Perimenopause FAQ

What is Perimenopause?

Perimenopause is the transition time between a woman's reproductive years and menopause.  Typically, perimenopause occurs between the ages 40 to 51 (average age is 47), but hormonal changes may start as early as the late 30's.  As women age, the supply of eggs in the ovaries is depleted.  In the 40's, the supply is very low, and menstrual cycles without ovulation (anovulatory cycles) become more frequent.  Due to the increase in anovulatory cycles, perimenopausal women often have low levels of progesterone, with high or fluctuating levels of estrogen.  High estrogen, low progesterone or an imbalance of estrogen to progesterone may be associated with many of the symptoms that perimenopausal women experience including hot flashes, night sweats, anxiety, depression, irritability, insomnia, headaches, palpitations and irregular, prolonged or heavy menses.  These symptoms are often worse before the menstrual period, so many women may think they are having PMS, when it may be the beginning of perimenopause.  If you are experiencing symptoms of Perimenopause, you are not alone.

I am 46 and still having regular menstrual periods, how would I know if I am in perimenopause?

The hormonal changes of perimenopause often begin in the late 30's and early 40's.  The menstrual periods may not be affected by hormonal changes until we get close to menopause, although some women notice changes in the frequency or amount of bleeding during their 40's.  More commonly women start to experience other symptoms first, such as anxiety, insomnia, hot flashes, night sweats, mood swings, depression and heart palpitations.  Even if you are not experiencing any symptoms, it is likely that your hormones are changing.

My doctor says I am in menopause because my FSH level is high.  I am still having periods, sometimes very heavy ones, and I thought menopause was the point at which your periods stop.

Menopause is defined as the point in time when a woman has gone 12 consecutive months without a menstrual period.  The average age in the US is 50-51. It used to be thought that a high FSH level was an indicator of menopause, and it is true that menopausal and postmenopausal women have high FSH levels.  However, we know from research studies that the FSH level begins to rise at age 30 and increases through the 30's and 40's.  Because of this information, the FSH level is now considered to be an unreliable marker of menopause, yet many doctors continue to use this test.  You may be in perimenopause, the years during the late 30's and 40's leading up to menopause.  Changes in menstrual flow, including heavier periods, are common in women during the perimenopausal years.

Sometimes I wake up at night soaking wet and cold. My friend told me it is probably night sweats (nighttime hot flashes), but I am only 40.  Does this mean I will have an early menopause?

Night sweats, or hot flashes that occur at night, are quite common in early perimenopause, and are often one of the first symptoms that women experience.  It is normal for hormones to begin to change around age 40, and for women to begin to experience some symptoms of hormonal change such as night sweats or hot flashes.  Most women who have early perimenopausal symptoms experience menopause at the average age of 50 - 51.  Night sweats and hot flashes are due to a variety of hormonal changes, not just to low estrogen.

I am having my periods every 2 weeks and they are very heavy. Sometimes it is difficult for me to go out because the bleeding is so heavy. Is this normal?  I am only 48.

Changes in the frequency and amount of menstrual bleeding are common in perimenopausal women.  It is often due to excess stimulation of the endometrium (uterine lining) by estrogen, and a lack of progesterone to balance this effect of estrogen.  While this is a common symptom, it is important to have your doctor check for overgrowth of the endometrium.  Many doctors will prescribe a synthetic progestin to decrease the bleeding due to estrogen.  Holistic physicians use natural progesterone to balance estrogen in perimenopause.

Almost every night I wake up around 2 - 3:00 AM.  It is hard to get back to sleep, and sometimes I feel so anxious.  I have never had problems with sleeping until recently.  Any ideas on what is causing this?  I am only 42, and I thought that insomnia was a problem for older people.

Many women experience this problem beginning in their early 40's.  It is associated with the hormonal changes of perimenopause when there is often excess estrogen produced, or too much estrogen relative to progesterone in the body.  Estrogen acts as a central nervous system stimulant, while progesterone has a relaxing effect on the brain.  With excess estrogen, symptoms such as insomnia, anxiety and irritability are common.  The use of supplemental progesterone can balance estrogen and may help to promote sleep and calm mood.

Since I turned 37, I am noticing that in the week before my period I experience a lot of bloating, as well as feeling irritable. I have never had PMS before, why I am I starting to have it now?

Many women in their late 30's and early 40's begin to have premenstrual symptoms due to the changes in hormones experienced at this time.  Studies have shown that estrogen levels may rise and progesterone levels fall as women enter perimenopause, and this is more pronounced in the premenstrual time.  Estrogen may increase fluid retention in the body, as well as having a stimulant effect on the brain causing irritability.  Other symptoms of "estrogen excess" include breast tenderness, insomnia, anxiety, and changes in the frequency and amount of the menstrual period.

I am 43 and having hot flashes several times a day.  Even though I am still having periods, my doctor wants to give me estrogen.  I would rather not use estrogen if I do not have to.

Hot flashes are due to hormonal changes, not just to low estrogen levels.  Other hormone changes that can contribute to hot flashes include high or fluctuating estrogen, as well as low progesterone, low beta-endorphin levels, and increased FSH, LH or cortisol. Research has shown that most perimenopausal age women (age 40 - 51) have normal or high estrogen and low progesterone levels, and the researchers recommend progesterone replacement rather than estrogen replacement for perimenopause.