perimenopause symptoms
Illustration by Oana Cazan

Here’s What You Need to Know about Perimenopause

Starting with, when do the hot flashes actually begin?!

Most women of a certain age—let’s say Generation X or older—will remember reading Judy Blume’s Are You There God? It’s Me Margaret. That seminal YA novel published in 1970 was how many young girls learned about, and how to cope with, their periods. And as many of those same women enter perimenopause in the years before their periods end, what they need is a sequel.

More than three-quarters of women aged 35-50 say they have never been taught a thing about perimenopause, according to a survey by BalmLabs, a skin care company created for women in the “peri” phase—and this is a truth that is echoed by experts in the field of women’s hormones.

“More than three-quarters of women aged 35-50 say they have never been taught a thing about perimenopause.”

So let’s start with the facts. “Perimenopause is the transition to menopause that comes after the reproductive years,” says Dr. Nikita Patel, a family physician at Women’s College Hospital in Toronto. “It is characterized by irregular menstrual cycles, hormonal changes and symptoms such as hot flashes.” Since it’s a fairly lengthy and amorphous transition, women can be forgiven for wondering if they’re in this phase as early as their 40th birthday (witness a Baroness Von Sketch Show skit in which a woman considers her forgetfulness and mood swings: “Maybe it’s perimenopause. Is it?!”) but generally it begins later. “On average the age of onset is 47, but this can vary. Perimenopause can begin about four to eight years before the final menstrual period,” says Patel. She adds: “The changes that occur during this time vary woman to woman and can very much affect a woman’s quality of life.”

Night sweats, weight gain and redistribution, vaginal dryness and mood swings are among the perimenopause symptoms. Sound like fun so far? Mental health can be affected, too. “Perimenopause risk of depression is higher than pre- and post-menopause—either new-onset depression or relapse in a woman with a previous history of depression,” Patel says. Add to that anxiety attacks, bone density changes, joint pain, sleep disruption, memory loss and heavy periods, and you have a life stage that can feel like a hormonal roller coaster.

In order to cope, some women opt for medical intervention called menopausal hormone therapy (MHT, the new term for HRT or hormone replacement therapy), which is prescribed short-term, for five years or less. But MHT comes with risks, warns Patel, and should be considered a last resort for women with severe symptoms. “If your symptoms are only vaginal dryness and your hot flashes aren’t too bad, you would be recommended to trial vaginal estrogens alone,” she says. “Or if you have depression and hot flashes with perimenopause but your hot flashes are not severe, you may consider treating the depression with an antidepressant and therapy.”

A recent study by the Women’s Health Initiative demonstrated that risks of MHT in older post-menopausal women include heart disease, stroke, blood clots and invasive breast cancers. Patel points out that “this is not typically the age group that presents with new onset of perimenopause symptoms. Most of these women are generally in their late 40s or early 50s. For young, healthy post-menopausal women who use the appropriate MHT for 5 years or less, the absolute risk for complications is low, but not zero.”

There are other options. Canadian natural health expert Lorna Vanderhaeghe estimates 80 per cent of women do very well managing perimenopause symptoms with diet, lifestyle changes and nutritional supplements to regulate estrogen levels and increase progesterone levels. Vanderhaeghe, author of A Smart Woman’s Guide to Hormones and maker of Smart Solutions supplements, points out that stress is a factor in how our body reacts hormonally and emotionally, yet “women are so busy that the one thing they don’t do, and sometimes can’t do, is stress reduction.”

She recommends women undertake a DNA hormone test, which shows how a woman’s body (of any age or life stage) is functioning hormonally. This information can be given to your doctor so that a plan of action to relieve symptoms can be created.

“It may help to remember that perimenopause is normal and you’re not going crazy.”

“Your endocrine system during your perimenopausal years needs supplementation—B vitamins, Omega 3s, D3, probiotics, and liver support,” says functional nutritionist and women’s hormone expert Alisa Vitti, author of WomanCode and founder of Flo Living supplements. “You can also add maca, an adaptogen for your hormones, and ashwagandha, an adaptogen for stress, which will help keep progesterone levels where they need to be to minimize symptoms.” Vitti’s latest book, In The Flo, presents a new method to balance hormones: tailoring food, exercise and lifestyle choices to the four phases of a woman’s menstrual cycle, known as the infradian rhythm.

Another area of the body affected by perimenopause is the skin. “Two of the most common skin complaints I hear from perimenopausal women are dullness and dryness. In the past five to 10 years, though, I’ve noticed that adult acne is really spiking in this group,” says Dr. Robin Schaffran, a Canadian based in Los Angeles and chief dermatologist for BalmLabs, a skin-care line zeroing in on women of this demographic. Why is our skin returning to its teenage turmoil? You guessed it. “Hormones affect the oil glands by increasing oil production,” explains Schaffran. “When this happens, the pores don’t work as efficiently to eliminate this excess oil and dead skin, which ultimately results in clogged pores and new acne lesions.” She proceeds to state the obvious: “It can be extremely frustrating to find yourself contending with acne at a time when you’re also dealing with dryness and wrinkles.”

At the end of the (exhausting, sweaty) day, how is a woman to cope with all of this? It may help to remember that perimenopause is normal and you’re not going crazy. “This is a natural process your body is going through, not to be feared,” says Vitti. “Drop the toxic mythology that says your monthly curse is now going to turn into an aging curse and instead embrace the process by getting educated. The more you acknowledge what is happening hormonally, the more you can get into action and nourish your body so it can do what it’s designed to do: thrive.”

 

    More Women’s Health