Health
6 Sneaky Symptoms Of Perimenopause
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Health
6 Sneaky Symptoms Of Perimenopause
If you’re in your 40s, you’ve probably reached—or are very quickly approaching— perimenopause. Don’t panic, we have all the information you need to navigate this phase.
Sweating through a Zoom meeting? Crying in the shower? Forgot 2 your Netflix log-in—again? Check, check, check. These seemingly random symptoms could actually be signs of perimenopause.
The stretch of years leading up to menopause (the one-year anniversary of your last menstrual cycle) is known as perimenopause—the transitional time leading into menopause, a natural process in which your ovaries stop producing eggs and the reproductive phase of your life comes to an end. The average age Canadian women hit menopause is 51, and the average duration of perimenopause is about four years, although it may only last a few months or extend to a decade, depend- ing on the person. Because there is no test to definitively diagnose it, no two women experience this phase in the same way, and since there are 34 recognized symptoms of perimenopause, it might be tricky to tell if you’re in it.
“It can be difficult because there are a lot of possible symptoms and many of them overlap with other health issues,” says Dr. Michelle Jacobson, an OB/GYN, menopause specialist and assistant professor in the department of obstetrics and gynaecology at the University of Toronto. Fortunately, once you figure out what's going on, there are a number of supports, strategies and treatments that can help. "Really there has never been a better time to be in perimenopause," she says.
6 Signs That You're Approaching Perimenopause
Irregular periods
During perimenopause, periods can be wildly irregular as ovulation becomes erratic. This can leave you racing for a vending machine for emergency tampons—or blessedly period-free during a beach holiday. The length of time between periods can be longer, you may skip some periods altogether or you may just have spotting. On the other hand, you might experience unusually heavy flows that last longer than your periods used to, or that come more frequently.
Abnormal and irregular periods might be the new normal during perimenopause, but you don’t have to be at the mercy of their unpredictability. Keep a stash of just-in-case period products in your purse and make note of when you have a flow and what it’s like. “It’s very important to keep a menstrual calendar,” says Dr. Shafeena Premji, medical director of Mahogany Medical Clinic in Calgary and board member of the Canadian Menopause Society. You can use it for reference when you talk to your doctor about your symptoms. If you experience excessive or prolonged bleeding, blood clots or have bleeding after sex, make an appointment right away (so you can rule out a possibly serious underlying issue).
Moodiness, Depression & Anxiety
If you’re finding that your emotions are all over the place, you’re not alone. About four in 10 women notice major mood symptoms during the transitional years into menopause. There may be irritability and low energy that feels similar to PMS, even when you aren’t menstruating. Women are also vulnerable to depression during perimenopause and the years right after menopause, with rates of major depression doubling for women during these life stages. Anxiety, irritability, memory loss and poor concentration are additional mood-related symptoms that many women experience to varying degrees.
“Plus, perimenopausal women in their 40s are a sandwich generation, and may have all the stressors of children, aging parents and being at the height of their careers compounding their disruptive symptoms,” says Dr. Jacobson. “All of this can have a big impact on mood.” If you’re concerned about frequent or dramatic mood swings or your risk of depression, talk to your primary health care provider.
Vaginal Changes
Suddenly experiencing pee leaks during Pilates class, a string of urinary tract infections (UTIs), and pain during sex are all symptoms that can be attributed to plummeting estrogen levels. “Genital urinary symptoms, including itching, burning, abnormal discharge and over active bladder, are all common,” says Dr. Jacobson. There can be a thinning of the lining of the urethra (the tube that passes urine from the bladder) and weakening of pelvic muscles that can contribute to urinary incontinence issues. Those changes to the urethra and bladder can also make you more vulnerable to bacterial infections. And as tissues of the vulva and lining of the vagina thin, they can become “drier and less elastic, which can lead to uncomfortable itching and burning and make intercourse less pleasurable. Talk to your doctor about treatments, and in the meantime reach for a vaginal lubricant to get some relief.
Aches & Pains
As your body adapts to the hormonal changes of perimenopause, it's not unusual to have a few more aches and pains. If you find that an old skating (or newish pickleball) injury is acting up more than you would expect, it could be connected to the decline in estrogen, too. Estrogen helps reduce inflammation, and without it many women notice more stiff ness and swelling. That, combined with carrying a few extra pounds (weight gain is also typical during this life stage) and a decline in bone density, can lead to low back pain, aching ankles, stiff shoulders and more. Applying heat, or soak ing in a hot bath, can soothe sore spots.
Hot Flashes
“Eighty percent of women will experience hot flashes,” says Dr. Premji. For some, it’s a sensation of mildly overheating that can be bit uncomfortable or annoying, but manageable. For 10 to 15 percent of women, though, hot flashes can be so intense that they disrupt daily life, making it impossible to lead a meeting or get to a dinner date on time, or even to sleep through the night. (Hello, night sweats! More on that below.)
What causes a woman to get all hot and bothered—at random, any time of the day and night? “It is a loss of control of the thermoregulatory centre in the brain due to the decrease in estrogen levels,” says Dr. Premji. And when the hypothalamus senses that you are too warm, it sets off an unfortunate series of actions to cool you down. Cue the hot, red skin (for those who are fair) and profuse sweat- ing. For women in perimenopause and menopause, hot flashes happen over an average period of seven years, but some experience them for longer. Avoiding triggers like caffeine and spicy foods, dressing in cool layers and practicing relaxation exercises can all help.
Poor Sleep
Not being able to catch enough z’s is a major complaint during perimenopause. As many as 46 percent of women have difficulty sleeping. This is often related to nighttime hot flashes but can also be caused by depressive symptoms or anxiety. Strange, intense dreams that keep you up in the wee hours are also common during these years. You may need to get serious about preserving your sleep by avoid- ing alcohol and caffeine, keeping your bedroom dark and quiet, and maintaining a strict bedtime to set you up for the best possible night’s rest.
While there can be many tricky symptoms to navi- gate, perimenopause can be a positive milestone, says Dr. Jacobson. “This can be a difficult time, but it can also be very liberating,” she says. “You’re moving into this next phase of your life that has very different demands and expectations.”
Treating Perimenopause
If any of your symptoms are bothering you, talk to your doctor. “It’s really important that women advocate for themselves,” says Dr. Jacobson. There are a range of treatments that can help, including hormone therapy (using estrogen or progestins via oral tablet, injection or cream, to even out hormone levels), cognitive behavioural therapy and lifestyle changes like getting enough exercise and sleep, as well as eating a balanced diet.
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