Tag: perimenopause

Tired? Moody? 9 telltale signs you’re in perimenopause

Woman napping under her desk at work

I was driving on the freeway when an intense rush of fear consumed me. I thought, “Do I pull over?” Luckily, a friend in the front seat started talking and it distracted me. Soon enough the fear dissipated (she never even knew). Following the car episode, I experienced times of increased heart rate, palpitations, and tightness when swallowing. These symptoms were familiar but it had been over 20 years since I experienced them.

I soon discovered that there was something else working behind the scenes: perimenopause. Even before the anxiety, I had experienced less-noticeable changes including more intense PMS, constant sore breasts, and irritability. I soon found myself researching this topic full-steam. I’d love to say I found one easy answer, but I didn’t. In fact, no other developmental stage has been less straightforward. This is precisely why we need to discuss them!  

So let’s get started.

What exactly is perimenopause?

Perimenopause is the transition period before menopause when the menstrual cycle ends. It typically lasts 1-5 years but can last up to 10 years depending on how you define it. The start of this transition is not marked by age but by ovarian reserve. In short, how many eggs a woman has in her uterus. To understand this, let’s do a quick hormone-cycle review.

During the peak reproductive years, estrogen is produced by follicle-stimulating hormone (FSH) and luteinizing hormone (LH). FSH stimulates the follicles to produce estrogen. When estrogen reaches a certain level, LH levels rise and the dominant follicle releases an egg. This is ovulation. The left-behind follicle produces progesterone along with estrogen to prepare for pregnancy. When pregnancy doesn’t occur, menstruation takes place and the cycle repeats itself. Because the quality and number of eggs diminish in the late reproductive years,  anti-mullerian hormone (AMH) and inhibin B — indicators of ovarian reserve — decline. In an attempt to stimulate more estrogen, FSH levels rise and the varying levels of estrogen cause cycles to become irregular.

Sometimes it’s enough to produce ovulation and sometimes it’s not. The STRAW staging system (Stages of reproductive aging workshop) outlines the changes from the first period to the last and beyond. Early perimenopause is defined as a menstrual cycle that changes by 7 days in length and late perimenopause are when cycles are greater than 60 days apart. When estrogen levels get low enough — and don’t go back up — cycles stop completely. The median age for early perimenopause is 47 and late perimenopause is 49. Eighty-eight percent of women go through menopause at age 51 but the range is anywhere from 40-58 years. A woman is considered in menopause when she goes an entire year without a menstrual cycle.

The telltale signs of (very) early perimenopause

About a year ago I had some labs run which, because they showed normal FSH and estrogen indicated that I was not perimenopausal. Like a lot of women, I went searching for answers. And that’s where I found The Centre for Menstrual Cycle and Ovulation Research (CEMCOR) and the work of Jerlynn Prior BA, MD, FRCPC and Professor of Endocrinology and Metabolism at the University of British Columbia in Vancouver, BC.

Prior argues that instead of a time of declining estrogen, perimenopause is a time of climbing estrogen levels. This can begin as soon as the mid-thirties to early 40s, something CEMCOR calls “very early perimenopause.” At the same time as estrogen levels increase, progesterone levels decrease, putting the body out of balance. According to one study, 37% of perimenopausal cycles have a second surge in estrogen called the “luteal out of phase (LOOP)” event, causing estrogen levels to be higher.

“High estrogen and progesterone levels in pregnancy are normal and necessary, but in the perimenopause, estrogen is high but progesterone is not,” writes Prior. “It is this imbalance that can cause significant difficulties for many women.”

According to CEMCOR, very early menopause occurs even when women have regular cycles and experience at least three of the following symptoms:

  1. New-onset heavy and/or longer flow
  2. Menstrual cycles that are shorter (25 days)
  3. New sore, swollen or lumpy breasts
  4. New mid-sleep wakening
  5. Increased cramps
  6. The onset of night sweats, typically premenstrually
  7. New migraine headaches or migraines that get worse
  8. New/increased premenstrual mood swings
  9. Unexplained weight gain

The ‘why’ behind perimenopause symptoms

According to the current definition of perimenopause, symptoms typically occur late in the game because of declining estrogen levels and include hot flashes, poor sleep, vaginal dryness, adverse mood (depression and anxiety), and memory problems.

