There is no test to diagnose perimenopause. A health care provider, if you choose to see one, should ask questions about new symptoms such as hot flashes, sleep disturbance, irritability, mood and brain fog as well as your recent menstrual cycle history. You can tell if you are in perimenopause by taking into account changes in your menstrual cycle (if you have one) and physical and psychological changes. In the medical world perimenopause is defined by menstrual cycle changes and is thought to begin when there are very noticeable changes in consecutive cycle lengths — 7 or more days difference.
We at Women Living Better believe perimenopause begins sooner than this when 1 or more of 3 types of subtle changes in menstrual cycles are evident — heavier or lighter menstrual bleeding, changes to the duration of menstrual flow (more or fewer days) and changes from your typical cycle length (but fewer than 7 days difference). So if you are in your mid to late 30s or early 40s, noticing these subtle menstrual cycle changes, changes to your sleep or mood or other symptoms or have thought to yourself, “I just don’t feel like myself”, it could be perimenopause.
Perimenopause = new hormonal patterns
A woman’s hormonal patterns across the lifespan can be thought of as three chapters. And really there is a Chapter 0 that begins when a girl has had her first period (menses). Chapter 0 lasts until her hormonal patterns settle into a regular rhythm and her cycle becomes more predictable as in Chapter 1 (below). This phase is called puberty. The official name for the first period is menarche.
Chapter I:
Predictable Cyclicality
(aka the reproductive years)
Cycles stabilize a few years after the first period (menarche) and, in theory, hormones move in predictable patterns creating a typical menstrual cycle. This phase is also sometimes called premenopause. Repeating that cycle over 6 months (180 days) would look something like this:
Chapter II:
Unpredictable Chaos
(aka the menopausal transition)
Hormonal patterns begin to change in the late 30s/early 40s — due to the fluctuating, often higher than before estrogen, and occasionally lower progesterone. This phase is referred to as the menopausal transition or perimenopause. These fluctuations cause things look (and often feel) chaotic.
Chapter III:
Relative Stability
(aka menopause)
After menopause, the ovaries no longer produce follicles so the hormones that rose and fell to govern cycles stay at even levels. Low levels of estrogen continue to be produced by the adrenal glands and in fatty tissue. A woman in this phase is said to be “in menopause” or post-menopausal.
Hormone receptors are body-wide
Hormones act all over our bodies and far beyond our ovaries!
We were amazed to learn how many places in the body have active receptor sites for estrogen and progesterone.
Hormones enable processes in our brains, lungs, skin, and digestive systems.
Meet Hormone Woman
Not feeling like myself comes from a combination of factors
Consider the combination of the changing hormonal patterns depicted above and the concept that hormones do their jobs by activating receptors in many organs throughout our bodies.
It’s no wonder perimenopause can cause such a wide array of symptoms.
This explains a lot about why we might say, “I am not feeling like myself” during perimenopause.
Symptoms Correlation (r) with Not Feeling Like Myself
In our research of women 35 to 55 we investigated what symptoms were most associated with the phrase “Not Feeling Like Myself”.
The most highly correlated symptoms were not hot flashes, night sweats and vaginal dryness.
The symptoms most highly correlated with “Not feeling like myself” were:
- Fatigue
- Overwhelm, feeling less able to cope
- Low feelings
- Anxiety
- Irritability
Learn more about this research here.
Dive deeper
What we envision every woman will know by 35.
Many women are told “they are too young for perimenopause” when they seek healthcare.
Dive even deeper
Do your expectations about perimenopause impact your symptoms?
Perimenopause is long, irregular, and unpredictable, but it does end