Prelude to Perimenopause: The Very First Signs of Change

What is pretty infuriating in the current menopausal conversation is the misconception that perimenopause only starts once our cycles become irregular. Well, what about those women who for most of their life have irregular cycles?

Also, this point of view is reducing menopause to just a reproductive transition, whereas the symptoms of perimenopause are largely neurological in nature.[1] So certainly, there will be some changes in our menstrual cycle, but

we might experience a cascade of other symptoms, some only just about noticeable, way before our periods are going to start to change.

So, let’s dive in. But before we discuss the symptoms, let’s first understand when some of the initial signs of perimenopause might kick in.

A woman's peak reproductive years are between the late teens and late 20s. By 30, fertility starts to decline.This decline happens faster once you reach your mid-30s.

The end of our fertile years is signalled by the first onset of more-often-than-usual anovulatory cycles (remember, occasionally it’s okay not to ovulate, life/stress etc can affect that). And, even if we do ovulate, the production of progesterone inevitably starts to decline. Yes, progesterone is the first one to say bye-bye and it is usually the culprit of our first perimenopausal symptoms.

Image 1. Estrogen and progesterone over a woman’s lifetime.[2]

The very first signs of perimenopause might be starting while you are still having regular periods.

Unfortunately, if you were taught anything about female physiology in school, you’ve probably heard that a sign of a healthy menstrual cycle is a regular bleed. But that’s only half of the story.

Ovulation is the second most important event in our cycle, if not the most important one.

We cannot produce progesterone without it and this hormone is just as important as estrogen. It’s like our Yin to our Yang to keep us in hormonal balance.

To name just a few functions of progesterone:

• It lightens our periods (hello heavy bleeders);

• It is a soothing hormone, without it we find it harder to relax, fall asleep or we get more easily upset or angry;

• Reduces inflammation and risk of cancer (by counterbalancing estrogen).

*Note, if you have a hormonal IUD fitted - there is no progesterone there. Instead, there are progestins, which are similar to progesterone but not the same.

So, the older we get past our fertility peak, the more progesterone production declines.

Therefore, the very first 9 possible symptoms of perimenopause[3] include:

• Worsened period pain

• Heavier periods

• Shorter (at first) menstrual cycles (< 26 days)

• Painful, lumpy breasts

• Difficulty sleeping, including mid-sleep waking

• Premenstrual night sweats

• New or increased premenstrual mood swings

• New or markedly increased migraine headaches

• Weight gain without changes in exercise or eating

Some of the symptoms, especially the ones related to our nervous system and ability to cope with stress (while the progesterone starts to decline) could be very subtle. One example would be the sudden change from being a confident driver to someone who’s not (me at the age of 39!).

Then the period of highly fluctuating estrogen kicks in, with levels often sky-high.

This only adds more fuel to the fire. Estrogen amplifies the stress responses of cortisol and norepinephrine to any already existing stress.

Luckily, the estrogen storm eventually subsides and flatlines by which point, a year or two after menopause, our body and brain and all the other organs that heavily rely on estrogen finally recalibrate themselves to lower levels of sex steroid hormones.

Questions? Thoughts? Let me know in the comments below.

[1] Perimenopause as a neurological transition state

[2] Estrogen and Progesterone, the Cornerstone of BHT

[3] The Estrogen Errors: Why Progesterone is Better for Women's Health; Susan Baxter PHD, and Jerilynn C. Prior MD