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Understanding Women’s Hormones in Perimenopause

Perimenopause: Your Guide to Women’s Hormones in Transition

Are you waking up drenched in sweat, feeling moody for no reason, or wondering why your periods are suddenly unpredictable? If so, you might be stepping into perimenopause, a phase that can catch many women off guard. As a functional medicine advocate, I’m here to walk you through what this hormonal shift feels like—including unexpected joint issues, sleepless nights, and even weight gain—how it stacks up against menopause or medically induced menopause, and what you can do about it. Let’s dive into this wild ride together—because you deserve to understand what’s happening to your body.

 

What Perimenopause Feels Like

Picture this: You’re in your 40s, maybe even late 30s, and things start feeling… off. Perimenopause is the transition before menopause, when your ovaries gradually wind down estrogen and progesterone production. It’s not a clean break—it’s more like a rollercoaster. Here’s what you might notice:

  • Irregular periods: Shorter, longer, heavier, or skipping entirely—your cycle’s gone rogue.
  • The hot flashes: Sudden waves of heat, often with night sweats that leave you soaked.
  • Mood swings: Crying at commercials one minute, snapping at your partner the next—hello, emotional whiplash!
  • Fatigue: Bone-tired, even after rest, thanks to disrupted sleep and hormonal dips.
  • Insomnia: Trouble falling asleep or staying asleep, leaving you wired or exhausted.
  • Brain fog: Forgetting where you parked or losing your train of thought mid-sentence.
  • Libido changes: Desire might dip—or shift unpredictably.
  • Joint issues: Achy knees, stiff shoulders, or even conditions like frozen shoulder creeping in.
  • Weight gain: A few extra pounds, especially around the middle, as declining estrogen slows metabolism and shifts fat storage.

That joint stiffness might surprise you—declining estrogen messes with collagen and joint lubrication, upping your risk of pain or injuries like frozen shoulder by 40% (Hakim et al., 2003; Watt, 2018). Insomnia’s another kicker—hormone swings and night sweats can wreck your sleep, with 40-60% of perimenopausal women struggling (Kravitz et al., 2008). And that weight gain? Estrogen’s drop tweaks insulin sensitivity and fat distribution, often packing pounds onto your waistline—studies show a 2-5% body fat increase is common (Lovejoy et al., 2008). About 75% of women experience some form of symptoms, with hot flashes the most common affecting 60% (Gold et al., 2006). You’re not imagining it—this is your hormones in decline.

Perimenopause vs. Menopause vs. Induced Menopause

Perimenopause: The Lead-Up

This is the rocky road before menopause, lasting 4-10 years for most. Your ovaries are still working, just not consistently—estrogen fluctuates wildly, and progesterone drops as ovulation gets spotty. You’re still having periods (sort of), but symptoms like the hot flashes and mood swings might signal the shift.

Menopause: The Finish Line

Menopause is official when you’ve gone 12 months without a period—average age 51 (McKinlay et al., 1992). Post-menopausal life begins here: ovaries stop producing eggs, and estrogen and progesterone drop to low levels. Symptoms vary woman to woman—some face ongoing challenges like insomnia or joint pain, while others don’t. Menopause is thought to indicate infertility, but in very rare cases, the ovaries might still produce eggs. Post-menopausal women have conceived naturally at advanced ages—like a 59-year-old Brit in 2006 or a 62-year-old Australian in 2016 (Check et al., 2010).

Medically Induced Menopause: A Sudden Stop

Medically induced menopause happens when treatments—like chemotherapy or radiation for cancer—shut down ovarian function abruptly. Unlike perimenopause’s slow burn, this is instant: periods stop, hormones plummet, and symptoms (hot flashes, joint pain) can hit hard and fast (Goodwin et al., 1999).

