What is “Normal” in Perimenopause?
17 Mar 2016

What is “Normal” in Perimenopause?

Sarah is ready to lock her teenagers in their rooms.  Her nerves are shot and her patience left the house long ago. On the days she’s not biting the heads of her family off, she can barely drag herself out of bed and her anxiety is crippling.

Sarah is 42, scared and wondering what the hell is going on.

She wants to know if what she is experiencing is normal.

Sound familiar?

A New Normal

Hormonal transitions can start as early as your mid-late 30’s. While you’re in the thick of raising kids (or considering having just one 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. Or, like Sarah, you may be a bitch-on-wheels. Your PMS symptoms, which were once mildly annoying, are now raging. You gain weight even though you’re exercising and eating right. And you lie awake night after night, staring at the ceiling.

In a perfect world, estrogen and progesterone start to taper off very gradually prior to menopause. Because this is usually such a slow shift, many women may hardly notice this change happening in their bodies. However, for some, these hormonal shifts may overwhelm the body’s ability to maintain any semblance of balance. The result is severe symptoms that can go on for years (on average, 5-10).

And then… there are some very lucky women for whom the whole perimenopause/menopause thing is just a blip on the radar. That’s normal too.

Is it PMS or Perimenopause?

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


Tweet: Many symptoms of PMS overlap with perimenopause. In both cases, hormone swings are the culprit.


How Can I know for Sure if I’m in Perimenopause?

The short answer is… you can’t. The symptoms you’re experiencing are the most reliable indicator. 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 testosterone levels).  The closer your FSH is to 50, the closer you are to menopause. But that number tells you nothing about your progesterone/estrogen balance… and that’s what you really care about. Saliva testing on day 19-21 of your cycle (when progesterone should be highest) can give a snapshot of whether these 2 hormones are in balance.

It’s a Hormone Problem, not a Prozac® Deficiency

It’s important to recognize what’s going on because many a woman has ended up on antidepressants or sleeping pills because she (and her healthcare provider) did not recognize that these problems were related to a HORMONE IMBALANCE and not true depression. Antidepressants won’t fix the root cause of the problem. Neither will birth control pills.

Misbehaving hormones can often be corrected with lifestyle, herbal and nutritional supplements. In some cases, hormone replacement may be necessary, but that’s not usually the place to start.

The Next Step

If changes in lifestyle don’t help, then it may be time to test your sex hormone levels and your cortisol levels. This is important because signs of imbalance overlap. Low progesterone can look like low thyroid; high cortisol can look like low progesterone, etc.

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 is a menopause expert and Doctor of Pharmacy. She helps women who are struggling with symptoms of perimenopause and menopause find natural hormone balancing solutions so they can rock their mojo through midlife and beyond. Her clients would tell you that her real gift is helping them reclaim parts of themselves they thought were gone forever.

Find out more about working with her at https://www.drannagarrett.com/work-with-me/.


Dr. Anna Garrett

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