I am 47 years old and was today when I realized I had been suffering from perimenopause for four years. Only with hindsight can I look back over my last four years and detect intermittent symptoms or even just mild bothersome symptoms that I can say are probably due to perimenopause.
What is perimenopause? Perimenopause is the transition stage before reaching menopause, which is defined as 12 months of continuous amenorrhea (or absence of menstrual cycles). According to the Menopause Society, formerly known as NAMS or the North American Menopause Society, menopause can begin as early as age 45. Perimenopause, or the transition or journey into menopause as I would like to describe it, can last anywhere from 1 to 10 years. Thus, a woman can present symptoms of perimenopause from the age of 35. This was an eye-opening statistic for me and something I didn't know before deciding to pursue additional certification to become a menopause specialist.
In a physiological sense, perimenopause has been called the “chaos zone.” For what? as it is marked by significant fluctuations in important hormones, namely estrogen, progesterone and testosterone. So symptoms do not necessarily arise because of psychological stress, the burden we carry as a physician mother, or environmental triggers. Perimenopausal symptoms literally occur due to the rapid decline in hormone levels and the compensatory increase in a pulverized ovarian reserve.
Currently I have pathognomonic hot flashes, night sweats and cycle changes. So it goes without saying that I go through this. I can count 14 symptoms that I currently have or have had that I can attribute to perimenopause. Some are mildly inconvenient levels, and others are quality of life changing levels that I can now only relate to the perimenopausal state.
Annoying symptom #1: dry eyes. I have worn monthly and extended wear contact lenses for at least 20 years. Over the last 5-6 years I have noticed that they “dry out” more easily. Being a good patient, I followed my optometrist's recommendations and switched to daily care. I was told that my dry eyes could be due to too much screen time – which I completely understand and accept as an aggravating factor. Over the past three years, however, even the dailies were getting boring before my day was over, so we upgraded and tried other “breathable” brands. I would apply re-moistening drops before the end of my day. It wasn't until later that I realized that dry eye could be a part of perimenopause and menopause. This article delves deeper into the issue.
The bottom line is that dry eye is more common in middle-aged women and is thought to be due to changes in the balance of sex hormones – estrogens and androgens – which influence the production of all components of the tear film.
Life-changing symptom #1: insomnia. Insomnia is complicated. The 3P theory of predisposing, precipitating and perpetuating factors shows the bio-psycho-social complexity of sleep and lack of sleep. This is why it was so easy for me to ignore my insomnia and attribute it to so many things – life, stress, I even convinced myself that maybe I had subtle anxiety (even though I didn't really think I was anxious). . I dove into remedies and such and learned about cognitive behavioral therapy for insomnia. However, over the past three years, sleep has become more elusive, with more frequent random nighttime awakenings and inability to go back to sleep. Again, it wasn't until later that I realized it might have been due to my hormonal fluctuations. Sleep information from NAMS.
Current opinion is that decreased estradiol and increased follicle-stimulating hormone, progesterone, and testosterone may negatively modulate sleep-wake behaviors and contribute to increased risk of sleep disorders and d insomnia in women transitioning to menopause.
Why am I writing this? Giving voice to the fact that symptoms experienced by middle-aged women may be due to a physiological change in our hormones. Hormonal changes are real and based on scientific facts that have been known for many years! Yet recognition that our symptoms may be due to perimenopause is still not accepted by mainstream medicine as a valid differential diagnosis. I am not suggesting that hormone therapy should be started immediately in everyone, but we need to at least give credence to the concerns raised by middle-aged women and see if the symptoms might be part of the transition state and be validated.
Caïssa Troutman is a family physician and specialist in obesity medicine.