"When you become a mom, your body transforms, shifts, and recalibrates during pregnancy, postpartum, and breastfeeding. In many ways, your body does not feel like your own until many years after having a child.
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As we get older, our bodies also change in various ways that also may bring us to a crossroads. For example, mothers may have to grapple with complicated decisions like whether or not to have one last child or what to do with unused embryos after IVF. Additionally, menstrual cycles at some point may also fluctuate, so becoming informed on how best to support your health at any stage of your life is important. But what happens when you notice some changes in your body that may indicate the beginning of menopause—otherwise known as perimenopause?
The word “menopause” certainly is laced with negative connotations of a difficult period in a woman’s life that may involve hot flashes, hormone therapy, mood swings, and so many other not-so-pleasant words. We hope to educate and demystify this transitional period in a woman’s life by delving deeper into what perimenopause is and when it can appear in a woman’s life. And, yes, it can begin in your 30s!
The word ‘menopause’ certainly is laced with negative connotations of a difficult period in a woman’s life that may involve hot flashes, hormone therapy, mood swings, and so many other not-so-pleasant words.
We interviewed Dr. Gretchen Frey, an OB-GYN with 32 years of experience and in-depth knowledge of menopause, perimenopause, reproductive health, and human sexuality. Dr. Frey is a Fellow of the American Congress of Obstetricians and Gynecologists (FACOG) and serves as a diplomat on the American Board of Obstetrics and Gynecology (ABOG).
Below is an overview of perimenopause and its symptoms as well as questions to ask your doctor to maximize your health and receive the information needed to guide you through this stage in any mother’s journey.
Perimenopause Defined
According to The North American Menopause Society, perimenopause is “the gradual transition between the reproductive years and menopause (the cessation of menstrual periods).” It literally means “around menopause.” According to Dr. Frey, “Perimenopause is the period of time between normal menstrual cycles (however that might look for each person) and menopause (which officially starts one year after the last menstrual period).”
She also noted that perimenopause can still occur in people with ovaries who do not have a uterus, but the bleeding changes will not happen. Dr. Frey explained further that perimenopause involves the change in the regular rhythm of the hormonal cycle that results in it being less consistent. “This is a normal process of transition to the eventual menopausal state, which is one of very low estrogen levels and no progesterone production,” Dr. Frey said.
Within perimenopause, estrogen levels fluctuate from high and low production unpredictably and ovulation may not happen. Without ovulation, progesterone may not be produced in a given cycle. As a result, Dr. Frey explained bleeding will still occur, but without a “coordinated hormone decrease,” it can happen at unpredictable times. These hormonal fluctuations can cause mood changes at any given time.
The Onset of Perimenopause
Typically, perimenopause begins sometime in your 40s, but it can also happen in your late 50s. Dr. Frey wanted women to know perimenopause can also start when women are in their late 30s, and if a period completely ends before age 40, this is considered “premature menopause.”
The duration of perimenopause is typically two to five years, which is when most of the “menopausal” symptoms will occur. However, Dr. Frey shared, “Some [symptoms] will last beyond the last menstrual period, especially hot flashes and vaginal dryness.”
Perimenopause Symptoms
Perimenopause symptoms do not have a specific pattern as to when they occur; therefore, they can come and go within a period of weeks or months and women may experience a sense of “normalcy” in between. This inconsistency can make it challenging to determine if any relief is due to any treatment or if it simply is the natural occurrence of perimenopause.
The First Signs of Perimenopause
Dr. Frey explained the very first sign of perimenopause is the change in the pattern of menstrual periods. More specifically, for those women with regular periods, they may have periods come earlier or later or perhaps not at all for months. When periods do occur, the amount of flow also varies from on-and-off spotty to a sudden heavy flow.
Dr. Frey also shared the following other signs of perimenopause.
- Mood changes, which may include “increased irritability, new or increased anxiety, sudden moments of sadness, and overall depression.”
- Changes in libido
- Changes in energy level and sleep quality
- The occurrence of hot flashes, which Dr. Frey defined as “a sudden feeling of heat in the face and neck lasting only a few minutes. Hot flashes can be rare (less than daily) or very frequent (several per hour).”
