"What is perimenopause? A recent article in "Menopause Magazine" (yes, that's a thing) concluded "Women in the Late Reproductive Stage (LRS) experience symptoms strikingly similar to those often associated with the menopause. Women do not expect these changes until the age of 50 years or later and are surprised by such symptoms before cycle irregularity." Uh, no kidding.
We doctors typically avoid esoteric diagnoses. We like things to be black and white: is that bone broken or not? Does the patient have diabetes or not? Unfortunately, there is no good test to determine if a woman is in perimenopause, so we diagnose based on symptoms.
The most common symptoms I see in my practice are sleep disturbance, irregular periods, and irritability. Sleep can be affected by night sweats, but I also often see a general increase in anxiety and even palpitations. I have so many patients report that anxiety was not an issue until they approached menopause.
Weight gain is also common, but this is trickier. I do not know of any hormone replacement that will reliably help with weight loss. However if you sleep better and feel better, you will have an easier time maintaining or losing weight.
There are all sorts of nice euphemisms, like "the change before the change," but I prefer to call it what it is: reverse puberty. Just like puberty, our hormonal peeks are higher and the valleys are lower, leading to unpredictable emotions, changes in metabolism, and the dreaded hot flashes. This can be a roller coaster for women, and not the fun kind.
Hormones are complicated, but we can simplify a little by dividing them into three main categories, and all categories come into play when describing the Perimenopause.
Sex hormones include estrogen, testosterone and progesterone.
Stress hormones include cortisol and DHEA.
Metabolic hormones include thyroid, glucagon and insulin.
To be honest, this is all one big ven diagram and every hormone directly or indirectly affects every other hormone. Example: if you are a female with high cortisol, you will likely have higher insulin and lower thyroid function."
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