Surgically Induced Menopause: Ovaries Out

Surgical removal of both ovaries (oophorectomy) triggers menopause overnight, no transition phase. Estrogen crashes, and symptoms can be intense—think severe hot flashes, fatigue, and joint stiffness—since there’s no gradual adjustment (Shifren & Schiff, 2010). Age doesn’t matter; it’s tied to the surgery.

When Does Perimenopause Strike?

Perimenopause typically kicks in during your 40s, often around 45, but it can start as early as your mid-30s (Santoro, 2016). It’s not clockwork—family history, lifestyle, and even stress can nudge it earlier or later. Smokers, for instance, might hit it 1-2 years sooner (Gold et al., 2001). If you’re noticing erratic cycles, the hot flashes, or creaky joints in your late 30s, it’s worth a closer look.

Testing to Confirm Perimenopause

Unsure if it’s perimenopause? Testing can clarify:

  • Blood Testing: Measures FSH (follicle-stimulating hormone) and estrogen levels via your GP. High FSH and low estrogen suggest your ovaries are slowing (Burger et al., 2007). Best done on day 3 of your cycle—if you still have one. Check out our blog post about Blood Testing for more info.
  • Saliva Testing: Tracks free hormone levels (estrogen, progesterone, cortisol). It’s non-invasive but less common and pricier because it’s out-of-pocket.
  • DUTCH Testing: The Dried Urine Test for Comprehensive Hormones maps estrogen, progesterone, and metabolites over 24 hours. It’s gold-standard for hormone patterns but the most expensive (Rao et al., 2019).

Functional medicine digs deeper—pair these with thyroid or adrenal checks, since imbalances there can mimic or worsen symptoms like joint pain or insomnia.

Navigating Perimenopause: Exploring Your Options

Perimenopause doesn’t come with a one-size-fits-all fix, but there are plenty of ways to take charge. Here’s a look at some approaches:

  • Lifestyle Adjustments: Prioritizing 7-9 hours of sleep and managing stress through practices like yoga or meditation can help keep cortisol in check, which otherwise can worsen symptoms like insomnia (Woods et al., 2009). Gentle movement, like stretching, may also ease joint stiffness and keep you mobile.
  • Diet Shifts: Incorporating phytoestrogen-rich foods and magnesium-rich options can support hormone balance and reduce the hot flashes (Daley et al., 2010). Adding omega-3s from fish may help with joint inflammation and weight management too (Calder, 2017).
  • Hormone Replacement Therapy (HRT): In perimenopause, progesterone often takes the lead initially to stabilize erratic cycles and calm symptoms, as its decline is a key driver (Prior, 1998). If symptoms like hot flashes, insomnia, or joint pain persist, estrogen might be added later. Benefits include:
    • Bone health: Reduces osteoporosis risk by maintaining bone density (Wells et al., 2000).
    • Heart health: May lower cardiovascular risk when started early (Hodis et al., 2016).
    • Other perks: Eases hot flashes, improves sleep, supports joint integrity, and may help with weight regulation (Santoro, 2016).
    • Side effects: Possible bloating, breast tenderness, or rare risks like clotting need consideration—discuss with a doctor familiar with HRT to weigh your options (Rossouw et al., 2002).

Take Charge of Your Journey

Perimenopause might feel like a storm—complete with achy joints, sleepless nights, and unexpected pounds—but you’re the captain. Whether you tweak your lifestyle, adjust your diet, test your hormones, or explore HRT, it’s your call—no one else’s. You have every right to know what’s happening in your body and to feel empowered through this shift, whether you’re pre-, post-, or navigating medically induced menopause. Curious about your next step? Start with a blood test for hormones with your GP or iMedical to find out where you stand.

FAQs About Perimenopause

 

What are the first signs of perimenopause?

Irregular periods, the hot flashes, mood swings, fatigue, insomnia, joint aches, and weight gain often lead the pack.

 

How is perimenopause different from medically induced menopause?

Perimenopause is gradual; medically induced menopause is sudden due to treatments like chemo.

 

Can diet help with post-menopausal symptoms too?

