Perimenopause: What to Expect When You're No Longer Expecting

What is Perimenopause?

Menopause is a natural and inevitable part of aging for women. Technically speaking, menopause has occurred when a woman has gone 12 months without menstruating. This follows the period of perimenopause, which is when hot flashes, hormone fluctuation, mood swings, memory loss, weight gain, and irregular menstruation can require medical interventions like hormone therapy or lifestyle changes like adapting diet and exercise to meet your new needs. Perimenopause can start as early as the late 30’s, but most often it occurs between the mid 40’s - mid 50’s. Lasting anywhere from the requisite 12 months of absent menses to be considered menopausal, all the way up to 14+ years of dysregulated hormone fluctuations and unpredictable periods until they’re completely absent. Since perimenopause is simply the term that describes the point at which a woman’s menstruation no longer follows a predictable pattern, the duration can vary considerably from one individual to the next.

What starts the process?

As women age we produce less of the sex hormone estrogen, which plays a role in ovulation. Fluctuating estrogen availability decreases the likelihood that your body will release an egg consistently on a monthly basis, which is why your cycles will become less predictable in both frequency and duration. Unfortunately, along with this lack of predictability also comes the dreaded hot flashes, sleep dysregulation, mood swings, headaches, unintentional weight gain (especially around the abdomen), and changes in your sex drive and natural lubrication.

Health Changes

The overall decrease in estrogen levels also means that once you’ve reached menopause, the risk of cardiovascular disease is comparable to that of men. It turns out that higher estrogen levels have an anti-inflammatory effect and help to prevent plaque build up in women’s coronary arteries prior to menopause. Unfortunately, that means that after menopause we lose that protection and have to rely on the same tools as our male counterparts to prevent heart diseases.

What can you do?

To help manage the symptoms of perimenopause there are medical interventions like hormone therapy, birth control to regulate menstruation, creams and lubricants to support sexual function and antidepressants to help control mood swings. These are all things to be considered and discussed with a Doctor or Pharmacist. There is also significant evidence that maintaining a moderate to high level of physical activity can also help manage the symptoms of perimenopause.

Physical activity does not change the frequency or duration of menstruation during perimenopause, but it can help manage mood swings, headaches, and sexual function. Exercise also helps to maintain bone density and cardiovascular health as we age. Although there are a variety of very specific exercise protocols that have been developed for women going through perimenopause, the best exercises are the ones you will do. Ideally, aiming for a variety of activities each week, including some strength training for muscle and bone maintenance and some cardio for endurance and heart health each week will yield the best results for supporting a healthy body. Check with your Physiotherapist or Kinesiologist for a tailored program for you specific needs and goals.

Why should you seek support?

Too often medical conditions seen as “female problems” get ignored, mocked, or lumped into a “well, that’s just life, deal with it” category. Along with being disruptive to sleep, hormones, mood, sexual function, and health status, perimenopause hits at a time of life when most women are already being pulled in too many directions. Whether dealing with career, relationships, aging parents, or raising kids (or all of the above), suddenly having to also contend with an unpredictable body and mind makes managing these responsibilities more difficult. Talking about the realities of perimenopause normalizes this biological process and opens the door for seeking support when needed and helps encourage the health system to do more research to answer so many of the less understood layers to perimenopause and menopause. Talk with a trusted health professional to see what might be some of the best options for you to manage this life transition more easily.