During this stage, 80% of women will have one or more of these symptoms. But other experts like Prior believe symptoms occur earlier due to higher (and erratic) levels of estrogen and lower levels of progesterone. Because the brain is accustomed to a predictable rise and fall of estrogen, during very early, early, and late perimenopause, these levels become irregular, which means they spike and crash. Even when levels drop back to normal in very early menopause, it’s the drop itself produces a discharge of stress and other hormones.

It’s kind of like puberty. Before levels get stable, they are less predictable which is why girls’ cycles take time to become regular. It’s like a rollercoaster instead of a smooth, predictable ride. And that rollercoaster ride sure is fun!

“What happens with a hot flush is like what a drug addict goes through during withdrawal — a major brain discharge of stress and other hormones,” writes Prior. “It is this hormonal discharge (along with the flush) that causes the anxious feelings, nausea and chest pain as well as the feeling of heat and the sweating that go with them.”

This can also help explain why I felt more anxious, a common complaint at midlife. In one study, out of 487 women aged 40-64, 53% of the premenopausal women reported anxiety and/or depressive symptoms, 66% of the perimenopausal did, and about half of the postmenopausal women. It’s no wonder that during this time, women feel more stressed.

What’s the most important thing for you to do?

Of course, not every symptom in midlife can be attributed to perimenopause alone, especially the mood changes. Life stressors that go along with midlife like raising kids, helping ageing parents, lifestyle changes, and other struggles. 

Step one is simply working towards understanding how female bodies change during this time, so you know what to expect.

If you’d like to learn more about how to ease perimenopausal symptoms, what hormones changes mean for the health of our bodies, and how to use this time to recharge health and well-being, listen in to my podcast interview with Dr. Prior here.

Let’s talk perimenopause: but first, put down the wine


With the sober and ‘sober curious’ movements gathering pace across the globe, conversations around alcohol are undergoing something of a renaissance. A groundswell of alcohol-free alternatives, and pushback against sobriety as a negative label, is in-step with new counselling methodologies around how we perceive alcohol and alcohol-free living.

Like many women, reflecting on a decades-long relationship with alcohol and with her own children approaching the age when she took her first drink, Emma Gilmour of Hope Rising Coaching began looking at her life through a different lens.

“I remember I was perched on the edge of my 11-year-old’s bed, glass of wine in hand, when they asked me to leave the drink outside. It hit me – my child didn’t feel safe around my drinking.

“I wasn’t drunk – although I might well have been later – but just having a drink in my hand meant they didn’t feel that I was in control, and that made them anxious. 

Perimenopause meets puberty

“I’m perimenopausal, my children are on the brink of ‘teenagedom’, so I was welcoming in a new era of independence. With plenty of wine.

“But in reality, my children needed me more then (and now) than they have ever done. They needed a mum who can truly listen and respond rather than reacting – a mum who is as present as possible. A mum who is capable of helping them when they make their own mistakes – not a mum who isn’t fit to get behind the wheel of a car.

“Instead, at that really crazy time in their life, of hormones and navigating relationships and everything else, I realised I wasn’t actually present in the way they needed me to be.

“Honestly, I’d fallen in bushes, ended up in hospital, and passed out in the back of taxis. But it was that small moment that actually landed with me.

“Alcohol makes kids feel insecure. I didn’t realise that. I had done so much work on myself – I was determined to be present for them and role model a healthy life in every regard. But because of that glass, they didn’t feel that I was. They felt anxious and didn’t want it in the room.”

Started drinking at 13

Originally from England, Emma grew up in Africa with parents who drank, but “no more than any of their friends did”.

“My grandparents, on the other hand, would start the day with a Gin and Cinzano. So, I started drinking when I was 13, maybe even younger. I think a lot of parents in our generation thought, ‘if we let them drink with us then they’ll be used to alcohol and better able to manage themselves’. Yet I am living proof that that approach doesn’t work!”

Pursuing a career in corporate marketing, Emma made the move to London – putting paid to any notion of ‘moderation’.

“It was Soho in the 90s – I was working hard, and boy was I playing hard. I met my husband, we kept partying and then we moved to Australia and had kids. Suddenly I was working at the same feverish rate in my professional career, while trying to raise a family. I was doing contract work for huge brands and always trying to prove myself so I could gain a real foothold in this new country.

“It was a recipe for a complete breakdown, which of course happened.”

