Perimenopause. It’s killing me!

So often I see women in my office with concerns of perimenopause. It’s understandable that perimenopause is so difficult. It is quite literally a rollercoaster.

When our ovaries are nearing the end of their functional life, they are on the struggle bus… literally.  They often are unresponsive to our brain yelling at them to make estrogen and do their job. During that time, we have low estrogen levels. This may leave us feeling symptoms of hot flashes, night sweats, problems sleeping, weight gain, brain fog, mood irritability, joint pains, libido changes, and skin dryness.  

The hard part is that IT’S NOT JUST THAT!!! After some ill-defined time in the low estrogen, brain-ignoring phase, the ovaries will try to redeem themselves by popping out a few eggs causing a huge surge in estrogen that leaves us with pregnancy level estrogen causing weight gain, bloating, breast tenderness, rage, PMS symptoms… and then a bad period. It can be SO rough.

There’s no defined age for perimenopause but the average age of menopause is 50-52, and that is defined as 1 year with no period. Often, women will start feeling fluctuations in their hormones in their late 40s or some even in their early 40s. I’m never one to tell women they aren’t in perimenopause.  If your hormones feel off, it’s likely fluctuations in ovarian function, which is basically the same as perimenopause.  

What do we do for perimenopause?

Well, the answer isn’t always easy!  I generally don’t recommend hormone testing. Since it’s a rollercoaster, we never know where you are in your ride, so labs tend to not mean much. Plus premenopausally, our estrogen levels range from 15-400 depending on what day we are in our cycle.  There’s no “optimal” estrogen level where everyone will feel good. Checking labs just gives us a snapshot in time of what was happening that day at that time. It could be different later that day. It doesn’t give us the road map we are looking for.  

So what can be done? What are possible treatment or management options for perimenopause?

I often recommend birth control pills in perimenopause, especially if you are still having fairly regular periods. Most perimenopausal women aren’t super excited at the idea of birth control pills but they often help. They help because they shut down the ovaries. They stop the rollercoaster and instead give you an even level of hormones every day. This often makes women feel better AND helps regular irregular periods. Birth control pills aren’t for everyone, though. Some women can’t take them or don’t want to take them. Other options are a progesterone IUD and an estrogen patch or even HRT.  It all depends on your symptoms and your risk factors.

The bottom line is perimenopause can be really rough on many women. Our bodies don’t give us a script unfortunately! 

Please reach out if you are struggling with perimenopausal issues. There are options to improve your quality of life and get you feeling like yourself again!