Perimenopause symptoms tend to creep up on us and over time and suddenly we realize that we do not feel right, but because the symptoms seem unrelated it can take a while to recognize. It is important to understand perimenopause and what happens as we approach middle age.
In our first installment of this series, we discussed the wide variety of ailments that most women experience during perimenopause. Everyone has their own unique combination of symptoms, many of which mimic other conditions.
Perimenopause is the biological process of our bodies preparing to end our ability to reproduce. It is a transition similar to adolescence, and many parallels can be drawn. It is characterized by dramatic changes in hormone production.
Hormones are the chemical messengers that are excreted into our bloodstream to send signals to different organs in our bodies. They control major systemic processes like our growth, metabolism, sexual function, reproduction and moods. Small changes in hormonal levels can create significant shifts.
The endocrine system is the set of glands that produce hormones. It is a complex dance that is responsible for the smooth operation of most of our bodily functions. The challenging thing about balancing hormones is that it is not just the absolute level of any hormone that matters. Of equal importance is the level of each hormone relative to the others.
What is happening to us as we go through this process of pausing? In our mid to late 30s or bodies start to change. The ovaries produce fewer eggs and as a result our hormones start to shift. In response to those hormonal changes our bodies experience new symptoms that we did not have before.
Estrogen levels are determined by two hormones follicle-stimulating hormone (FSH) and luteinizing hormone (LH). FSH helps the ovaries produce estrogen. Once our estrogen levels reach a certain high the brain tells the body to produce LH so that the egg can be released. The empty follicle releases progesterone in preparation for pregnancy. If there is no fertilization, progesterone levels fall and the cycle begins again.
Eventually our periods become less and less frequent. It can take anywhere from a few months to 10 years for this process to end. About six months to a year before menstruation completely stops estrogen levels start to drop dramatically.
There are a variety of different hormonal changes that produce different perimenopausal symptoms. Sometimes the ovaries produce too much estrogen or too much progesterone or both. Sometimes there’s too little estrogen or progesterone or both. In addition the balance of estrogen and progesterone relative to each other creates other symptoms. On top of all of that, for some women testosterone levels can also be out of whack, which creates a whole other set of problems.
Perimenopause is not a disease, it is a natural process that can be relatively symptom free (I know it’s hard to believe but I know some women who never really have experienced symptoms), but the symptoms can be paralyzing for others.
For me, perimenopause has forced me to take a harder look at my lifestyle and the things I am doing that support or detract from my health and wellbeing. When we are younger suboptimal choices have less of an impact on us than they do when we get older. This process is the opportunity to reflect and reassess and set a new course for our “third age.”
In the next post, we will cover some of the approaches to managing symptoms and how to find the help you need.
Frequently asked questions about what happens during perimenopause.
Premature menopause is similar to perimenopause but it is called premature when a woman is under the age of 40.
Women who experience menopause early are at risk for disorders related to low estrogen levels such as, osteoporosis and heart disease.
If you are experiencing premature menopause, a medical evaluation is critical.
Harvard Health Publishing, Harvard Medical School
Perimenopause: Rocky road to menopause