Originally written and posted in July 2019 by Erica Stephenson
“Can we check my hormone levels to see if I am menopausal?”
This is a relatively common question asked of me during routine annual exams. Because age-related hormonal shifts are normal, and symptoms present differently for different women, the answer is not always straightforward.
For example, one woman might have fairly regular menstrual cycles with gradually lighter monthly periods until she no longer has them, while another might be affected by erratic, unpredictable, and heavy cycles until they subside. As with menstrual differences, vasomotor symptoms (think: hot flashes and night sweats) can vary widely as well.
With a broadly ranging slew of information available on the internet these days, it can be difficult to determine what is “normal.” Here, I’ll discuss what’s normal, what’s not, and what might help ease this transition.
What is the difference between perimenopause and menopause?
The years leading up to menopause are a transition called perimenopause. You might be surprised by the changing pattern of your periods with age, particularly approaching the mid/late 40s and early 50s.
Perimenopause, on average, may last anywhere from 4 to 8 years before menstrual periods finally stop. The average age of menopause, which is defined as 12 consecutive months with no menstrual period, in the United States is 51 years old.
That’s the AVERAGE; many factors can influence an individual woman’s age at menopause, including lifestyle and genetics. Your mother’s age or sisters’ ages can be a good guide for when you might hit the magic menopause mark.
Here’s what all this means: You could go several weeks to months with no menstrual bleeding before Aunt Flow decides to visit… And the clock restarts from there until you can count a full, consecutive 12 months without menstrual bleeding.
When should you call your doctor about perimenopause symptoms?
This varies by symptom type and severity. Vasomotor symptoms can be mild and annoying at worst for some women, or rather disruptive and life-impacting for others. If your hot flashes or night sweats are impacting your quality of life, it’s probably time to visit your OBGYN.
Vaginal dryness and libido changes have the potential to negatively impact intimacy during this transition as well. Your provider can discuss the many different management options for vasomotor and vaginal symptoms with you, and you can come up with a plan together about how to approach them.
It’s important to recognize that although hormone replacement therapy, or HRT, is one route, there are also some other options available to help ease the perimenopausal transition.
Abnormal bleeding patterns can make it more confusing to decipher normal versus abnormal. In this scenario, visiting your OBGYN is generally the best recommendation in order to determine whether what you are experiencing is normal or not.
ANY episode of heavy bleeding (heavy, defined as soaking 1 pad every 2 hours or less), passing clots, or prolonged episode of menstrual flow does warrant an OBGYN visit. Conversely, if you have gone several cycles without a period, it’s a good idea to schedule a visit to make sure this is normal as well.
If you have gone a full 12 months without a period (thus meeting the criteria for menopause), followed by an episode of bleeding, it is very important to schedule an appointment with your provider for further evaluation.
Though not as often discussed, mood changes with hormonal shifts due to age may occur during perimenopause. This may present as an increase in tearfulness, excessive worry or anxiety, or even low mood such as depression. If you find your mood changes to be disruptive to your day-to-day activities, an appointment with your OBGYN is probably in order.
What you can do to reduce hot flashes?
Lifestyle factors can affect the severity of perimenopausal symptoms for some women, and making some small changes may help to improve their quality of life.
For example, getting some regular cardiovascular exercise several times a week can help to reduce the severity of hot flashes. Aiming for 30-40 minutes of exercise, 4-5 days per week is a good target, and it can include activities like walking, yoga, and even gardening if intense activity is not your forte. Exercise also has the added benefit of releasing endorphins to improve mood, increase energy levels, and improve sleep quality.
Likewise, reducing alcohol intake and caffeine intake can help to better regulate core body temperature, also influencing and reducing vasomotor symptoms. Keeping the thermostat low and sleeping with light blankets can be helpful for managing night sweats, and cutting back on caffeine intake may improve sleep quality.
There are some natural over-the-counter products on the market with herbal ingredients; if you decide to try one, use it with caution. These products are not as tightly regulated as medications and could have some unknown interactions with other medications you are taking.
Perimenopause is a transition that affects individual women in different ways and can be confusing to navigate. If you have questions about what is normal, what to expect, or how to improve your quality of life during perimenopause and beyond, schedule an appointment to talk to your healthcare provider. Our goal is to ease the transition, so you can enjoy your life without the disruption of troublesome symptoms.
The North American Menopause Society:
ACOG: The Menopause Years: