Unpredictability of Perimenopause

Have you ever tried to predict Chicago’s weather in mid-summer? Then you’ve got a pretty good idea of what navigating perimenopause feels like. Just when you think you’ve got it figured out, it throws you a curveball. Let’s talk about this unpredictable phase of our lives that, believe it or not, is just as normal as those sudden weather changes.

Unpredictable, Just Like the Weather

Many women enter perimenopause in their early to mid-40s, but the changes can start in a woman’s mid-30s. Perimenopause may begin 5 to 10 years prior to menopause. Remember how we plan our days around the weather, especially during those unpredictable summer months in Chicagoland? Perimenopause is kind of like that. We’re cruising along with our regular menstrual cycle, and then suddenly, it’s like the weather changes – our bodies start doing their own thing. It’s this transition period before menopause where our hormones seem to be as fickle as a summer storm, and honestly, it can be just as confusing.

During this time, the demands on women intensify. Many of us are at the peak of our careers, deep in the throes of parenting, or starting to care for aging parents—all with the background of changing hormones. This balancing act can amplify the stress and confusion of perimenopause, making it even more challenging to navigate. Recognizing and addressing these compounded stressors is crucial for our overall well-being.

Trying to get help for perimenopause can sometimes feel like trying to get a straight answer about tomorrow’s weather – it’s hit or miss. You might be told your hormone levels are ‘normal,’ or even be misdiagnosed with depression or anxiety. But here’s the thing: perimenopause is more about how you’re feeling than what a test says. It’s about finding a healthcare provider who gets that. There is no hormonal test to determine whether you are in perimenopause or not. I will always search for other diagnoses before deciding symptoms are due to perimenopause. Women’s complaints are often minimized; you’ll find sometimes you need to be a stronger advocate or search out doctors that will listen to you.

The Perimenopause Forecast

As our ovarian egg counts decline, it sets off a chain reaction in our hormone levels. The declining estrogen levels cause our body’s internal weather system to get all stirred up. Now, let’s break down what this really means for us. Hot flashes? They can hit you like those sudden heatwaves. Night sweats? Think of them as those unexpected thunderstorms at night. And mood swings – they’re pretty much like those quick wind changes, coming and going without much warning. Not to mention the irregular periods, which are as unpredictable as those days when you can’t decide whether to carry an umbrella or wear sunglasses.

Choosing Your Treatment

When it comes to treating perimenopause, it’s about finding what works for your body, just like picking the right outfit for a day’s weather.

I recommend the pill for perimenopausal symptoms if there are no contraindications. You might be wondering, “The birth control pill, at this stage?” Absolutely. It’s a low-dose combination of hormones that helps even out those wild hormonal fluctuations while providing reliable form of birth control (which we still need.) You don’t have to remain on the birth control pill forever, but you can stay on it up to age 55. At that point, most patients are considered menopausal and can then start hormone replacement therapy (HRT.)

HRT is another route, and it’s worth discussing with your doctor. It’s usually a lower dose of hormones compared to the birth control pill so you may experience continued symptoms more readily that the traditional pill . Keep in mind, though, it’s not a one-size-fits-all solution and doesn’t double as birth control. You may also need progesterone depending on whether you have a uterus or not.

What if hormones are not your thing or an option for you?

• SSRIs: For many of us, hormone therapy can be a game-changer. If hormone therapy isn’t right for you, certain SSRIs (like paroxetine or venlafaxine) can be a great alternative. These are often used for depression but can be effective for hot flashes too.

• Non-Hormonal Prescription Options: Here’s where it gets interesting. Low-dose paroxetine and Veozah  are FDA-approved non-hormonal treatment specifically for hot flashes. But other medications, like gabapentin and clonidine, often used for entirely different conditions, have been found to help with hot flashes and night sweats.

• Lifestyle Adjustments and Alternative Therapies: Sometimes, the best approach involves no prescriptions at all.  Cognitive behavioral therapy (CBT), yoga, and even acupuncture have helped some us in managing perimenopause symptoms. And never underestimate the power of diet – plant-based foods like soybeans and flaxseed can also help. But remember, the data behind these treatments in not strong and I would not consider these evidence based treatments.

• The Power of a Holistic Approach: Remember, addressing one health issue can sometimes improve others. For instance, improving your diet might not only help with weight management but also reduce hot flashes. It’s all about finding the right balance, just like layering up or down depending on the day’s weather.

Navigating This Together

Navigating perimenopause is a bit like getting through those unpredictable summer months in Chicago – it’s all about being prepared and knowing you’re not alone. This phase is a big part of our lives, and understanding it helps us manage it better. Let’s keep the conversation going, share tips, and support each other through this. After all, just like the weather, perimenopause is a normal, albeit sometimes challenging, part of life.