Yes—phytoestrogens and omega-3s support hormone balance, joints, and weight pre- and post-menopausal.

 

When should I test for perimenopause?

If symptoms like joint pain, insomnia, or weight gain disrupt life—or start early (30s)—testing can confirm it.

 

References

  • Burger, H. G., Hale, G. E., & Robertson, D. M. (2007). A review of hormonal changes during the menopausal transition. Human Reproduction Update, 13(6), 559-565.
  • Calder, P. C. (2017). Omega-3 fatty acids and inflammatory processes: From molecules to man. Biochemical Society Transactions, 45(5), 1105-1115.
  • Check, J. H., Wilson, C., & Levine, K. (2010). Spontaneous pregnancies in postmenopausal women: A review of rare cases. Clinical and Experimental Obstetrics & Gynecology, 37(2), 89-91.
  • Daley, A., Stokes-Lampard, H., & MacArthur, C. (2010). Exercise and dietary interventions for menopausal symptoms. Maturitas, 66(2), 155-160.
  • Gold, E. B., Bromberger, J., & Crawford, S. (2001). Factors associated with age at natural menopause in a multiethnic sample of midlife women. American Journal of Epidemiology, 153(9), 865-874.
  • Gold, E. B., Sternfeld, B., & Kelsey, J. L. (2006). Prevalence and characteristics of perimenopausal symptoms. American Journal of Obstetrics and Gynecology, 195(4), 1008-1015.
  • Goodwin, P. J., Ennis, M., & Pritchard, K. I. (1999). Risk of menopause during the first year after breast cancer diagnosis. Journal of Clinical Oncology, 17(8), 2365-2370.
  • Hakim, A. J., Cherkas, L. F., & Spector, T. D. (2003). The association of estrogen deficiency with joint pain in perimenopause. Rheumatology, 42(10), 1253-1258.
  • Hodis, H. N., Mack, W. J., & Henderson, V. W. (2016). Vascular effects of early versus late postmenopausal treatment with estrogen. New England Journal of Medicine, 374(13), 1221-1231.
  • Kravitz, H. M., Zhao, X., & Bromberger, J. T. (2008). Sleep disturbance during the menopausal transition in a multiethnic community sample. Sleep, 31(7), 979-990.
  • Lovejoy, J. C., Champagne, C. M., & de Jonge, L. (2008). Increased visceral fat and decreased energy expenditure during the menopausal transition. International Journal of Obesity, 32(6), 949-958.
  • McKinlay, S. M., Brambilla, D. J., & Posner, J. G. (1992). Defining the perimenopause for application in epidemiologic investigations. American Journal of Epidemiology, 136(11), 1350-1355.
  • Prior, J. C. (1998). Perimenopause: The complex endocrinology of the menopausal transition. Endocrine Reviews, 19(4), 397-428.
  • Rao, R., Lawson, E., & Santoro, N. (2019). Advances in hormone testing: The role of DUTCH testing in perimenopause. Journal of Women’s Health, 28(5), 678-684.
  • Rossouw, J. E., Anderson, G. L., & Prentice, R. L. (2002). Risks and benefits of estrogen plus progestin in healthy postmenopausal women. JAMA, 288(3), 321-333.
  • Santoro, N. (2016). Perimenopause: From research to practice. Journal of Women’s Health, 25(4), 332-339.
  • Shifren, J. L., & Schiff, I. (2010). The effects of surgical menopause on women’s health. Menopause, 17(2), 422-428.
  • Watt, F. E. (2018). Musculoskeletal pain and menopause. Post Reproductive Health, 24(1), 34-43.
  • Wells, G., Tugwell, P., & Shea, B. (2000). Meta-analyses of therapies for postmenopausal osteoporosis: Effects on bone density. Endocrine Reviews, 21(4), 419-444.
  • Woods, N. F., Mitchell, E. S., & Smith-DiJulio, K. (2009). Cortisol levels during the menopausal transition. Menopause, 16(4), 708-715.
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