearing menopause, but it doesn’t confirm perimenopause. FSH levels can vary widely during perimenopause, making interpretation challenging.
Symptom tracking
Often, the most reliable method is to track your symptoms and menstrual cycle changes over time:
- Keeping a diary of symptoms, their frequency, and severity can be very helpful. Note changes in your menstrual cycle, including frequency and flow.
Clinical evaluation
A healthcare provider’s assessment is crucial:
- They’ll consider your age, symptoms, medical history, and any relevant family history. A physical exam may be performed to rule out other potential causes of your symptoms.
Thyroid function tests
Sometimes, thyroid disorders can mimic perimenopausal symptoms, so your doctor might recommend thyroid function tests to rule out these conditions.
Remember, perimenopause is a gradual transition, and its onset and duration can vary greatly among women. While there’s no definitive test, a combination of symptom tracking, clinical evaluation, and sometimes hormone testing can help confirm if you’re in perimenopause.
If you’re experiencing symptoms that you think might be related to perimenopause, the best course of action is to consult with a healthcare provider. They can help interpret your symptoms, conduct necessary tests, and guide you through this transition with appropriate management strategies.
Other subtle signs to watch for
- Digestive issues: Bloating, gas, and changes in bowel habits can also be linked to perimenopause.
- Increased sensitivity to alcohol or caffeine: You might notice you can’t tolerate these as well as you used to.
- Decreased libido: While this can be related to hormonal shifts, it’s also affected by stress and fatigue, both of which tend to increase during perimenopause.
Keeping a journal of these symptoms can help you track patterns and make connections, which can be useful when discussing options with your doctor.
Toolkit for perimenopause
Here are some products that might help manage those subtle but persistent symptoms:
- Cognitive support: Supplements like omega-3 fatty acids or brain-boosting vitamins may help with memory and focus.
- Joint relief: Anti-inflammatory supplements such as turmeric or omega-3s can ease achy joints.
- Skin care: Moisturizing creams containing hyaluronic acid or ceramides can improve skin hydration.
- Natural hormone balancers: Products like red clover or flaxseed are thought to support hormone balance during perimenopause.
