Is It Just Stress...Or Perimenopause? Doctors Explain How To Tell The Difference
Your period came a week early last month. It’s probably due to stress, you say to yourself.
You stood in the canned food aisle for five minutes yesterday, trying to remember that one ingredient you needed to cook your famous turkey chili. I’m just getting old, you think.
You keep waking up at 3 a.m. every morning for no discernible reason. My partner’s probably snoring again, you decide.
Yes, all of these seemingly unrelated incidents could be a simple coincidence of life—or they could be a sign of something bigger. If you’re in your late 30s or 40s, it could be a shift in your reproductive health. It could be perimenopause.
It’s an undeniable truth that many perimenopause symptoms are often brushed off as side effects of our busy, stressful lives or even misdiagnosed as something else entirely. Real Housewives of Beverly Hills star Dorit Kemsley experienced this first-hand, telling Women’s Health that she erroneously assumed her perimenopause symptoms were the result of post-traumatic stress disorder (PTSD) from a home invasion and her separation from husband PK.
Why is it that perimenopause—something millions of women go through—remains such a slippery diagnosis? And how can we actually tell if we’re in it? Asked and answered. (Hint: Get ready to get real comfortable with your menstrual cycle!)
Meet the expert: Mary Rosser, MD, PhD, is an ob-gyn and director of integrated women’s health at New York-Presbyterian/Columbia University Irving Medical Center. She is also a NAMS-certified menopause practitioner.
The Difference Between Perimenopause And Menopause
Menopause may be a more familiar concept to most. It occurs when a woman hasn’t had her menstrual cycle for 12 consecutive months. The average age for menopause in the U.S. is around 52 years old.
Perimenopause, on the other hand, is less widely understood, partly because of a lack of education and awareness around this transitional time and partly because its bounds are broader and squishier. The word perimenopause literally means “around menopause,” and it’s the period before menopause during which hormone levels start to fluctuate. The average age for perimenopause in the U.S. is around 47 years old, and while the average duration of perimenopause is four years, it can range from eight to 10, according to the Cleveland Clinic. With such a wide window, women could start experiencing symptoms as early as their mid-30s.
Why Perimenopause Symptoms Can Be So Hard To Pinpoint
There are a number of factors that make identifying perimenopause symptoms difficult. One is the life stage during which perimenopause typically occurs, says Dr. Rosser.
“We have aging parents. We have growing children, if we decided to have children. We have our relationships. Many of us have careers outside of the home. And then there's daily stresses. All of this is colliding for women in their 40s,” she explains. “It’s a little hard to tease out what could be perimenopause: Are the irregular periods due to stress or are they due to hormones changing?”
Another factor is that symptoms are often non-specific and could be indicative of a different condition or of aging in general. For instance, Dr. Rosser has seen patients complaining of joint pain get a full workup done by a rheumatologist to rule out an autoimmune disorder or osteoarthritis when, in reality, it’s actually perimenopause causing the stiffness and aches.
And, finally, if a woman simply isn’t paying attention to what’s going on with her body, she may not notice small symptoms and changes until they snowball over months and years and can no longer be ignored. (Hello, poorly timed hot flashes during that important client meeting!) All the more reason to keep tabs on any new or different symptoms you're noticing, either by keeping notes on pen and paper or in your phone, or by using a wearable like the menopause-friendly health trackers here.
Perimenopause Symptoms To Look Out For
While every woman will experience perimenopause differently, there are a handful of “typical” signs that could indicate you’re in this phase.
Irregular Periods
A change in your menstrual cycle is often the first symptom of perimenopause, says Dr. Rosser. “It could be going from every 28 or so days to a shorter interval, like every 21 to 24 days,” she says. “People could miss periods or there could be spotting or irregular bleeding.”
If you’re not already tracking your cycles, these subtle shifts could go unnoticed. That’s why Dr. Rosser recommends using a calendar to mark when your period starts, how heavy it is, and any other accompanying symptoms. (If you’d prefer a more high-tech method, there are plenty of wearables that can help you track perimenopause symptoms, like irregular menstrual cycles.)
If you start to notice significant changes in the amount you’re bleeding (i.e., your flow gets quite heavy), Dr. Rosser advises bringing it up with your doc, so she can eliminate fibroids or cysts as a potential cause (and make sure you’re not becoming anemic from blood loss).
