Common Signs of Perimenopause, from Shieva Ghofran of Tribe Called V

Photograph: Andrea Carson

above: Dr. Shieva Ghofrany

Oh, we know. Menopause is the stage of life that many women do not look forward to.
While it means an end to monthly periods, it also means that symptoms like hot flashes, night sweats, weight gain, hair loss could start happening. The good news is, there are ways to manage it all. We had a chat about the subject with Shieva Ghofrany, MD, a physician at Coastal OBGYN in Stamford and cofounder of tribecalledv.com, a site with the goal to increase knowledge and decrease anxiety about everything related to ob/gyn health.


What is perimenopause?

The best way to define perimenopause is to start with menopause—which is defined as the moment where you have had twelve months with no period. The average age is fifty-one or fifty-two. Up to ten-plus years before menopause, you can have fluctuations in your hormone levels that are defined as perimenopause as your ovulation and the quality of ovulation changes. Rather than your cycle before perimenopause, which is typically very cyclic and predictable, the period of perimenopause is hallmarked as predictably unpredictable. For example, your hormonal changes will be all over the place. That said, it’s important to realize that this is a normal part of our bodies’ changes and not pathological.

What happens in your body that triggers “the change”?
When we are born, we have about 1 million eggs in our ovaries, and then once we get to puberty, that number has decreased to 300,000 to 400,000. While during each “cycle” we only release a single egg during ovulation, the process entails many of the eggs to essentially disintegrate. As we get to perimenopause, our hormones don’t necessarily continue with the nice predictability we discussed, meaning the quality of ovulation may be different and/or you will have cycles where you don’t ovulate at all because of the hormonal fluctuations. And once we reach the age at which our hormones have decreased so much that they cannot trigger the ovulation to occur at all for twelve straight months, we are considered having “gone through menopause.”

What are some common symptoms?
Changes can include but are not limited to hot flashes, night sweats, mood changes, weight changes especially often in the midsection, hair changes (more on your chin, less on your head), more ovulation pain and breast tenderness, period irregularities and less elastic skin. Perimenopause is very clearly what our bodies just go through naturally, though we do not just need to grin and bear it. Each person may experience any or all of the symptoms, and the knowledge of this coupled with the ability to improve the symptoms is where the magic lies.

How long do symptoms last?
It’s good to know that after menopause, the vasomotor symptoms may continue up to five or seven years, but for most women they will eventually go away and can be managed with a variety of modalities—holistic and medical. On the other hand, the vaginal atrophy that causes pain with sex will progress more each year but can be dramatically improved with various lubricants, moisturizers and, most importantly, vaginal estrogen formulations.

Can I still get pregnant once I’ve entered perimenopause?
It’s important to note a few things, first being that even during perimenopause, while you may or may not ovulate in any given cycle, you still may get pregnant, so contraception is important if you do not want to have a baby. Second, it’s important to note that for each human, each week/month/or year may offer different symptoms or no symptoms during perimenopause. Third, I encourage everyone to know that once they’ve passed perimenopause and become “menopausal” as they’ve finished the year without a period, they will often feel better since the fluctuations of the hormones are often what triggers the most concern.

Can your doctor do any sort of tests to confirm you’re perimenopausal?
What can lead to confusion is the thought that we can somehow test for and rule in or rule out perimenopause. Of course, if someone outside of the expected age range (less than thirty-eight to forty) and is missing their period or having significant hot flashes/sweats, then a specific panel of hormone tests is warranted to ensure they are not in need of specific treatment (i.e.: for thyroid issues, abnormal prolactin hormone levels which can signify a pituitary issue or premature ovarian insufficiency/premature menopause). In women who are merely exhibiting milder symptoms (though let me highlight that they may still feel lousy!) and are in their forties, “checking their hormones” (specifically FSH/LH, estradiol/progesterone) is not of value and can actually confuse the picture. This is because the hallmark of perimenopause is that it is “predictably unpredictable,” and this means the hormones can fluctuate day-to-day, week-to-week and month-to-month—so any given blood test is only a snapshot in the moment and doesn’t change the management. We know there are many providers who encourage lengthier/more costly testing through blood/saliva or urine, aimed at “evaluating the whole month/cycle” to gain knowledge—but again, once we understand that each month can and likely will fluctuate, we understand that this is not of value.

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