Common Questions About Perimenopause

by | Jun 12, 2024

Did you know by 2030, the world population of menopausal and postmenopausal women is projected to increase to 1.2 billion, with 47 million new entrants every year? We need a sociocultural shift in treatment and awareness. 

If you are entering your late 30s or early 40s then chances are you are beginning your perimenopausal journey. And perimenopause occurs long before you miss your first period. 

 Do you know what to do or have a plan?  If not, let’s hope the following will provide you answers on your next steps. 

At PPW, we specialize in education, treatment and empowerment on your hormone journey. 

What is perimenopause? 

Perimenopause is kind of like your body’s way of easing into retirement. It’s the time before menopause, when your lady bits (ovaries) are slowing down and getting ready to chill out for good. This usually happens in your 40s, but it can be a party crasher and show up a bit earlier like your late 30s. In fact, we believe that women should start getting screened at age 35 for perimenopause symptoms and having these conversations with their providers. 

During this time, your ovaries are like a factory that’s slowly shutting down production. You may first notice that you are not sleeping that well, your anxiety is increasing and you have gained weight seemingly overnight. And this is all without changing anything! This change is due to a drop in your progesterone. You want to think of progesterone as your chill hormone. It soothes us, helps us sleep better and handle stress. Then to add insult to injury our estrogen starts fluctuating wildly further making the hormone chaos worse. This can cause mood swings, hot flashes or flushes, vaginal dryness, frequent UTIs, joint pain, frozen shoulder, anxiety, depression, heavy periods, breast tenderness, fibroids, hair thinning, low libido, reflux, constipation, low energy, weight gain, heart palpitations and many other not-so-fun symptoms. 

For those of you that have had surgical or chemical menopause, you unfortunately, get slammed into menopause overnight. And this can happen regardless of your age. We have clients in their early 30s already in menopause due to removal of ovaries and uterus. 

So what can you do to tame the hormone chaos?

There are many things that you can do to sail through perimenopause. Unfortunately, many of you are left in the dark on what to do and your providers are no help. They themselves, have received very little training on peri to post-menopausal care. And, many of you have come to us having tried EVERYTHING. You have read the books, listened to podcasts, tried the cleanses, the detoxes and the “hormone balancing” supplements. You have gone to your doctor only to be given two options which are usually birth control and/or anti-depressants. This is NOT ENOUGH. You deserve to be educated on your changing hormones and given the best options. 

We know there is so much more that can be done and you do not have to go it alone. At PPW, we undo years of bad nutrition advice, burn out and restrictive dieting. We focus on nourishing your body, deep nervous system support (it sets the pace for healing), gut health, mindset work, and mineral replenishment. We use targeted supplementation and HRT recommendations with a qualified provider. At PPW you have an expert on your side who understands the physiology of peri to post-menopausal care. 

What is HRT (hormone replacement therapy) and is it safe?

HRT has a tumultuous past and most providers are basing their recommendations on a poorly designed and deeply flawed study (Women’s Health Initiative from 2002). Unfortunately, the downstream effects from this study deprived a generation of women from the benefits of HRT. The dosing, type of hormones and the delivery systems have vastly improved. But what hasn’t improved is the perception and training from providers and society at large. 

We understand the nuances of HRT and when done right with a qualified provider, HRT can be a lifesaver. HRT works best when it is used as prevention rather than treatment and we recommend women start on HRT in perimenopause. While there are some women who for various reasons are unable to take HRT, for the majority of women HRT is safe and recommended. See the position statement from the Menopause Society (formerly known as The North American Menopause Society) here. 

At PPW, we’ll educate you on the benefits, types, delivery systems, and set you up with a provider. And you can be on these for as long as you want. If a doctor recommends you can only be on them for a short period of time, they are not HRT literate and you need a new doctor. 

Keep in mind, if you do not change your lifestyle and nutrition then HRT will only get you so far. You have to do the work to help maximize the benefits. 

Do I need to test my hormones to find out if I am in perimenopause?

No, you do not need to test your hormones. Hormones are fluctuating and we go by your symptoms and so should your provider. Bloodwork will only give you one snapshot and doesn’t provide the variations that can occur daily and monthly. 

Can you balance hormones in midlife?

No, you cannot balance your hormones in midlife. Many of our clients are seeking hormone balance and unfortunately that will not occur in perimenopause. 

Avoid misinformation and over-hyped supplements that are aimed to help balance your hormones. You cannot out-diet or out-supplement fluctuating and declining hormones.  It’s the un-sexy stuff like your foundational health, minerals and HRT that will help. Need help? At PPW, we specialize in education, treatment and empowerment on your hormone journey

What are the best supplements for perimenopause?

There’s no one-size-fits-all answer to the best supplements for perimenopause. Again, supplements can be helpful and we do use them but once the foundations are in place. Just throwing 20+ supplements at your system with no strategy will get you nowhere and probably wasting a ton of money. 

What are the signs that perimenopause is ending?

​​The good news is that there’s a tell-tale sign that perimenopause is finally on its way out: infrequent periods. As you inch closer to menopause, your periods will typically become more and more spread out. Doctors generally consider a woman to be nearing the end of perimenopause when her periods are more than 60 days apart. This late perimenopause phase can last anywhere from one to three years, so be patient! The average age of menopause in the U.S. is 51 years old. 

