The Risks of Perimenopause: What You Need to Know

Are you or anyone you know suffering from perimenopause? Most people don’t know what it is. When they go to a health care provider, they are either drugged or dismissed. They are told they are stressed or just normal and it will pass. 

This is a time of life when estrogen fluctuates and levels of progesterone decline due to lack of eggs, lack of ovulation or insufficient amounts of progesterone to balance the growth and stimulation effects of estrogen. It is a very difficult and confusing time of life for many women. Symptoms can lead to anxiety, depression, costly work ups and loss of work and/or the inability to fully participate in home and social life. 

During perimenopause, a lot of damage can be done so it behooves you to be aware of the symptoms and take action. 

Age of Onset

• Perimenopause usually starts in the mid 40’s and can start earlier, as soon as 30.
• It can last around 10 years.
• Many symptoms overlap with symptoms of menopause.

According to a 2022 survey:¹

The most common symptom of perimenopause is mood change.

• These mood changes can have devastating effects on relationships. Many men seek me out to help their wives. They see the changes in their mood and personality, and everyone suffers. One woman said: “My husband says I am unbearable. I spent the last 8 years going to doctors and spent thousands of dollars. No one found anything.” When I told her that she was in perimenopause, she broke down in tears and said: “Why didn’t anyone tell me this before?”

More symptoms

Perimenopause is an under recognized condition. There are about 34 different symptoms. Do you have any of these?

1. Change in mood
2. Poor memory
3. Lack of sleep
4. Irritability
5. Vaginal dryness
6. Frequent urination
7. Painful sex
8. Breast tenderness 
9. Breast cysts
10. Low libido
11. Bloating 
12. Poor digestion
13. Weight gain
14. Hot flashes
15. Night sweats
16. Body odor
17. Fatigue
18. Anxiety
19. Depression
20. Headaches
21. Dizzy spells
22. Vertigo
23. Joint pain
24. Muscle pain
25. Hair loss
26. Brittle nails
27. Dry itchy skin
28. Acne
29. Irregular periods
30. Brain fog
31. Palpitations
32. Fibrocystic breasts
33. Fibroids
34. Fluid retention

Complications and Cost

The symptoms of perimenopause are so widespread, and some are very disturbing. One of my patients with palpitations underwent a costly and lengthy cardiac work up and was written off as being stressed out when her symptoms were due to perimenopause. These other common issues that occur more frequently in perimenopause can be avoided.

Fibrocystic Breasts

Many women develop cysts in their breasts and ovaries due to fluctuating levels of hormones leading to more frequent mammograms, ultrasounds and biopsies. Imbalances due to having higher estrogen relative to progesterone. This may cause dilation of ducts, vessels, tissue overgrowth, and fluid retention and leads to the swelling found in fibrocystic breasts.²

Palpitations

Palpitations are common in perimenopause otherwise known as the menopause transition. Studies showed that palpitations occurred in 42% of perimenopausal women. ³

Fibroids

Fibroids peak in size in perimenopause. This may lead to heavy bleeding, back pain, urinary tract symptoms such as frequent urination from the uterus pressing on the spine or bladder. ⁴ Over 600,000 women per year in the US underwent hysterectomies due to complications of fibroids. ⁵The rates are decreasing due to more advanced techniques. Nevertheless, the symptoms can be debilitating and lead to costly solutions. 

Bleeding

In a study of 150 women over 40 with abnormal vaginal bleeding, moderate to severe anemia was found in about 58% of women in perimenopause and only 10% post menopause.⁶ Anemia can cause weakness, fatigue, dizziness, palpitations and other symptoms. To properly diagnose this, a pelvic ultrasound and uterine biopsy must be done. This can be stressful. 

Easing symptoms

First and foremost, you must realize that you are in perimenopause and that symptoms can be eased.

• Reduce sugar, alcohol and saturated fat
• Increase nutrient dense foods such as vegetables and low sugar fruit
• Increase cruciferous vegetables such as broccoli, cauliflower, kale, arugula, radishes, Brussels sprouts
• Try herbs such as black cohosh, chasteberry, Diindolylmethane (DIM), indole 3 carbinol (I3C)
• Relaxation techniques, cognitive behavioral therapy, meditation
• Fiber, magnesium
• Regular bowel movements
• Decrease toxins in food, personal care and cleaning products
• Bioidentical progesterone

There is so much more you can do. You may feel like you are going crazy but you are not. There is hope and help. If you want to know if bioidentical hormone replacement is right for you, if it is safe and what to expect, take the course Is HRT for You. Reach out for support and don’t suffer in vain. 

1. Perimenopause Symptoms Statistics 2022 – Forth. Published October 24, 2022. Accessed July 15, 2023. https://www.forthwithlife.co.uk/blog/perimenopause-symptoms-statistics-2022/
2. Dang BQ, Miles B, Young P, He J, Nguyen QD. An Interesting Imaging Presentation of a Common Benign Entity: Fibrocystic Changes in a Postmenopausal Patient. Cureus. 15(3):e36292. doi:10.7759/cureus.36292
3. Carpenter JS, Cortés YI, Tisdale JE, et al. Palpitations Across the Menopause Transition in SWAN: Trajectories, Characteristics, and Associations with Subclinical CVD. Menopause N Y N. 2023;30(1):18-27. doi:10.1097/GME.0000000000002082
4. Ulin M, Ali M, Chaudhry ZT, Al-Hendy A, Yang Q. Uterine Fibroids in Menopause and Perimenopause. Menopause N Y N. 2020;27(2):238-242. doi:10.1097/GME.0000000000001438
5. Wu JM, Wechter ME, Geller EJ, Nguyen TV, Visco AG. Hysterectomy rates in the United States, 2003. Obstet Gynecol. 2007;110(5):1091-1095. doi:10.1097/01.AOG.0000285997.38553.4b
6. Nguyen PN, Nguyen VT. Assessment of paraclinical characteristics in peri- and postmenopausal bleeding women: is there a correlation between hemoglobin levels and ultrasonic indices? J Taibah Univ Med Sci. 2022;18(3):488-498. doi:10.1016/j.jtumed.2022.10.011