For months, my nights had a strange new rhythm. Like clockwork, I would wake up at 3:07 a.m. (yes, I checked) and stare at the ceiling, wide awake. The house was still, the world outside completely dark. But my brain? Wide awake! Ready to think about everything from tomorrow’s grocery list to that embarrassing thing I said in 2009. I’d flip my pillow, toss, turn, try breathing exercises, even bargain with myself. Just close your eyes, you can do this. But the hours crept by until dawn, leaving me foggy, cranky, and wondering what on earth was happening to me.
Turns out, middle-of-the-night wakeups are just one of the many sneaky symptoms of perimenopause, something I thought I wouldn’t have to think about for years.
To get real answers, we reached out to Dhyana Velasco, MD, of Lovelace Medical Group Women’s Health.
She sheds light on the often-overlooked signs of perimenopause, why they happen, and how women can take control of their health during this transition instead of feeling blindsided by it.
Can you define perimenopause and menopause and explain the difference between the two?
Perimenopause is when a woman starts to have gradual changes to her ovarian hormonal production in the years leading up to menopause. This stage of life can start as early as 10 years before a woman reaches menopause. Menopause is when a woman has stopped menstruating for 12 consecutive months. On average, women reach menopause at the age of 51. Some women do so sooner, and some women later than that age. Reaching menopause means that the ovaries are no longer ovulating.
What are some early signs of perimenopause that women might overlook?
Early signs of perimenopause can sometimes be obvious, such as hot flashes or night sweats, mood changes, and a variety of other symptoms that may make a woman feel not like her usual self. In many cases, the signs can be less obvious. They are difficult to recognize as changes related to perimenopause. However, they can certainly affect a woman’s quality of life. It is always important to rule out any other medical conditions that could be contributing to symptoms.
Since every woman’s experience is different, how can someone determine if they are in perimenopause?
To determine if a woman is in perimenopause, the best way to recognize it is by having awareness of her age and symptoms. It is not possible to determine exactly when each woman will reach menopause, whether before or after the age of 51. However, we know that up to 10 years before reaching menopause, we can start to recognize symptoms of the changes in hormonal production. This is perimenopause. Blood tests are not used to specifically diagnose perimenopause. They are important in relation to ruling out other medical conditions, such as thyroid disease, diabetes, and other conditions that can develop over a woman’s adult lifetime.
What role do hormones like estrogen and progesterone play during this transition?
A woman’s production of estrogen, progesterone, and overall the hormones of the menstrual cycle starts to become less organized during perimenopause. Therefore, some women experience some symptoms, and some women don’t. It is an area of women’s health that needs more attention and research, especially when it comes to treatment options for women in perimenopause that are safe and backed by evidence-based medicine.
Hot flashes and irregular periods are well-known symptoms, but what are some surprising or lesser-known symptoms of perimenopause?
Aside from hot flashes and irregular periods, there are many surprising and lesser-known symptoms of perimenopause that can result from metabolic or inflammatory changes to the body. Some may experience weight gain, skin dryness, hair loss, and even joint pain, to name a few.
How do hormonal changes during perimenopause affect mental health, such as mood swings, anxiety, or depression?
Perimenopause can also have effects on mental health. It is not uncommon for women to feel that they have mood swings, anxiety when they didn’t have it before, and even depression. This is another area of women’s health that needs more attention and research, especially since the medical field relies more on medications for treatment, rather than a multi-focused approach.
Many women experience brain fog and memory issues. What causes this, and are there ways to combat it?
Brain fog and memory issues are also commonly described as starting during the perimenopausal years. A gradual decrease in the production of estrogen by the ovaries during perimenopause can result in these changes. There is not yet a standard, evidence-based approach or treatment option that is available or offered to women. It is again a multi-focused approach that combines lifestyle changes, oral supplements that improve neuronal function, such as Magnesium L-Threonate, and perhaps consideration for hormone replacement therapy. This is an area of women’s health that is receiving much more attention and focus as of late, as it should.
What are some treatment options available for managing perimenopausal symptoms?
There is not a standard set of treatment options for perimenopausal symptoms. Overall, identifying the symptoms that are having a negative effect on the quality of life of a woman and addressing them specifically is what will bring the best results. If a specific medical condition is identified, such as an abnormality with thyroid function, then the initial focus should be on addressing and managing the condition. Concurrently, a focus on lifestyle modifications that improve our health, such as exercise and focusing on nutritional health, is key to achieving the goal of a better quality of life.
Hormone replacement therapy (HRT) is often discussed but can be controversial. Who is a good candidate for it, and are there alternatives?
Hormone Replacement Therapy (HRT) is often discussed in the setting of menopausal symptoms. However, as of late, it has become a topic of great interest for perimenopausal women as well. Women experiencing disruptions brought by perimenopausal hormonal fluctuations are wondering if HRT is something to consider. This, again, is an area of women’s health that merits a lot more attention.
