Perimenopause or “second puberty” is the two to ten years before the final period. It’s different from menopause, which is the life phase that begins one year after the final period. Symptoms, if they occur at all, occur mostly during perimenopause and are temporary.
The normal age for the final period is anywhere from 45 to 55, so the normal age for perimenopause is up to ten years before that—as young as 35. In other words, if you were born before 1984, you could be in perimenopause and yet still be relatively young. That’s why perimenopause is not about aging but is instead about an important (and unavoidable) recalibration of your hormonal system.
The timing of menopause is genetic
As I explain in my book Hormone Repair Manual, menopause has been around for as long as we’ve been human and is not just an accident of living too long. According to some historians, menopause may even have been the driving force behind the evolution of a longer human lifespan.
You are genetically programmed to achieve menopause at approximately the age your mother or female relatives achieved it. If that’s on the younger end of normal (mid-40s), you’re fine and healthy. It doesn’t mean you’re aging more rapidly than your friends. If, on the other hand, you’re genetically programmed to achieve menopause on the older end of normal (mid-50s), then your perimenopause is happening alongside aging but is not caused by aging.
Finally, if you enter menopause before age 40, it’s the medical condition of premature menopause or primary ovarian insufficiency and is also not about aging.
How to diagnose perimenopause
Menopause (including early menopause) can be diagnosed by two high FSH readings (more than 40 IU/L) at least a month apart.
Perimenopause cannot be diagnosed by FSH or any other lab test. Instead, it’s diagnosed based on age and symptoms. According to Canadian endocrinology professor Jerilynn C Prior, a midlife woman with regular cycles is likely to be in perimenopause if she notices any three of the following nine changes:
- new-onset of heavy and/or longer flow
- shorter menstrual cycles (<26 days)
- new sore, swollen or lumpy breasts
- new mid-sleep waking
- increased menstrual cramps
- premenstrual night sweats
- new or markedly increased migraine headaches
- new or increased premenstrual mood swings
- weight gain without changes in exercise or eating.
In other words, if you’re older than 37 and have at least three symptoms on this list, you’re likely to be experiencing perimenopause.
What are the hormonal changes of perimenopause?
In the early phases of perimenopause, the biggest change is lower progesterone due to shorter luteal phases and more anovulatory cycles—despite regular periods. Lower progesterone contributes to anxiety, breast pain, heart palpitations, night sweats, frequent migraines and crazy, heavy periods. At the same time that progesterone drops away, estrogen spikes up to three times normal which contributes to irritable mood, breast pain and heavy periods.
👉🏽 Tip: High estrogen symptoms stem both from the direct effects of the hormone and from estrogen’s indirect effects on mast cells and histamine.
The fact that perimenopausal symptoms stem largely from losing progesterone, not estrogen, is why progesterone, not estrogen, can be the better treatment. And just as a little reassurance, it is possible to conceive during perimenopause.
For treatment ideas, see my book Hormone Repair Manual where I discuss my favourite combo of magnesium plus taurine as well as modern body-identical hormone therapy including transdermal estrogen (Estradot) and natural progesterone (Prometrium or Utrogestan).