Some women experience changes in other symptoms during this late perimenopause stage, but it’s not universal.

  • Hot flashes: Hot flashes might actually become more frequent as you approach menopause.
  • Mood swings and sleep: These symptoms may improve or become less frequent.
  • Headaches: You might experience headaches less often.

It’s important to remember that everyone’s experience with perimenopause is different. The pattern of your periods and how your symptoms change can vary. 

How do I handle midlife weight gain in perimenopause?

Yes, weight gain is common during perimenopause. Declining estrogen levels and other hormonal changes can lead to increased belly fat, decreased metabolism, and appetite changes. We focus on metabolism repair while improving your metabolic flexibility. We undo years of over-exercising and undereating. Once we get the fire burning again in your metabolism and you have the right strategy in place like focusing on weight training, ditching the intense cardio, and nervous system support you will notice a shift in your body composition. This is where the mindset comes in. We have to value health over “thinness”. This is essential to your healing. 

We cover Midlife Metabolism in-depth with our clients in our group coaching calls and 1:1. There is so much you can do that doesn’t include fasting, detoxes and cleanses. 

Can you get pregnant during perimenopause?

Absolutely. Perimenopause is a transitional phase leading up to menopause, where your body gradually winds down hormone production. While it’s a sign that your fertile years are nearing an end, ovulation (the release of an egg) can still occur during this time. This means pregnancy is still possible, although it becomes less likely compared to when you were younger.

The decline in estrogen and other hormones during perimenopause disrupts the menstrual cycle, making it irregular and unpredictable. You might skip periods altogether or experience cycles with a wider range of lengths. Ovulation can happen during any of these cycles, even the seemingly erratic ones. 

Does perimenopause cause fatigue?

Fatigue is a common issue during perimenopause, affecting nearly half of women. There are two main reasons for this: hormonal fluctuations and sleep disruptions. As you approach menopause, your estrogen levels drop, which can leave you feeling sluggish because estrogen helps regulate energy levels. Other hormones like progesterone and testosterone can also be affected, further contributing to fatigue.

Sleep disruptions are another major factor. Hot flashes and night sweats, classic symptoms of perimenopause, can wreak havoc on your sleep quality. You might wake up frequently drenched in sweat, interrupting precious sleep cycles and leaving you exhausted during the day.

We help you reset your circadian rhythms and get you sleeping again. Sleep is foundational to your peri to post menopause roadmap. Need help? At PPW, we specialize in education, treatment and empowerment on your hormone journey

Does perimenopause cause hair loss?

Yes, perimenopause can contribute to hair loss. During perimenopause, your estrogen levels start to decline. Estrogen plays a role in hair growth, so a decrease can disrupt the hair growth cycle and lead to hair thinning or shedding. Perimenopause can also lead to a relative increase in androgens (male sex hormones). In some women, these androgens can contribute to a type of hair loss called androgenetic alopecia, which is also known as female pattern hair loss. This typically causes a receding hairline or thinning hair at the crown of the head.

Why do I have spotting instead of a period during perimenopause?

Spotting instead of a full period is a frequent occurrence during perimenopause, a sign of your body’s hormonal fluctuations as it transitions towards menopause. When estrogen levels start to decline, ovulation (the release of an egg) becomes less regular or ceases altogether. This disrupts the normal hormonal choreography that governs your menstrual cycle, leading to unpredictable bleeding patterns.

Can perimenopause cause cramps?

Yes, perimenopause can absolutely cause cramps, and for some women, they might even be worse than the cramps they experienced during their regular menstrual cycles. The main culprit behind perimenopausal cramps is the dramatic shift in hormone levels, particularly estrogen and progesterone. During perimenopause, estrogen levels fluctuate significantly, sometimes even staying high after ovulation. This can trigger the release of prostaglandins, hormone-like substances that cause the uterus to contract and lead to cramping.

Why does breast pain occur during perimenopause? 

During perimenopause, your body starts winding down production of estrogen and progesterone, the hormones that regulate your menstrual cycle. Estrogen plays a key role in regulating fluid balance in breast tissue. As estrogen levels decline, fluid can build up in the breasts, leading to feelings of swelling, tenderness, and achiness. This is similar to what happens right before your period, but during perimenopause, it can occur more frequently and unpredictably due to the hormonal ups and downs.

How does perimenopause cause anxiety?

Perimenopause can be a time of emotional ups and downs, and anxiety is a common experience for many women during this transition. The main reason is the dramatic shift in hormone levels, particularly estrogen and progesterone. These hormones influence brain chemicals like serotonin, which plays a role in mood regulation. As estrogen and progesterone levels decline during perimenopause, it can disrupt this delicate balance and contribute to anxiety symptoms.

Can perimenopause cause heart palpitations?

Yes, heart palpitations are a common symptom during perimenopause. They can feel like your heart is racing, fluttering, or skipping a beat.  Estrogen plays a role in regulating the autonomic nervous system, which controls your heart rate and rhythm. As estrogen levels decline during perimenopause, it can disrupt this system and lead to occasional heart palpitations.

Need more help? At PPW, we specialize in education, treatment and empowerment on your hormone journey