Perimenopause or “second puberty” is the two to ten years before the end time. It is different from menopause, which is the life stage that begins one year after the last stage. If you experience symptoms (and not everyone does), they usually occur during perimenopause and temporarily.
Because you can have your last period (menopause) anywhere from age 45 to 55, you can start having perimenopause symptoms as young as your late 30s, but more likely in your mid-40s. So, if you were born before 1986, you may be in perimenopause territory and still quite young. That’s why perimenopause is not about aging. Rather, it’s an important (and inevitable) recalibration of your hormonal system.
The timing of menopause is genetic
As I explained in my book Handbook of Hormone RegulationMenopause has been human for a long time and is not just an accident of longevity. According to some historians, Menopause may be the driving force behind the evolution of longer human lifespans.
You are genetically programmed to reach menopause at approximately the age that your mother or female relative reached it. If that’s on the younger end of normal (mid-40s), that’s how you are. This does not mean that you are aging faster than your friends. If, on the other hand, you are genetically programmed to achieve menopause at the older end of normal (mid-50s), your perimenopause occurs with aging but not cause through aging.
Finally, if you enter menopause before the age of 40, this is the medical condition of premature menopause or primary ovarian insufficiency and not about aging either.
How to diagnose perimenopause
Menopause (including early menopause) can be diagnosed by two high FSH readings (greater than 40 IU/L) at least one month apart.
Perimenopause cannot be diagnosed by FSH or any other lab test. Instead, it is diagnosed based on age and symptoms. According to Canadian endocrinology professor Jerilynn C Prior, a midlife woman with regular cycles is likely in perimenopause if she notices any three of the following nine changes:
- new onset of heavy and/or longer flow
- shorter menstrual cycles (<26 days)
- new sores, swollen or lumpy breasts
- new awakening in the middle of sleep
- increased menstruation
- night sweats before menstruation
- new or significantly increased migraine headaches
- new or increased premenstrual mood swings
- weight gain without changes in exercise or diet.
In other words, if you’re older than 37 and have at least three symptoms on this list, you’re probably experiencing perimenopause.
What are the hormonal changes of perimenopause?
The first hormonal change during perimenopause is a drop in progesterone due to a shorter luteal phase and more anovulatory cycles—despite having regular periods. Loss of progesterone can contribute to anxiety, chest pain, heart palpitations, night sweats, frequent migraines and crazy, heavy periods.
Along with the drop in progesterone, estrogen begins to spike up to three times normal. And that can contribute to irritable mood, breast pain and heavy periods.
👉🏽 Tip: High estrogen stimulates mast cells and histamine which can contribute to symptoms such as insomnia, breast pain, and heavy periods, by
The fact that perimenopausal symptoms stem primarily from the loss of progesterone, not estrogen, is why progesterone, not estrogen, may be the better treatment. And just a little certainty: this is it is possible to get pregnant during perimenopause.
For treatment ideas, see my book Hormone Repair Manual, where I discuss my favorite combo of magnesium plus taurine as well as modern body-identical hormone therapy, including transdermal estrogen (Estradot) and natural progesterone (Prometrium or Utrogestan).
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