How do I know if I am in Perimenopause?

Perimenopause is a natural phase in a woman’s life, but it’s often difficult to diagnose because the symptoms can overlap with other conditions. Many women find themselves experiencing a variety of physical, emotional, and mental changes that are commonly attributed to stress, aging, or other health issues. This can make it challenging for both women and their healthcare providers to pinpoint that they’re actually in the perimenopausal phase.

As a result, women may spend years dealing with symptoms like brain fog, insomnia, anxiety, and depression, without fully understanding what is happening in their bodies. Recognizing perimenopause is crucial, as it allows women to make informed decisions about their health and well-being during this transitional period. Understanding what to expect can empower you to navigate this time with a lot more ease and confidence.

What is Perimenopause?

Perimenopause refers to the period of time before menopause, when your body starts to transition into its non-reproductive years. It typically begins in our 40s, but for some women, it can start as early as 35 years old. During this phase, our ovaries gradually produce less hormones, leading to hormonal fluctuations that may cause a range of symptoms. While every woman’s experience is unique, perimenopause can last anywhere from a few months to several years.

How to Diagnose Perimenopause

Diagnosing perimenopause can be challenging as there is no universal consensus in the medical community, and different doctors may use varying methods that may or may not include hormonal testing.

According to Dr. Aviva Romm, renowned MD, midwife and herbalist, in her book Botanical Medicine for Women's Health, hormonal markers for perimenopause include a luteinizing hormone (LH) level greater than 50 mIU/L and an estradiol level less than 50 pg/mL. However, because hormone levels fluctuate during this transition, a diagnosis may not be clear-cut, and women often need to rely on a combination of test results, symptoms and medical history.

According to ND Lara Briden, an expert in women’s hormonal health, perimenopause cannot be diagnosed solely based on lab tests. Instead, she typically diagnoses it based on age and symptoms. Dr. Briden relies on the guidelines created by Canadian endocrinology professor Dr. Jerilynn C. Prior. According to Dr. Prior’s guidelines, a midlife woman with regular cycles is likely in perimenopause if she experiences at least three of the following nine changes:

1. new-onset heavy and/or longer periods

2. shorter menstrual cycles (<26 days)

3. sore or swollen breasts

4. mid-sleep waking

5. increased menstrual cramps

6. premenstrual night sweats

7. new or increased migraine headaches

8. heightened premenstrual mood swings

9. or weight gain without changes in exercise or diet

If you're over 37 and experience at least three of these symptoms, it's likely you are entering perimenopause, provided other conditions have been ruled out.

What is my Approach?

When it comes to addressing the changes of perimenopause, I primarily focus on symptoms, as they are often the best indicator of what’s happening in your body. However, I believe hormonal testing can be a very helpful tool to guide treatment and ensure a comprehensive approach.

If you suspect you are in perimenopause, it’s crucial to find a practitioner who is experienced and will take your symptoms and quality of life seriously. For most women, having a healthcare team that includes a holistic practitioner like myself to support your body with the right diet, supplements, and herbal remedies, along with an MD and/or ND who can request testing and prescribe hormones when necessary, is key. This kind of support is important regardless of whether you choose to pursue hormone replacement therapy or not.