Mom, you’re in the prime of your life. You should be peaking. So why are you feeling a bit peaked instead? It could be the stress of caretaking, or working, or just feeling a bit off. It happens. Or, it’s also possible that you’re experiencing early signs of “the changes.” We know!
If puberty and menopause are bookends to fertility, perimenopause is the slow wind down until menstruation pauses for a year. Menopause normally occurs between ages 45-55, though it sometimes happens as early as your mid-30s. (It can also be induced by things like chemotherapy and medications.) The exact age is variable, and possibly genetic.
“It’s not like you magically hit an age and go into menopause,” says Jackie Linder, a board-certified nurse midwife with HerMD in Millburn, noting that if your mom went into menopause comparatively early or late, you may, too. Caused by hormonal changes in estrogen and progesterone, the perimenopausal journey is equally variable, lasting from a few months to as long as a decade or more, presenting an array of issues which could be peri or not. It’s confusing, to be sure.
“It’s important that with all these symptoms, we don’t just blame the change,” says Linder, noting the importance of working with practitioners who will treat you as an individual with a unique set of symptoms that can be caused by myriad things.
IDENTIFYING THE CHANGES
According to Jacqueline Saitta, MD, a Ridgewood- and Bayonnebased OB/GYN known for her expertise in women’s hormonal issues, perimenopause tends to hit women just as they are “running the race of life,” juggling demanding jobs with managing kids and aging parents. “They’re having these symptoms and don’t have a label for it,” she says, making it hard to parse life’s challenges from a change of life.
In early perimenopause, changing hormones may cause your periods to become heavier and more painful. As time goes on, they may come more frequently and last longer or come more sporadically and feel more like spotting. Cycle changes can be caused by anything from stress and air travel to new medications and restrictive dieting. If you suspect you may be starting perimenopause, the first thing to do is become more self-aware. “The most important thing is to know thyself,” says Saitta, who recommends tracking symptoms in a journal. Similarly, Nicolette Morgan, a Summit-based pelvic floor occupational therapist, suggests clients keep tabs on ovulation by using a basal body tracker like Natural Cycles or wearable tech like Apple watches and Oura. Both will help communicate changes with your doctor.
Along with cycle fluctuations, women may experience migraines, breast pain, insomnia, irritability, hot flashes, aches and pains, skin texture changes, and weight gain, especially around the midsection.
Perimenopause can be tricky to treat, since everyone’s journey is different, and symptoms may come and go with no rhyme or reason, says Saitta. “It’s not a one-size-fits-all situation. It depends on the constellation of symptoms,” she says. Some women specifically request hormone replacement therapy (HRT) as a way to manage symptoms—can it? HRT, which can offer relief for some but not all symptoms (for example, it won’t necessarily help shed weight), comes in many forms, including very low estrogen birth control pills which also have the benefit of preventing “oops” pregnancies caused by unpredictable ovulation (women over the age of 40 in the U.S. account for 20 percent of all births). Due to reactions and fluctuating hormones, HRT can also potentially worsen issues (and create new ones), which is why lifestyle changes, self-care, and managing issues medically, if necessary (such as antidepressants or weight loss drugs) are typically recommended first. Wondering what symptoms to look out for?
YOU’RE FEELING HOT, HOT, HOT
One minute you’re fine. The next, a smoldering internal heat spreads across your face, neck and chest while your heart races, skin flushes red, and sweat pools everywhere. Fun. Hot flashes (also known as vasomotor symptoms) can be managed by lifestyle changes like wearing layers, sleeping on cooling sheets, and using misting sprays, as well as using hormones or natural herbs. Once discussed in hushed tones, women are now talking openly on social media about this natural shared experience—which is fantastic. But be wary. Not all information is accurate, so be sure to speak with your doctor before starting any supplements or treatments.
YOU’RE JUST NOT INTO IT
Stress. Exhaustion. Feeling blah. Lots of things can sink one’s sex drive during the peri-period. If your lack of interest is due to discomfort, however, that needs to be addressed ASAP. “Any pain with sex is not normal,” says Morgan. If there’s dryness, a symptom more common in late peri- or post-menopause, an estrogen cream or lubricants can help. “If not, there is a good chance there is tension in the pelvic floor muscles that is impacting the pain,” she says. This happens for many reasons, including tension and pressure caused by abdominal scarring (like C-sections) that worsen as women enter perimenopause.
YOU HAVE CONTROL ISSUES
Though common, new, worsening or returning incontinence (i.e. after giving birth) may signal that reduced estrogen in the body is impacting the tissue integrity. “From my perspective this means that the muscles may be weaker or tighter and not functioning as well as they were prior to hormonal changes,” says Morgan. A doctor or pelvic floor specialist can help determine the right treatment, from surgery and medication to Botox and physical therapy.
IT’S HARDER TO GET AND STAY FIT
“If you notice that you can’t tolerate as intense of exercise as you were doing before this could be a sign that the hormone changes are affecting muscle endurance,” says Morgan. Although it’s harder to make fitness gains, it’s worth pushing through since exercise (especially weight training) regulates blood sugar, amps energy levels, boosts strength, maintains bone health, fosters mobility, and prevents muscle atrophy caused by reduced estrogen.
WAIT, WHAT WAS I DOING?
Studies have shown women experience cognitive changes (aka brain fog) during perimenopause. Forgetfulness, lack of focus, memory issues, fatigue, and a general feeling of fuzziness can be caused by fluctuating hormones, as well as night sweats, anxiety, aches, insomnia and other sleep disruptors. Good sleep hygiene, managing mental health, and hormone therapy can help clear the cobwebs.
—Jennifer Kantor is a lifestyle writer and mom of two from Maplewood.
