Perimenopause Part 1: The Signs, The Symptoms and How We Feel About it
Menopause is a hot topic right now, and with good reason. People experiencing perimenopause are more vocal about it and attempting to change the narrative. Women are taking action rather than passively undergoing unwelcome changes.
What Makes Exploring Perimenopause so Challenging?
While transparency is reducing stigma and building community around this shared experience, it’s also revealing how little we – both the medical community, and the general population – really know about this stage of life. Furthermore, how to best support our patients and ourselves through it. This creates opportunity for misinformation and conflicting advice to run rampant. Thus, making an already unpredictable phase even harder to navigate.
Where Do We Start?
It can help to start with the science and terminology. Let’s explore what is actually happening in the body during the period of time called the menopausal transition.
What Are We Talking About?
“Menopause” is often used to describe the entire transitional period when someone gradually stops menstruating, but there are actually multiple stages. Here’s how it’s broken down:
Premenopause/reproductive stage: time from first period onward; for people with regular menses, hormone levels and menstruation will cycle predictably.
Perimenopause/menopausal transition: cycles become irregular, hormone levels are unpredictable. In early perimenopause, cycles start to vary by more than 7 days. Late menopause is defined when at least two periods are missed in a row.
Menopause: a “tipping point,” reached after 12 months of no menstruation. Hormone levels are now predictably low.
Postmenopause: everything after menopause. Hormones are stable, so symptoms typically stop.
What’s Happening with Hormones?
For people who have female reproductive organs, the ovaries produce estrogen and progesterone. During the menopausal transition, ovaries produce less of these hormones. However, rather than a steady decline, hormone levels are “sputtering,” which leads to fluctuations in hormone levels, and therefore, symptoms. Because hormone levels may look normal one day and wildly different the next, testing for perimenopause can be difficult.
As a result of these fluctuating hormones, a series of expected changes begin to occur:
- Menstrual cycle becomes less predictable
- Decreased lean muscle mass
- Increased fat in the midsection
- Mental health and cognitive changes – brain fog, depression, anxiety, and others
- Changes in food cravings and appetite – often increased
- Fatigue
Understandably, women are searching for solutions to these uncomfortable changes to their bodies and minds. Let’s dive a little more into the “why” behind some of the symptoms before we explore how to handle them.
“My Body Isn’t My Own Anymore”
This is a common feeling our clients express when they are in the menopausal transition. Just like puberty, this is a biologically determined, hormonally-driven, normal and expected time of change. That doesn’t make it easier to live through – especially in a culture that values youth and thinness – but normalizing the experience and knowing what to expect can help.
Appetite, Eating, and Body Changes
One of the first, and most commonly bemoaned, changes many women experience during perimenopause is increased fat around the midsection. In a culture that continues to value the thin ideal, this change can bring it with deep and difficult emotions, especially when “what worked before” doesn’t make a difference. Living in a changing body can be scary; feeling like you can’t control those changes, when we are taught by the diet industry that controlling our bodies is not only possible, but an expectation, can lead to significant body dissatisfaction, confusion, and disordered eating patterns.
As hormones change, so does almost every function in our body. Changes in mental function – which includes everything from mood and energy to mental clarity and appetite – are more ambiguous and difficult to identify than physical changes like weight gain, but they are really all intertwined.
Estrogen is a key player in the brain. It has a role in regulating our mood as well hunger/fullness hormones. When estrogen levels fluctuate, so do mood and appetite. Anxiety, depression, brain fog, and mood swings are common hallmarks of perimenopause, as well as reported increased appetite and cravings.
Progesterone is also active in the brain. It can support a sense of calm and mood regulation, and nutritionally, it plays a role in blood sugar regulation. Fluctuations in progesterone during perimenopause can contribute to increased cravings for sweets.
Cortisol increases during perimenopause, which can also increase appetite and cravings for sweet foods. Especially for women who have not historically had a sweet tooth, this change can feel sudden and unexpected and lead to feelings of “doing something wrong.”
To sum it all up, hormonal changes impact both mood and appetite, which leads to the changing eating behaviors that can be distressing: strong cravings, eating at different times, eating different types of food, and feeling like you have less “impulse control” around food. All of this happening simultaneously alongside changes in the way our body behaves physically can lead to increased negative body image and disordered eating patterns.Women are taught from a young age to blame ourselves and our bodies for completely natural processes – often that are designed to protect us. During periods of transition – puberty, pregnancy, childbirth, menopause, and other big life changes – this can be even more prevalent. It can feel easy to feel shame, confusion, or self-blame, when all our body is doing is trying to survive!
So, What Do I Do?
Knowing that there is a biological reason for these symptoms can help reassure women that it’s not “all in our heads!” The good news is that these changes are generally temporary and tend to improve after menopause is reached. In the meantime, working with a therapist or dietitian can help with navigating this transition. A professional can help guide you through tolerating the distress of change, and make space for goals beyond weight loss that might actually make this period of time a bit more comfortable. In future blogs in this series, we’ll touch on some of those areas, including nutrition and lifestyle changes to help you feel empowered and in control. Stay tuned!