There is insufficient research and scientific evidence to give women treatment choices that are backed by evidence-based research. There is also insufficient education for us, the clinicians, to be able to offer treatments that are recognized as safe and effective for all women, whether in menopause or perimenopause. The first step in determining if you are a good candidate for HRT is to see your clinician for a comprehensive evaluation that considers your medical history, as well as your current health status. If your clinician determines that you meet contraindications to HRT, then they can discuss a few non-hormonal options that have been shown to help. The options are limited, and it depends on your specific symptoms.
How do lifestyle factors like diet, exercise, and stress management impact perimenopausal symptoms?
Lifestyle factors such as diet, exercise, and stress management have a very important impact on health throughout perimenopause and menopause. There are modifications to your dietary choices and focused exercise that can specifically target the changes resulting from this stage of life. For example, as the estrogen production decreases during perimenopausal years, we start to lose bone mass density and become more prone to osteopenia and osteoporosis. We also accumulate more fat around our organs, called visceral fat. And we have more inflammation throughout our bodies. These are conditions that can really affect our health and longevity. Aside from considering HRT, we need to focus on combating these changes with specific things like weight-bearing exercise, plus supplements and foods to support bone health and reduce inflammation.
Are there any supplements or natural remedies that actually work for symptom relief?
There are many products nowadays that offer support for women in perimenopause and menopause. Some are a combination of supplements, herbs, and even plant-derived hormones that are advertised as effective for all. It is important to know, as with any non-regulated product or supplement, that something labeled “natural” does not always guarantee its safety. It is best to consult with your clinician before trying any products for symptom relief.
Sleep disturbances are common during perimenopause. What can women do to improve their sleep quality?
One of the common symptoms of perimenopause and menopause is a change in sleep. Many women have trouble falling asleep, staying asleep, or going back to sleep if they are awakened during the night. This is very disruptive and contributes to excessive fatigue. Among several sleep hygiene options, there are things that can help to improve sleep, such as focusing on reducing stress or cutting back on screen time in the evening. If night sweats are causing awakening and inability to fall back asleep, then the first step is to apply environmental changes that result in cooling. (Different sheets, clothing, room ventilation, or even a cooling pad for the bed may be worth investing in.) Ultimately, there are medication options, both non-hormonal and hormonal, that can alleviate sleep disturbances by reducing night sweats and/or providing sleep support.
Many women feel dismissed by healthcare providers when they bring up menopause-related concerns. How can they advocate for themselves?
It is true that many women feel dismissed by their healthcare providers when the topic of menopause or perimenopause is brought up. This is an area of women’s health that has not received enough attention or focused research, or even training for us clinicians, so that women feel adequately heard, validated, and treated. It is important for a woman to have an awareness and understanding of what and how she is experiencing the perimenopausal transition into menopause. Most importantly, it is crucial for a woman to identify the combined factors that are having a negative effect on her quality of life.
There is not one treatment that addresses or fixes it all. But as the medical field begins to give it the attention it deserves, it is important for women to know that their health is important, and they should seek a healthcare provider who can support them in this stage of life.
At what point should a woman seek professional help for her symptoms rather than just managing them on her own?
When a woman recognizes changes in her health that could be related to perimenopause, it is important to first ensure that an overall health assessment is done. This can be done by your PCP or by your OB/GYN at an annual well-woman exam. The visit will focus on ensuring all age-appropriate screenings are up to date, such as a Pap test for cervical cancer screening, a mammogram for breast cancer screening, and a colon cancer screening. There are also various blood tests that a provider can order to assess for medical conditions such as diabetes and thyroid disease. Once these tests are completed and reviewed, you can seek specific consultation with a healthcare provider with training to address perimenopause and menopause.
What are some long-term health considerations for postmenopausal women, such as bone density or heart health?
Long-term health considerations for postmenopausal women are important. The medical community acknowledges the importance of early interventions to avoid the long-term effects of hormonal changes of menopause. There is mounting evidence to show that a proactive approach to reducing the risk of osteoporosis and cardiovascular disease is necessary.
If a woman is approaching menopause, what proactive steps can she take now to ease the transition?
As a woman gains understanding and awareness of the health changes brought by her perimenopausal transition into menopause, she becomes better equipped to apply a multi-pronged approach to her health. Consideration towards lifestyle modifications that may include dietary changes, targeted exercise, supplements, and possibly HRT, is important as an overall approach towards improved health, quality of life, and longevity.
What is one piece of advice you wish every woman knew about menopause?
The one piece of advice I give perimenopausal and menopausal women is that it is incredibly important to advocate for one’s own health. It is important to make informed decisions, especially when it comes to our health. It’s also important to trust that the medical community is working towards the improvement of women’s health beyond the reproductive years.
Thanks so much to Dhyana Velasco, MD, for providing this valuable information.
To schedule a gynecology appointment with Lovelace Medical Group Women’s Health, call 505-727-4500.
