10 Facts About Perimenopause Women Over 30 Need to Know -- NOW.

Thanks to celebrities like Drew Barrymore, Naomi Watts and Michelle Obama, we’re finally talking about perimenopause.

However, despite the increased attention, it appears we’re not really any wiser. In this study, almost half (45%) of the women surveyed didn’t know the difference between perimenopause and menopause. In a proprietary study by perimenopause startup NNABI less than a third (26%) of participants attributed their symptoms to perimenopause — even though they were screened based on experiencing perimenopausal symptoms in the past six months. Given there’s up to 42 million women in the US currently in perimenopause, and that over one billion women around the world will have experienced perimenopause by 2025, isn’t it time for a clear understanding of the symptoms and the solutions? Consider this your starting point. 

1. You’re either in perimenopause or menopause, never both. 

Perimenopause is derived from the Greek word peri, which means “around” or “near” + menopause, the day denoting 12 months without a menstrual period. However, the term “near” is a misnomer. While on average, perimenopause lasts four to eight years, it can last much longer, says Dr. Ferris. “Some literature suggests this transitional phase can last as long as 14 years,” she says.

Menopause lasts a day, but perimenopause can span decades. According to Harvard Health, menopause is a point in time, but perimenopause is an extended transitional state. “Perimenopause refers to the months and years that lead up to the menopausal transition, in which the reproductive hormonal changes (estradiol and progesterone) that begin to happen can start causing symptoms,” says Lylen Ferris, ND, director of clinical education at Doctor's Data, Inc. “A woman reaches menopause once she has had no periods for 12 months.”

2. Perimenopause can kick off in your thirties. 

According to the Mayo Clinic, the average onset of perimenopause is 47, however in some women, the hormonal fluctuations associated with perimenopause can begin in their thirties, says Dr. Ferris. Naomi Watts famously shared that she was 36 when she started perimenopause — just as she was ready to start a family. She’s not unique, says Gabrielle Francis, ND, Chiropractor, Acupuncturist, and author of The Rockstar Remedy: A Rock & Roll Doctor's Prescription for Living a Long, Healthy Life. “I work in fertility, and many women are choosing to have families later in life. It’s not uncommon for me to be helping someone get pregnant while she is in perimenopause.” Says Dr. Ferris, “Women can still be menstruating regularly, can still be having babies, and can be experiencing hormonal changes that cause symptoms.” 

3. Symptoms can peak just as you’re hitting your stride. And they can be crippling.

During their thirties and forties, many women are hustling on multiple fronts — getting married, starting a family,starting a business, up-leveling their careers, caring for aging parents, going back to work after having kids, sending kids to college, to name some. Add perimenopause to the mix and it can lead to burnout.“The ovaries produce 80% of the hormones estrogen, progesterone, and testosterone,” says Dr. Francis. “Once a woman is in menopause, her ovaries shut down, and the adrenal and thyroid take over.” However, she says, many women today are moving into perimenopause (and menopause) with adrenal fatigue and thyroid imbalances. In other words, says Dr. Francis, the engine is preparing to shut down but the backup generators are burnt out. 

According to a UK study, perimenopause has over 34 symptoms, with nearly three in four women (74%) experiencing symptoms. The top three are changes in mood, memory, and poor sleep; others include hot flashes, night sweats, brain fog, anxiety, depression, digestive problems, bloating, weight gain, joint pain, muscle tension, migraines, frequent urination, vaginal dryness, low libido, hair loss, dry skin, and acne. In the NNABI study (conducted in August 2022 among 400 perimenopausal women in the US aged 35-54), 85% of participants said the symptoms they experienced interfered in their day-to-day lives somewhat to very much.

4. You might suffer more in perimenopause than menopause.

“The suffering that people mostly attribute to menopause is actually perimenopause,” says Dr. Francis. That’s because during perimenopause, hormones are fluctuating and changing rapidly, whereas in menopause hormones are no longer being secreted in any significant way, says Dr. Ferris. “These surges and drops in hormones are very similar to the hormones of a pubescent teenager,” says Dr. Francis. “That’s why there are a lot of emotional ups and downs.” Dr. Francis often hears patients say that they’re overwhelmed, anxious, or even that they don’t recognize themselves. “They often feel they have a lower tolerance for stress,” she says. “It can really affect every aspect of their life and all their relationships.”

