I am 47 years old and was today years old when I realized I have been going through perimenopause for the last four years. It is only with a retrospective lens that I can review my last four years and pick up intermittent symptoms or even just mild nuisance-level symptoms that I can say are likely from perimenopause.
What is perimenopause? Perimenopause is the transition stage before reaching menopause, which is defined as 12 months of continuous amenorrhea (or no menstrual cycles). According to the Menopause Society, formerly known as NAMS or the North American Menopause Society, menopause can start as early as 45 years of age. Perimenopause, or the menopausal transition or journey, as I would like to describe it, can last anywhere from 1 to 10 years. So, a woman can be exhibiting symptoms of perimenopause as early as 35 years old. This was a jaw-opening statistic for me and something I was oblivious to before I decided to pursue additional certification to be a menopause specialist.
In a physiological sense, perimenopause has been called the “zone of chaos.” Why? because it is marked by significant fluctuations of important hormones, namely estrogen, progesterone, and testosterone. So, the symptoms occur not necessarily because of psychological stress, the burdens we carry as working physician moms, or environmental triggers. Symptoms of perimenopause occur literally because of the rapid decline of hormone levels and compensatory rise by a sputtering ovarian reserve.
Currently, I have pathognomonic hot flashes, night sweats, and cycle changes. So, it is a no-brainer that I am going through it. I can count 14 symptoms I currently have or have had that I can attribute to perimenopause. Some are mild-bothersome annoying levels, and some are quality-of-life-changing levels which I can only tie now to the perimenopause state.
Bothersome symptom #1: eye dryness. I have worn monthly and extended-wear contact lenses for at least 20-some years. In the last 5 to 6 years, I have noted that they would just “get dry” easier. Being a good patient, I followed my optometrist’s recommendation and switched to dailies. I was told that my dry eyes could be from too much screen time – which I totally understand and accept is an aggravating factor for sure. In the last three years, though, even the dailies would get bothersome before my day actually ends, so we would upgrade and try other brands that are “breathable.” I would apply rewetting drops before my day ends. It was only later on that I realized dry eye can be part of perimenopause and menopause. This article goes deeper into it.
The gist is that dry eyes are more common in women in midlife and are believed to be due to changes in the balance of sex hormones—estrogen and androgen—which influence the production of all components of the tear film.
Life-changing symptom #1: insomnia. Insomnia is complicated. The 3Ps theory of predisposing, precipitating, and perpetuating factors shows the bio-psycho-social complexity of sleep and lack of sleep. This is why it was so easy for me to discount my insomnia and chalk it up to so many things – life, stress, I even convinced myself that maybe I had some subtle anxiety (even though I didn’t really think I was anxious). I dove into remedies and such and learned about cognitive behavioral therapy for insomnia. In the last three years though, sleep would become more elusive with more frequent random nighttime awakenings and not being able to go back to sleep. Again, it was only later that I realized that this could have been part of my hormonal fluctuations. Information about sleep from NAMS.
The current thinking is that the decreases in estradiol and increases in follicle-stimulating hormone, progesterone, and testosterone may adversely modulate sleep-wake behaviors and contribute to the heightened risk for sleep disturbance and insomnia in women undergoing the menopause transition.
Why am I writing this? To give voice to the fact that symptoms midlife women experience can be due to a physiological change in our hormones. Hormone changes are real and are based on scientific facts that have been known for many years! Yet it seems acknowledging that our symptoms can be due to perimenopause is still not accepted in mainstream medicine as a valid differential diagnosis. I am not suggesting that hormone therapy should be started on everyone right away, but at the least, we need to give credence to concerns brought up by midlife women and see if symptoms could be part of the transitional state and be validated.
Caissa Troutman is an obesity medicine and family physician.
