Is It Really Peri?

“What is Perimenopause, anyway?”

“No one f—ing knows.”

That short conversation in the front seat of a pickup truck on the second season of the HBO show Somebody Somewhere pretty much sums it up.  

We are all so confused.  

Even weirder, things don’t seem to have moved on much.

Back in 2019 the Canadian comedy Baroness Von Sketch Show featured a befuddled character battling a range of crazy symptoms, including sudden, unexplained fury and forgetfulness. As she talks to other people about it – friends, her mother, her doctor – she only gets more bewildered. 

At one point in the brilliant sketch – titled It’s Not Perimenopause… Is it? – the character cries “I still get acne! I have a snowboard!” 

We get it! Peri is happening too soon for us too! We would think that doctors, the medical system and our wider communities would be able to help, guide and inform us through it, but they are still wrapping their heads around all this too. 

Because this stuff is complicated. 

Here’s what we know for sure: Peri is very different from menopause, which is marked by going 12 months without a period. Peri can start years and years before we were even expecting to think about menopause, let alone prepare for it. 

Every woman will experience it differently, and for different lengths of time: anywhere from a few years to upwards of a decade.

Menopause and Perimenopause have been lumped together for far too long. It’s time for Peri to be discussed separately so women can understand what is happening – and figure out how to deal with it. 

The average age of menopause in North America is 51. So the hard truth is, if you are over 35, you may already be in the very earliest stages. 

Peri might appear with a subtle shift in your coping mechanisms, or your period. It could be wreaking havoc, launching you into full-scale panic attacks or waking you up with nightmares in the middle of the night. You could be dealing with insomnia, dry skin, joint or body pain, bloating or digestive problems. 

If that’s the case, here’s why: in the earliest stages of Perimenopause, progesterone begins to drop and we experience changes in our hypothalamus-pituitary-adrenal axis, which regulates our ability to handle stress. 

Progesterone is deeply connected to managing our stress response, and when it drops in relation to estrogen, all hell can break loose. Estrogen is dropping too, overall, over time.

Despite our new crop of symptoms, many of us still want to know for sure. Although you might be tempted by a new crop of Peri testing that is appearing on the market, according to the North American Menopause Society (NAMS) these are still expensive and unreliable.

NAMS: “When a woman suspects she’s in Perimenopause, it is an excellent time to have a complete medical examination by a qualified healthcare professional. The diagnosis of Perimenopause can usually be made by reviewing a woman’s medical history, her menstrual history, and her signs and symptoms.”

So book a consultation with a medical professional who can evaluate your symptoms and hormone levels. Need a doctor? The NAMS “Find a Menopause Practitioner” directory is a good place to start. If you can pay out of pocket, a Peri-informed integrative or functional practitioner can also help – just make sure to ask about their background when you call for an appointment. 

In the meantime, pay attention to your body and track any changes. If you're experiencing significant shifts in your menstrual cycle, mood, or energy levels, it's worth bringing up to your doctor. 

And do not despair: From lifestyle changes like exercise and healthy eating to hormone replacement therapy, if you are having symptoms, there is a range of options to choose from to help. It's important to work with your healthcare provider to find the best solution for your individual needs. 

Remember, Perimenopause is a natural part of life for women. It's nothing to be ashamed of or embarrassed about. In fact, this phase can be a time of empowerment and growth. You have the opportunity to take charge of your health and make informed decisions about your body. So, embrace this new chapter with confidence and curiosity. Seek out information, support, and resources that can help you navigate this journey with grace. 

The good news? Just knowing that Peri has arrived can be a huge relief. This is even backed up by research: In a small study conducted in Iran, published in BMC Psychiatry journal in 2022, women who underwent a period of acceptance and commitment therapy, called ACT, showed signs of improved mood. 

And this is one of the reasons why many of the menopause coaching programs on the market use a form of ACT – along with other forms of cognitive behavioral therapy – in their work. Acceptance is key to moving through this transition more smoothly.  

Once you know what you are dealing with, then you can start seeing Perimenopause as another life challenge. We’ve been through enough of those by now to know that no matter how long it lasts, we will be able to handle this one too.