The TLDR on Perimenopause

Weird symptoms? It's probably your hormones.

I’m frustrated with the lack of efficiency in understanding this space, so I’m giving it to you straight. This is a bare-bones summary of my findings over the last six months.

• If you were born with ovaries, are 35+, and noticing strange and unpleasant shifts to your health or quality of life, it’s probably got something to do with your hormones. Hormone shifts at this age affect every system in our bodies.

• Your body is essentially going through reverse puberty. Hormone levels are decreasing. And unlike male hormones, female hormones are doing so erratically — which is causing all the fun and hard to pin down symptoms.

• The symptoms of early hormone shifts (perimenopause) are vast and varied, but usually include worsening PMS with both physical and emotional changes (cramping, bloating, anxiety, stronger mood swings, etc.) and weight gain — especially around your midsection. Weird body odor all of a sudden? Keep forgetting things? Heart palpitations? Sudden increase in anxiety? Just feeling not really like yourself? It can all be related to your hormones.

• While most women enter perimenopause in their 40’s, some experience disruptive symptoms years earlier. These can last (and fluctuate widely) for over a decade, so saddle up.

• You will reach menopause when it’s been 12 months since your last period. Menopause is (hopefully) one day of your life. Then you will be post-menopausal. No more eggs, no more need for ovulation, no more period, and much lower hormone levels overall.

• Navigating the ups and downs of perimenopause will likely take more time, more experimentation, and more effort than figuring out what you need to do to thrive in menopause.

• You CAN get to a place where you feel like your badass self again — but you need to make your health a priority, and you need to find the right care provider.

• Your primary care provider and OB/GYN likely have little to no training in peri/menopause, so they won’t be much help (unfortunately). You will have to find alternate care. It’s shocking that there is virtually no proactive education for this - on both sides. Our hormones are talking to us, and there are a lot of effective treatments, but few providers are available to listen and treat holistically.

• There is a long history of dismissing and gaslighting women over our hormone health symptoms. This is changing, but for now it’s still up to you to educate yourself, listen to your body, and find your way in a system that isn’t educated in—or designed to—optimize your quality of life at this stage.

• What I am advising my friends to look for is a provider who specializes in peri/menopause AND will offer labs and bloodwork to test a variety of hormone levels, vitamin levels and additional biomarkers that could explain your symptoms BEFORE ordering other expensive tests or advising prescription medication or supplements. This approach is called functional medicine, and I believe this approach can deliver better outcomes during this phase of life. [more on labs later]

• Many predominant healthcare providers (even publications authored by the Mayo clinic, etc.) will tell you that testing in perimenopause, especially when you are still having regular periods is a waste because your hormone levels fluctuate throughout the month. They will tell you there is no test for perimenopause. They will tell you that if you are on hormonal birth control or hormone replacement therapy that these tests won’t tell you anything. This is outdated guidance. Your hormone levels do fluctuate, and medications do affect them, but there are useful tests to help you understand and manage your symptoms with more precision while you are in perimenopause and beyond.

• A well-rounded care plan will include lifestyle changes (diet, exercise, sleep, stress management) and some supplements. Many of us will also benefit from taking hormones in this stage of life (birth control or other hormone replacement therapy medications) as part of an integrated care plan.

Imagine how the world will change when every woman in midlife feels full of energy, free of pain, physically strong, and cognitively sharp. THAT is the world I want to live in.