Why Peri is – and isn’t – Such a Mystery

Perimenopause! What is this sorcery, and why does it have me in its grips?

Your confusion is justified. It seems like just yesterday you were in the midst of university life, and then, in a blink, life fast-forwarded. You may still be nurturing young children or navigating your career path – or even still grappling with student loans.

Menopause – it's for old ladies right?

Newsflash! The average age of menopause hovers around 51. However the Peri prelude can commence years prior. If you're over 35 and witnessing changes, you might be in its early stages.

The initiation of menopause marks a distinct chapter separate from menopause itself. Unfortunately, media, medical professionals, researchers, and the majority still blur the lines between the two.

A significant obstacle? The persistent lack of targeted research on Perimenopause, layered over the already deficient research on menopause.

Consider this: there are over 1.1 million studies on pregnancy in PubMed, the US National Institutes of Health's database of clinical research. This dwarfs the 94,000  studies on menopause and less than 6,000 on Perimenopause.

An abundance of studies on pregnancy – a phase only some women experience – while research on the universal experience of menopause and Perimenopause is sorely lacking. This imbalance won't rectify itself in our lifetimes, but let's appraise the progress thus far.

Incredibly, North American experts began diving deep into Perimenopause merely two decades ago, in 2001, with the Stages of Reproductive Aging Workshop (STRAW). They reconvened 10 years later to refine their insights, producing STRAW + 10, a vital document guiding Perimenopause treatment and discussion to this day.

 Incremental contributions over the years have begun sketching a broad Perimenopause roadmap.

Remember, every woman will navigate Perimenopause uniquely, but the journey usually unfolds somewhat like this:

Very early Peri: Periods remain regular but may exhibit subtle shifts. The most common symptoms, often mood and sleep disturbances, result from a diminishing ability to handle stress as progesterone levels fall, destabilizing our stress response system—the hypothalamic-pituitary-adrenal (HPA) axis. This temporary recalibration alters the operation of our entire nervous system.

Early Peri: Periods may become erratic, with cycle lengths varying by seven or more days. Mood-related issues from the very early stages may continue or intensify due to declining progesterone and fluctuating estrogen. These include depression, anxiety, insomnia, panic attacks, and more. Pre-existing mental health issues may also exacerbate. Extreme mood issues may even evoke suicidal ideation – something actress Gabrielle Union has courageously disclosed. If you're experiencing this, please seek help from a mental health professional.

Late Peri: Your cycles become highly irregular, and you may skip several. As per treatment guidelines published in The Journal of Clinical Endocrinology & Metabolism, estrogen levels plunge significantly during late perimenopause, triggering or intensifying menopausal symptoms. Common symptoms include increased hot flashes, night sweats, mood changes, weight gain, and Genitourinary Syndrome of Menopause symptoms like vaginal irritation and dryness.

Final menstruation: After a year without a period, you transition into post-menopause.

So, how long does this saga last? It varies wildly. Some women journey through perimenopause in a couple of years, while others meander for over a decade before menopause. 

Yes, it's exasperating. But reflect on past challenges – you never knew their duration either.

 And just as you conquered them, you're armed to triumph over this one too.

Author - Ann Marie McQueen, Hot Flash Inc.