Peri-what? The lowdown on perimenopause

Awhile back on Embrace Your Cyclical Power a lady shared that she asked her doctor whether she could be in perimenopause as she has a few symptoms and he said that wasn’t possible because she was only 44.

What?! That is completely WRONG.

Then he said they could take a blood test to check and suggested they do it that day even though when she was at Day 12 of her menstrual cycle.

Nooooooo! That’s WRONG too. You can’t just test your hormones ANY day of your cycle, especially if you want to see if you are in the early stages of perimenopause.

So so many women I see tell me a similar story, so let’s set the record straight.

Perimenopause symptoms

According to Dr Jerilynn Prior, a Professor of Endocrinology and Metabolism who is the Scientific Director of the Centre for Menstrual Cycle and Ovulation Research, (yep, that’s a thing), people with periods in their late 30s/early 40s are likely to be in perimenopause if you have any three of the following nine changes, despite regular menstrual cycles:

  • New onset heavy and/or longer flow
  • Shorter, menstrual cycles (less than 25 days)
  • New sore, swollen or lumpy breasts
  • New mid-sleep waking
  • Increased menstrual cramps
  • Onset of night sweats, in particular premenstrually
  • New or markedly increased migraine headaches
  • New or increased premenstrual mood swings
  • Weight gain without changes in exercise or eating

One thing to note though is that high stress, thyroid issues, overexercising and other issues can also cause these symptoms even if you’re not perimenopause. Yep, confusing, hey?

So when I work with people in their late 30s and early 40s who are experiencing these symptoms we work on their diet and lifestyle to help support regular ovulation and good progesterone levels. This often helps MASSIVELY and these “perimenopause” symptoms may fade a way or be much more manageable.

What about tests for perimenopause? 

The gold standard for hormone testing is the pricey dried urine test called the DUTCH test. You need to work with a practitioner to have this test and I highly recommend my friend and colleague Karin Reiter who can order this test for you wherever you are in the world and interpret it for you.

But a much cheaper option is a blood test for progesterone but the timing of it is really crucial. It needs to be done approx 5-7 days after you’ve ovulated. Timing is key! If you don’t test at the right time you’re not going to get an accurate progesterone test done and you might as well not have bothered with the test in the first place. As you near the end of your perimenopause transition and are quite close to menopause, a blood test for anti-mullerian hormone (AMH) can give you an indication when you’ll reach menopause.

Phases of perimenopause 

I was surprised when I learnt that menopause is actually a one day event. (Who knew!) It marks 12 months since your last period. Most people “graduate” to menopause around the age 50/51. The years leading up to that day are perimenopause (and it last anywhere from 2-12 years, yes, that long!) and then after that date you are postmenopausal.

Dr Jerilyn Prior describes perimenopause being in 4 phases:

Phase 1 – Very early perimenopause – lasts 2-5 years

Regular cycle but may shorten to 21-26 days. Likely to have less progesterone with risk of heavier periods, increased period pain, migraines and sleep issues.

Phase 2 – Early menopause transition – lasts 2-3 years

Cycle length can vary by more than 7 days. Worsening hot flashes and night sweats.

Phase 3 – Late menopause transition – around 4 years until your reach menopause

Start missing periods or have a cycle which is 60 day or longer.

Phase 4 – Late perimenopause

You have had your last period and are in the “menopause waiting room” for 12 months until you “graduate” to menopause.

I won’t lie, some of perimenopause symptoms can be very uncomfortable (heavy periods and hot flashes) and even frightening (anxiety and brain fog). But there are definitely things that can be done to support you through the process.

Ways to ease perimenopause symptoms

  1. Nutrition
  2. Gut health and liver function
  3. Stress management
  4. Menopause hormone therapy (commonly known as HRT)

I love helping people with the first 3 of this list and for hormone therapy I highly recommend Dr Naomi Potter on Instagram who gives out really good advice.

Some easy ways to tackle your perimenopause symptoms TODAY

  • Prioritise your sleep – virtually everyone need better sleep!
  • Do something every day which calms your nervous system – breathing techniques, meditation, yoga, daily walk etc.
  • Reduce caffeine and alcohol – sorry but these two favourites really affect our hormone production and have a big impact on hot flashes
  • Make veggies the main event of every meal – especially look to include cooked cruciferous vegetables which help us metabolise oestrogen
  • Make sure you’re having at least one healthy daily poo

By joining Embrace Your Cyclical Power you will guarantee yourself a roadmap to navigate your perimenopause years. Imagine being part of an awesome group of women in their 30s and 40s from around the world cheering each other on. Come and join the party with us!

“PMS kind of switched me into a Mr Hyde every month and I was very upset about it - I felt I was fighting a losing battle of self-control. Now I have learned to be kinder to myself and I can handle PMS and perimenopause much better”.

Christel Ong, Massage Therapist, Singapore