Perimenopause: What is it, and How Did We Get Here?

We already know that women are woefully undereducated when it comes to menopause. That’s even more true for perimenopause. At Alloy, we’re trying to change that.

Let’s start by just defining the word perimenopause. The etymology of the word is Greek: peri means “surrounding,” and “menopause” is from the Greek word “pausis,” for pause and “mēn” for month. It literally translates to “surrounding the pause (or in this case, end) of monthly cycles.”

Prior to perimenopause, things have ideally followed a pretty stable course, including monthly periods. Once you’re in perimenopause, you’re on the path to the cessation of your menstrual cycles. But, this path is anything but straightforward. Your hormones, which up to now have been regulated by the feedback loop of your menstrual cycle, don’t just stop one day, and neither do your periods.

I like to use the analogy of vehicle travel. When you are driving on a smooth road, it’s simple. You get to enjoy your trip with the exception of a few bumps along the way. You might have a little anxiety, some irritability, a few aches and pains here and there, the occasional headache. But, typically, you’re calm, collected, and certainly cool. But what happens when the path becomes a bunch of rolling hills over uncertain terrain? What happens when the road you’re on is no longer known to you? What happens when you drive into a hot desert? That’s perimenopause, and with it comes instability. More anxiety, mood changes, depression, aches, headaches, fatigue, palpitations…and your body has very little certainty as to how to navigate.

Perimenopause, or the menopause transition, typically starts 5-10 years prior to menopause, depending on your genetics and ethnicity, and lasts until your menstruation stops for an entire year, at which point we can officially declare you to be in menopause. During this transitional period, our hormones are fluctuating. It’s analogous to driving on that uncertain path. When your hormones fluctuate, it’s common to feel irritable, angry, flustered, hot, and cold, without warning, and seemingly without rhyme or reason. We also experience changes in our menstrual cycles. This can mean heavy periods, irregular periods, and an unpredictability to your cycle. Some of us feel fatigue as a result of heavier bleeding, we might become anemic. Sleep might go out the window. We can get palpitations or achy joints, we might have hair loss, we might lose our libido.

Why? Let’s start at the beginning. And by the beginning, we mean 20 weeks gestation. You’ve had the same eggs since you were in your mother’s womb, starting at 20 weeks gestation. Now, as you enter perimenopause and your eggs begin to atrophy and deplete, your hormones fluctuate and eventually go down.

Our hormones, particularly estrogen, bind to chemicals that are called receptors. Just as the word implies, they receive the hormones for things to work. The receptors are located everywhere in a woman’s body. Our brain, our joints, our hair follicles, our heart and many other places have these receptors. Estrogen is essential to the function of pretty much everything in our bodies. So, when the estrogen that our body is accustomed to having is not there, we experience all of the symptoms we mentioned.

And perimenopause symptoms don’t just affect us! They affect the ones we love. While our bodies and minds are trying to cope with what’s happening, our families and friends are trying to as well. And, at the same time, we’re expected to carry on juggling our homes, jobs, children, and partners. And it can feel impossible.

Our current healthcare system is still behind when it comes to perimenopause. If you go to a doctor, you may be diagnosed with depression or anxiety. Tests might show your “hormones” are “normal.” But with the fluctuations that come with perimenopause, testing for hormones isn’t that useful. They might be way up one day and way down the next. And what’s most important is not what any test result says. What’s important is how you’re feeling.

So, how do we fix it? That’s a big question with a big, nuanced answer. It depends on your symptoms. For most women, the best recommendation is to use a combined contraceptive method, if there are no contraindications to its use. It’s the estrogen and progesterone method of treatment, also known as “The Pill.”

How is birth control beneficial during this time of life? It’s a low-dose combination of hormones that helps with the fluctuations. It’s a steady amount of daily hormones that helps your ovaries along so that they don’t have to work as hard driving on that unsteady, hilly path. As an added bonus, it provides reliable birth control, which, yes, you still need!

If you can’t take estrogen, there are also progesterone-only options. You don’t have to remain on the birth control pill forever, but you can stay on it up to age 55. At that point, most patients are considered menopausal and can then start Menopausal Hormone Treatment.

While the aforementioned methods of treatment are best and preferred, you can also start on menopausal hormone therapy in the form of a pill or patch with or without progesterone, depending on whether you still have your uterus. This is a lower dose of hormones and is NOT effective birth control, and since you are still producing fluctuating quantities of estrogen, you may experience side effects more readily than if you were using the birth control method. The side effects include unstable irregular bleeding mostly, but some people get breast tenderness or nausea, and some people don’t end up feeling relief because it’s not enough.

Perimenopause is a phase of life that has been largely ignored, but the tides are turning. I recently read an article from the UK titled Call For Women to Receive Menopause Checks at 40. It’s focused on preventing heart problems during menopause, and recommends health checks to people aged 40-74. It also talks about the changes in our muscular composition and metabolism that happen during this time. Finally! Perimenopause is being recognized as a real health concern. That’s a good thing, because we deserve it.