By Dr. Rachel E. Drouilhet
An article I read recently highlighted how female friend circles and family members often prepare us well for what to expect during puberty, menstrual cycles, pregnancy and postpartum. However, the same guidance is notably absent for what happens on the other side of the child-bearing years.
If you have noticed new physical or emotional symptoms and thought, “Could this be menopause, or am I just losing it?” chances are, you’re not alone.
WHAT IS PERIMENOPAUSE?
Perimenopause is the time frame from when menstrual cycles start to become irregular to one year after the last period.
- A regular period is defined as 28 days (plus or minus seven days) between the first day of bleeding of one period to the first day of bleeding in the next. Irregular is anything more or less than this window.
- The total amount of time from irregular cycles to the last period varies by person. The average is about four years, but it can last up to 10.
- In the United States, the average age of the last menstrual period is 51.
- If you can, it may help to ask around to your mom, older sisters or aunts about when they stopped having periods, as timing does have a genetic link.
Though hormonal changes drive perimenopause, the diagnosis is clinical — meaning your providers rely most heavily on the timing of your periods and symptoms. While bloodwork for certain hormones like estradiol, follicle-stimulating hormone (FSH) and Luteinizing Hormone (LH) can sometimes give us clues, these levels change from day to day, or even throughout the day, so they are not as reliable. Now is the time to start using a period tracker app to prepare for your next gynecology visit.
KEY SYMPTOMS
Vasomotor symptoms, or “hot flashes,” are the most common symptom of perimenopause and most directly correlate with the body’s overall drop in estrogen. A “hot flash” is a brief (usually under five minutes) sensation of intense internal warmth that can be associated with sweating, heart palpitations or even anxiety. Other perimenopausal symptoms are harder to isolate, as they have many contributing factors but often involve things like sleep disruptions, irritability, vaginal dryness or changes in libido.
WHAT ELSE COULD IT BE?
It’s important to talk to your doctor about irregular periods or bothersome sleep and mood symptoms, as there can be other driving factors.
Based on your specific symptoms, your provider may want to screen for:
- Thyroid disease
- Pregnancy
- Depression
- Rare conditions such as a prolactinoma or adrenal disease
- Medication side effects (sudden weight loss associated with GLP-1 medications also can cause brief irregular cycles)
WHEN TO SEEK HELP
The most important question to ask yourself when deciding to seek treatment is, “Is this negatively impacting my daily life?” If the answer is yes, please do not hesitate to talk to your OB/GYN.
You don’t have to guess or navigate these symptoms alone. Thanks to newer studies and the development of new medications, there have been major improvements in treating perimenopausal symptoms.
Dr. Rachel E. Drouilhet is an obstetrics and gynecology specialist with Memorial Physician Clinics. Reach her at (228) 206- 1905.