Hot Flashes And Night Sweats
This sudden rise in body temperature affects an estimated 35 to 50 percent of perimenopausal women, according to Harvard Health. Again, the severity will differ from woman to woman—some may feel just slightly warm while others may start dripping sweat. It's worth keeping notes when you start to notice discomfort due to heightened body temperature throughout your days and nights.
Sleep Disturbances
Whether caused by night sweats or hormonal fluctuations, many women will find themselves snoozing less soundly during perimenopause. (Those 3 a.m. wake-ups are not a myth!) Dr. Rosser adds that poor Zs can lead to irritability and mood shifts the following day (additional signs of perimenopause).
Brain fog
An inability to concentrate or focus is another common sign, according to Dr. Rosser, and one that, like joint pain, sends some patients to a specialist. “People have gone to get testing with neurology and when the workups are negative they find out that maybe this is because of the hormonal fluctuations that are seen with perimenopause,” she says.
Weight Changes
Fluctuating hormones can result in a fluctuating waistline. That’s because as estrogen decreases, fat stores occur less in the hips and thighs and more in the midsection. Overall weight gain is also common for about 70 percent of women, according to the Journal of Health Psychology.
Vaginal Dryness
Along with a low libido (thanks dropping testosterone levels), many will also see shifts in their sexual health. Dryness could cause sex to become more painful.
How To Prep Accordingly For Perimenopause
Another factor further complicating the perimemopause diagnosis: There’s no silver bullet diagnostic to determine whether you’re actually in this phase or not. “It's not an easy blood test, and I know people would like it to be,” Dr. Rosser says.
Why can't it be a simple test, you ask? With hormone levels fluctuating so much, a one-and-done blood test only captures your levels at that moment in time—which could give misleading results. Even before perimenopause, hormones naturally fluctuate with your cycle and may be different from cycle to cycle, so Dr. Rosser doesn’t put too much stock in hormone testing for this purpose. Still, your ob-gyn may choose to do a hormone test to see if your follicle-stimulating hormone levels are elevated or to check thyroid function.
When it comes to a diagnosis, it all comes back to the symptoms. Dr. Rosser recommends working with a healthcare provider certified in menopause management to help monitor and analyze your symptoms to determine if you may or may not be in perimenopause.
Since irregular menstrual cycles are usually the first—and one of the most telling—indicators, tracking will be an important tool, so the sooner you can start notating your periods (even in your late 20s or early 30s) the more data you and your doc will have to work from. (If you have not noticed any changes, even subtle ones, to your cycle and, say, stress or sleep issues are your only symptoms, it never hurts to still address those things with your doctor—but they may not be related to perimenopause. Either way, your doctor will have a harder time untangling your symptoms without notes from you about when and what you're experiencing so they can spot patterns and better parse out if perimenopause could be at play.)
“After [at least] three to four months, we look at this together and we say, ‘What are your most bothersome symptoms?’ And then we can start walking down the road of treatment [options],” Dr. Rosser explains. This may look like lifestyle changes (think: diet and exercise), cognitive behavioral therapy (which Dr. Rosser says is still the gold standard for managing sleep issues), or hormone therapy.
Lifestyle Habits To Implement In Your 40s To Make Perimenopause More Comfortable
It’s never too early to get started priming your body for menopause, Dr. Rosser says: “The healthier that you can be starting early, the better off your perimenopause-menopause transition is going to be.”
Dr. Rosser likes to use the American Heart Association’s (AHA) Essential 8—which promotes habits like exercise, healthy eating, blood sugar and cholesterol management—as a general guidepost for healthful living (especially since heart disease is the No. 1 cause of death for women).
To that end, if you’re not already getting a blend of cardio and strength-training in your exercise routine, now’s the time to do it. The AHA recommends 150 minutes of moderate or 75 minutes of vigorous physical activity each week. Strength-training will not only aid in weight management but will help with bone density as you age. (If you’re not sure where to start with a resistance program, check out WH’s beginner’s guide.)
Now’s also the time to make healthful eating choices (are you getting enough protein?) and curb alcohol consumption (the body doesn’t metabolize alcohol as well during menopause).
Finally, ensure you’re prioritizing sleep: Adults need seven to nine hours per night, according to the AHA, to help prevent chronic diseases, promote brain function, and aid in healing.
And if you’re in your 30s or 40s and haven’t established these health habits yet, Dr. Rosser says not to worry too much: “It's never too late to get back on track.”
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