Why Do I Feel Like I’m Going Through Puberty Again!? Perimenopause at 40
The term perimenopause often signals to women the end of their most vital and engaging years. The shame that can be associated with this, and aging in general, has kept women quiet for decades (the biggest signal of how ashamed women have been made to feel is this - the majority of my patients have no idea when their own mothers went into menopause, or what that experience was like because no one ever spoke about it directly). Not only does this leave women isolated and frustrated, but it increases their health risks.
So let’s talk about your health and wellness after 40 because perimenopause is not a disease and you are not dysfunctional!
20% of women will be perimenopausal at the age of 40 - that's 1 out of every 5 women who’s currently 40 years old. Yet most women have been told that menopause will happen somewhere between the age of 51-55 and often that’s the last they think about it, imagining that when menopause hits (much later in life) the hot flashes will signal this change. Additionally, perimenopause (the period of time when your hormones are shifting prior to you actually becoming menopausal) is rarely associated with hot flashes so many women have no idea this hormonal shift has even started to occur.
But they know something has changed…
I want every woman to understand the hormonal shifts in perimenopause so that she can take control and make choices that make sense for her own, personal experience.
Understanding Your Cycles
When you are in your most consistent reproductive years estrogen and progesterone cycle in tandem with one another to maintain balance. In the first half of your cycle estrogen rises and falls relatively gently and progesterone remains low but steady. Once you’ve ovulated, estrogen starts to rise more dramatically, as does progesterone. In a predictable monthly cycle, once you ovulate, that egg will be the primary producer of progesterone. When in balance, both estrogen and progesterone are well tolerated by the body and once the end of your cycle comes, the drop in progesterone will signal menstrual flow, estrogen will drop, and you’ll have your period.
Unlike menopause, when your hormones are in a consistently low state, in perimenopause your hormones are going to become really erratic and somewhat unpredictable. This is because you’re no longer ovulating as consistently.
What Happens in Perimenopause
What this means is that initially, only your progesterone levels are going to start to decline. Because progesterone helps to calm and stabilize your nervous system, the most common symptoms I see in women associated with this decline in progesterone is insomnia and mood changes (sometimes experienced more as a decreased tolerance to stress overall).
Unlike progesterone, estrogen does not initially decline in perimenopause. Instead it can become incredibly erratic! Estrogen levels will change on a day-to-day and even hourly basis for some women during perimenopause. This can mean women experience symptoms of both low estrogen and high estrogen - for example breast tenderness and hot flashes.
As women move further into perimenopause we’ll often see her cycles start to become longer and she’ll even skip periods. This signals the start of a more consistent drop in estrogen.
So how do you know if this is what’s happening to you?
FSH is the most common test run to evaluate whether a woman is menopausal because it will change most consistently through perimenopause. As it becomes more difficult for your body to ovulate, the signals from your brain to your ovaries (including FSH) will have to become louder and larger. The trick with this is to know that it can take 2-3 years of you being in the midst of these hormonal shifts before FSH will truly start to increase. Meaning, if you’ve had FSH tested and been told it’s not perimenopause - look deeper and consider testing your estrogen and progesterone in both the early part of your cycle, and a week before your period is due.
Getting a clear snapshot of your hormone levels, in combination with identifying the symptoms you’ve started to experience more regularly, will give you and your health care provider a much clearer idea of what your body is struggling with the most. And with knowledge comes the powder to do something about it!
A Final Word
Name it, claim it and recognize that you are not doomed to see the best parts of your life come crashing down around you when you start to go through perimenopause. Nothing is wrong with you and if your body is struggling to find balance through these normal hormonal changes there are so many ways you can support yourself to ensure you don’t lose who you are or who you want to become.
The silver lining around all of this is that once you officially hit menopause (aka. It’s been a full year since you’ve had a period), your hormones will no longer fluctuate and your body will have a chance to adjust to this new hormonal landscape. Meaning, it will all get a lot easier to manage.
Perimenopause is not the beginning of the end and truly, menopause can be a freeing time in a woman’s life, especially if she’s open to it.
If you want to learn more about naturopathic medicine and how we approach perimenopause you can read more on that here. You can also reach out to us for support!
Ready to make a change?
If you're searching for more guidance and understanding of how you can support perimenopause with naturopathic medicine, you can book a complimentary consult with me here.
Yours in health,
Dr. Hayhlee Clarence, ND