5. Women aren’t the only ones who suffer.

Indeed, when women aren’t feeling their best, it isn’t just women who suffer, says Dr Ferris. “Husbands and children suffer. Efficiency in the workplace suffers. Women are often the primary caregivers in their families, and it’s typically when these hormone changes begin that women may be caring for children, teenagers, aging parents,” she says. “We have to remember, if mama ain’t happy then nobody is happy!” says Karolynn Echols, MD, Professor of Obstetrics and Gynecology and Practicing Urogynecologist and Integrative Medicine Specialist. 

6. The financial implications are universal. 

Given that older millennials, the largest generationin the workforce, are now entering perimenopause, continuing to overlook this key stage in a woman’s life will cost dearly. “Perimenopausal symptoms such as mood swings, sleep disturbances and fatigue can affect work productivity and performance,” saysDr. Echols, who recommendsa multifaceted approach involving healthcare policy, workplace support initiatives, and broader societal conversations about women’s health and aging. “Recognizing and subsequently responding to these unique challenges faced by this demographic can help ensure a more inclusive and supportive environment for all women going through perimenopause,” says Dr. Echols.

7. Doctors still don’t know much about perimenopause. 

“The idea that hormonal changes associated with aging can begin to happen in our thirties is a new idea to most women, and to many doctors,” says Dr. Ferris. “Most medical students are not taught about the nuances of menopause and perimenopause, so once in practice, they’re not equipped to educate their patients about this transition. Additionally, primary care doctors may be leaving these sorts of conversations to OB/GYN docs, but it’s the primary care docs who see patients more regularly. The result is that most women don’t know what to expect as they age,” says Dr. Ferris. “One of my goals as a teacher and as a clinician is to educate doctors about perimenopause so that they can begin thinking about symptoms in a new way.”

The unfortunate ramification that occurs is that perimenopause is often missed or misdiagnosed. “There is limited awareness among healthcare providers about the specific needs of women during perimenopause, leading to under-recognized and inaccurate treatment of symptoms,” says Dr. Echols. Coupled with this, most women find themselves as Naomi Watts says she was, “clueless.” Many patients don’t identify their emotional symptoms — versus irregular cycles, bleeding, and hot flashes — with perimenopause, says Dr. Francis. As a result, they’ll often see a plethora of doctors and end up with a lot of “band-aids” for symptoms. It’s amazing how many doctors will tell them they have depression and give them meds and not talk to them at all about hormones, adrenals, thyroid, and such, she says. “I work on getting them balanced individually. If they are in balance, then perimenopause is a time of powerful transition and not a crisis.”

8. We need focused research and solutions. 

“More attention is needed to better understand the root causes of perimenopausal symptoms that will then lead to the development of more novel, effective treatments,” says Dr. Echols, an advisor to NNABI, who recently launched a botanical supplement, backed by clinical trials, to tackle the root causes of perimenopausal symptoms. “We need to investigate the role of hormone and chemical imbalances and other biological processes that contribute to symptoms such as mood swings, low energy, vaginal dryness, hair loss, and sleep disturbances,” she says.“While treatments exist for common symptoms like hot flashes and mood swings, there are definitely gaps in addressing those symptoms that 1) are less recognized or 2) may vary widely among women,” says Dr. Echols.“Recognizingandcommunicating the perimenopausal diagnosis to a woman empowers her mind and soul, which is more than half the battle,” she says. “Then, proper treatment helps restore her body, ultimately leading to a more active and productive lifestyle.”

9. Treating symptoms in perimenopause can literally save lives.

“I can say from experience that in some women, hormonal fluctuations can be debilitating,” says Dr. Ferris. “When doctors address the hormonal imbalances associated with perimenopause while women are still menstruating, they can bring them great symptom relief,” she says. “But what I find even more exciting is that the perimenopausal years provide an opportunity for healthcare providers to begin interventions that can potentially prevent the development of diseases [like] osteoporosis, cardiovascular disease, breast cancer, and cognitive decline, the most serious of which is Alzheimer’s disease. All these diseases are more prevalent in menopausal women, as the hormones estrogen and progesterone (and to some degree testosterone) protect the bones, hearts, breasts, and brains of these women. As these hormones decline, women are at greater risk.”

10. The time to act is NOW.

“Perimenopause is not ‘sexy’ and it’s definitely misunderstood, so until we make people listen there will continue to be a lack of interest and lack of research,” says Dr. Echols. “Women will continue to suffer in silence because women’s healthcare has never been a priority. That needs to change right now,” she says. Her advice? Have as much open discussion as possible about perimenopause. “Women need to talk about it as much as they talk about sex and pregnancy,” says Dr. Echols. “Every woman needs to know that they are not alone.”