Forced to re-evaluate her life, Emma began to realise just how far she had drifted from her own values.

“I’d always thought ‘corporate life, working mum, great example to my kids of what a mum can be’ – and there’s nothing wrong with that, except for the way that I was doing it.  I was living an example that would lead them to burn out.

“The final piece of the puzzle landed that December. We had loads of people around – we were always a big party household – and I went to put my kids to bed. My eldest was 11 at this stage, and said to me, ‘mum, can you leave the wine glass out of the bedroom? Because it makes me feel anxious’.

Out of step with parenting values

“That made me sit up and take notice. How does this behaviour that is so fundamental to my everyday life sit with my values and my parenting? It was a wake-up call.”

For Emma, though, part of leading by example meant looking at her drinking very differently – ditching the usual ‘shame and blame’ methods; choosing curiosity instead, and seeking to understand why she drank and the stories she told herself to justify it.

“The fact is, mid-life can be pretty hectic, particularly if you’re sandwiched between hormonal teenagers and ageing parents. Science shows us that the hormonal fluctuations that occur in peri-menopause are on a par with adolescence, so both mums and teens can be pretty volatile!!

“All that leads to excess production of the stress hormone, cortisol, which can lead to high blood pressure, heart disease, and more. That constant state of high alert can lead to chronic stress and burnout – triggers for many people to lean on alcohol to ‘de-stress’ and ‘unwind’. Which actually equates to pouring petrol on a bonfire.

“So, there you are, trying to parent a hormonal pre-teen or teenager with a greatly reduced coping capacity. While they’re pushing for increased independence, they actually need you more than ever – your stability and your availability. AND they need you to model the behaviours you want them to exhibit themselves, particularly when it comes to their relationship with alcohol.”

The science of women and wine

As Emma points out, the combination of female physiology and hormonal change make the additional of alcohol like pouring petrol on a fire.

“Already, as a woman, you have less alcohol dehydrogenase – the enzyme that helps the liver break down alcohol – in your body than a man does. And levels decline further in peri-menopause and beyond. Additionally, as we age our cartilage and tendons lose water. The more water in your body, the better it can dilute alcohol. So that one drink or two can hit you like it was a bottle full!

“Then there’s the anxiety – a symptom of peri-menopause. Alcohol is also well known to exacerbate anxiety and depression. So many women experiencing peri-menopausal anxiety reach for alcohol to relieve these symptoms, but are only creating a more intense experience.

“Alcohol also messes with oestrogen, which is a hugely important hormone in our peri-menopausal symptoms.  The liver is responsible for processing both alcohol and hormones like oestrogen and, as we get older – especially if we’ve been drinkers most of our lives, our liver gets less efficient. That means it can end up dumping excess oestrogen into the body instead of getting rid of it. Imbalanced oestrogen can lead to some serious counter indications, including urinary incontinence, osteoporosis, heart disease, cancer and low libido. 

“And as if that wasn’t enough, alcohol can strip you of nutrients like calcium and magnesium, which you need a lot of during perimenopause and menopause, trigger hot flushes, affect sleep, and generally multiply the effects of hormonal changes.”

Unpick your relationship with alcohol

“But of course, tell a child not to do something and it’s the most appealing thing in the world. I feel like adults experience the same response. If you truly want to break the habit and be at peace with your decision – not living in a state of constant deprivation – you have to actually unpick that relationship.

“It can be anything – food, shopping, work, whatever. But there’s a sense, certainly with women, that we’re not enough and we’re looking outside ourselves for something to make it better. It’s only when you take the drink, or the chocolate, or the spending away, that you can start working on it.”

For Emma, in caring for her children, ultimately, she realised the need to care for herself.

Self-care is all important

“The biggest gift you can give your children is modelling self-reliance and self-love. When we have so little time for ourselves we tend to fill it with the wrong things – we don’t even remember what we actually like anymore! We spend our lives accommodating other people, so starting again means examining all of that.

Find out what really brings you joy and invest in it – because you deserve to be truly happy and fulfilled.

“If putting the brakes on your drinking sounds like it might make sense, know that you won’t be missing out. You’ll be creating an opportunity to peel everything back and work out how to become a more robust human – to love yourself and take care of yourself.

“It’s the best investment you’ll ever make,” Emma reflects, “for you and everyone you care about, and who cares about you.”