Perimenopause and Fertility
Dr. Frey wanted women to know they can definitely still get pregnant during perimenopause and up to 12 months after their final menstrual period. So if you know your family is complete, take the necessary precautions. And if you are still trying for a baby, don’t lose hope.
[Women] can definitely still get pregnant during perimenopause and up to 12 months after their final menstrual period.
Dr. Frey said, “Hormonal methods like birth control pills, the ring, or the patch can be well suited for perimenopause because they eliminate many of the hormonal fluctuations and their associated symptoms.” Additionally, hormonal IUDs like Mirena and Liletta can also be helpful because of their reliability, and they can assist with controlling heavy or unpredictable menstrual bleeding. During perimenopause, natural family planning (ovulation tracking or rhythm method) is not recommended because menstrual cycles are inconsistent.
If a woman wants to get pregnant, Dr. Frey shared that it may be challenging to conceive during perimenopause because fertility quickly declines in the late 30s (as any woman who’s heard the term “geriatric pregnancy” knows well).
“According to the American Society of Reproductive Medicine (ASRM), most women become unable to have a successful pregnancy in their mid 40s, whether through natural conception or with fertility treatments such as IVF,” Dr. Frey said.
Questions to Ask Your Medical Provider
Having ongoing conversations with your doctor can help alleviate fears and also empower you to understand the changes happening in your body. Dr. Frey advised women to discuss with their doctor any symptoms or concerns to determine if these symptoms are due to perimenopause. “Unfortunately, there is no definitive test for perimenopause—it’s a clinical diagnosis made based on the available information.” Your doctor may check your hormone levels, but since they are often fluctuating, it may prove to be an unreliable indicator. Your medical provider may also want to rule out other potential causes of your symptoms like diabetes or low thyroid before officially confirming perimenopause.
Ways to Alleviate Perimenopause Symptoms
Fortunately, there are several things women can do on their own to help alleviate some of the more distressing perimenopause symptoms. Dr. Frey suggested the following:
- Exercise: This can help alleviate depression and improve mood. Dr. Frey recommended at least 30 minutes a day of movement.
- Diet: Fresh whole foods are best, as they nourish the body. These include fruits, vegetables, whole grains, healthy fats from fish, nuts, and olive oil. Reduce your consumption of sugar, caffeine, processed foods, and alcohol, as they can affect your mood.
- Meditation: Ten minutes of mindfulness twice a day focused on breathing and tuning into your body and your surroundings can help improve your mood.
- Herbal Remedies: There are some herbal remedies that can assist in improving your quality of life during this transition. They include black cohosh for hot flashes and St. John’s wort, which can lessen depression.
- Therapy: If the mood changes are hard to manage, a therapist can help you process these feelings and help you adjust to the changes happening in your body.
Another option to consider is hormone therapy (also known as HRT), which could aid in easing perimenopause symptoms. Dr. Frey explained, “Hormone therapy is nearly 100% effective in relieving hot flashes, and for many women, it [can] stabilize mood and normalize bleeding patterns. The risks of hormone therapy are much less than is commonly believed—it can be used by most people for at least five years without any additional health risk.” Consult with your OB-GYN or menopause specialist for more information on this treatment option.
Additional Resources
For more information on perimenopause, Dr. Frey recommended the following resources:
- The Mayo Clinic
- The American College of Obstetricians and Gynecologists: Search “Perimenopause” under the “For Patients” tab.
- North American Menopause Society: This site has a Frequently-Asked-Questions section with useful answers as well as a position statement about hormone therapy and safety information.
- The Change Podcast By Dr. Caitlin O’Connor: This podcast provides a more holistic approach to perimenopause, hosted by Dr. O’Connor, a Denver area naturopathic doctor. They discuss self-care and lifestyle measures to consider during perimenopause.
- What Fresh Hell Is This? By Heather Corinna: This book provides a LGBTQ+ inclusive, practical, and medically accurate discussion of perimenopause and menopause, with humor infused throughout.
