Perimenopause explined

Right, let's talk about perimenopause - the reproductive equivalent of a mystery novel where nobody tells you who the villain is until halfway through. Dr Rajita Patil from UCLA Health's Comprehensive Menopause Care program has some enlightening things to say about this particularly confusing chapter of our lives.

Perimenopause is essentially the warm-up act before menopause's main event. You can start experiencing symptoms as early as your 30s, which explains why you might have been wondering if you're losing your mind rather than entering a new life stage. The symptoms are so varied that even doctors sometimes miss the connection.

The official definition depends on how reliable your period is or if it suddenly becomes unreliable. If you've been regular like clockwork for years and suddenly your period shifts by several days, that's perimenopause signalling its start. Of course, if you've always been irregular, this becomes as helpful as a chocolate teapot for diagnosis.

Hormonal birth control masks perimenopause completely, which means you could be deep in the transition without realising it. There's no definitive test, but FSH (follicle-stimulating hormone) levels over 25 suggest perimenopause, and over 50 make it highly likely.

The sneaky bit is that your sensitivity to the natural pre-period estrogen drop increases during perimenopause. So symptoms you might have barely noticed before - mood changes, PMS, fatigue - suddenly become much more pronounced. As hormone levels continue their downward trajectory, estrogen receptors throughout your entire body start complaining loudly.

Everyone knows about hot flushes, night sweats, vaginal dryness, and mood swings. But perimenopause has a whole arsenal of lesser-known symptoms that can leave you thinking you're developing multiple unrelated health issues:

• Anxiety and depression (new or worsening)
• Brain fog and fatigue 
• Disappearing libido
• Heart palpitations that make you wonder if you're having a cardiac event
• Hair loss (because apparently losing your marbles isn't enough)
• Insomnia that leaves you staring at the ceiling at 3 am
• Joint pain like you've aged 20 years overnight
• Muscle aches for no apparent reason
• Sudden urgent need to find a loo immediately
• Skin that's drying up like autumn leaves

Dr. Patil highlights that menopause is about more than just symptoms; the changing levels of estrogen can also increase risks such as osteoporosis and heart disease. Luckily, hormone therapy offers relief from hot flushes, mood swings, joint pain, or sleep problems, and helps protect bones, while options like fezolinetant specifically target hot flushes. 

When hot flushes are managed, many women find that their sleep, mood, and mental clarity improve. Making healthy lifestyle choices—such as staying active, eating well, and getting enough rest—play a crucial role in maintaining a healthy weight, strengthening bones, caring for the heart, and improving sleep quality. Dr. Patil encourages women to keep track of their symptoms and speak up for the care they deserve, so they don’t have to face these challenges alone.

‍