09 May 2013

Wait, I’m too Young for This!!

She’s sneaky.

She’s subtle some days, but other days her subtlety is like that of a 2×4 to the side of your head.

SHE is perimenopause (or premenopause)…and she is the mistress of disguise.

Signs of perimenopause can start as early as your mid-late 30’s. While you’re in the thick of raising kids (or considering having more), your ovaries may be looking toward retirement.

Maybe you notice that you’re just a little grouchier or that your periods aren’t quite as regular. Your PMS symptoms, which were once mildly annoying, are now raging. You gain weight even though you’re exercising and eating right.

Hormones begin shifting naturally around the age of 35 when estrogen and progesterone start to taper off very gradually prior to menopause. Because this is usually such a slow shift, many women may hardly feel this change happening in their bodies. However, for the majority of women, these hormonal shifts may overwhelm their bodies’ ability to maintain balance. The result is severe symptoms that can go on for years.  There are some women who don’t experience any of this until much later (myself included). I’m 53 and things are just starting to get a little wonky. That’s normal too.

Is it PMS or Perimenopause?

Many of the symptoms of PMS overlap with perimenopause. In both cases, the symptoms are caused by hormone swings. The difference is that PMS symptoms happen during the second half of your cycle. Perimenopause symptoms can happen at any time. Journaling your symptoms may help you sort this out if you’re not sure what’s going on.

How Can I Know for Sure?

The short answer is…you can’t. Lab tests in perimenopause can be unreliable because your hormones are whipping around constantly on any given the day. A lab test only gives a snapshot of what’s going on, so results can vary depending on the timing of the test. Many a woman has been dismissed with “your lab tests are normal” when she is, in fact, in perimenopause. You know your body better than anyone, so don’t settle for this if you feel like something is off.

If you do have blood tests, your doctor will most likely test your FSH (and maybe your estrogen or progesterone levels).  The closer your FSH is to 50, the closer you are to menopause.

Have a Talk with Your Mom

We get the sex talk when we’re going through puberty, right? I think we need to have a second talk!  There’s a strong correlation between the age your mother was at menopause and what you can expect. Unfortunately, many of our mothers had hysterectomies at fairly early ages since surgery was the treatment of choice for a uterus that was acting up. They can’t help us, but if you have older sisters, their experience may also provide some clues for you.

First Things First

The first sign of perimenopause that you are likely to notice is some change in your period. Shorter, longer, heavier, lighter. Other symptoms may come with time.

It’s important to recognize what’s going on because many a woman has ended up on antidepressants because she (and her healthcare provider) did not recognize that her emotional symptoms were related to a HORMONE IMBALANCE and not true depression. Hormone imbalances can be corrected with lifestyle, herbal and nutritional supplements. In some cases, hormone replacement may be necessary, but that’s not always the place to start.

Then What?

If changes in lifestyle don’t help, then it may be time to test your sex hormone levels and your cortisol levels. High cortisol levels can keep the rest of the musicians in the orchestra from playing their best, so it’s important to have a picture of how you handle stress and address that first. Testing can be done with saliva, blood or urine (there are plusses and minuses for each method). Knowing your specific imbalances allows your hormone care provider to create a unique management plan for you.


Dr. Anna Garrett

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