Perimenopause has a way of sneaking up on you. You’re more irritated and on edge than ever, and sleep is harder to come by these days. Your body is changing in unexpected ways, making the waistband of your jeans tighter. And why all the brain fog? Perimenopause symptoms can be particularly difficult to parse out, as many can be chalked up to life changes and stress, something that midlife women are often experiencing in spades. But as many women discover, their symptoms can be traced back to the hormonal changes of perimenopause.
What to expect in perimenopause—and when
Perimenopause is the life stage that occurs years before menopause. The timing is different for all women, but it generally begins in the 30s or 40s. It’s when the ovaries produce less of the hormones estrogen and progesterone, though this decline is not even. Instead, hormones fluctuate, triggering symptoms like menstrual irregularity (cycles that are longer, shorter, periods that are lighter, heavier, or non-existent), hot flashes and night sweats, vaginal dryness, painful sex, and urinary incontinence.
This period of time can last far longer than you’d want. On average, women are in perimenopause for four to eight years. Once you have gone 12 consecutive months without a period, you’ve officially transitioned through menopause, marking the end of your reproductive years. The average age of menopause is age 51. You’ll remain in postmenopause for the rest of your life, and while many symptoms improve (such as hot flashes), others (such as genitourinary symptoms) unfortunately remain.
How your body changes in perimenopause
Not only do you not feel like yourself during perimenopause, you may not look the same in the mirror either. And that can be particularly difficult to process. Research suggests that up to 70% of women experience weight gain in midlife. It’s also common to see your body composition change, as fat mass increases, muscle decreases, and your body shape shifts to a more belly fat-storing apple shape.
Reasons for this are multi-faceted. Estrogen encourages the body to fast track fat into the abdomen. Also called visceral fat, this is inflammatory deep-belly fat that hugs your organs. At the same time, after age 30, muscle mass also declines by three to eight percent per decade. Given muscle is metabolically active tissue, this loss of muscle results in a lower calorie burn, also encouraging fat gain.
On top of it all, lifestyle, including reduced physical activity, unhealthy eating patterns, and overeating, stress, and busy schedules that squeeze out healthy habits, have all been named as contributors to body changes in midlife and the menopausal years. Even with the same diet and exercise in premenopause, you may still notice these differences in your body composition now.
The changes that you see can have health consequences in ways that you don’t. Weight gain, especially abdominal fat, puts you at risk for heart disease, insulin resistance and diabetes, excess liver fat (steatotic liver disease), unhealthy blood pressure and cholesterol levels, breast and colon cancer, osteoarthritis, mood problems, and cognitive decline.
Related: Why you should be tracking your body composition
Perimenopause and memory: what’s happening to your brain
If you lose your phone multiple times a day, struggle with brain blips, can’t find the right word, and repeat stories, you might really worry about what’s going on with your memory. But it might just be perimenopause.
Hormonal shifts in perimenopause affect your brain function. Estrogen receptors are found in brain regions like the hippocampus (key in memory and learning) and prefrontal cortex (responsible for higher-order thinking). What’s more, menopause changes the structure of the brain, decreasing gray matter in areas that govern memory and executive function. (One specific area that suffers? Verbal memory.) All of that adds up to a body of research that points to how common it is for cognitive problems to emerge in perimenopause.
The sleep you are (or aren’t) getting in perimenopause
When it’s difficult to go and stay asleep, you may wonder if a good night of sleep will never happen again. There’s a good reason why shut-eye is more elusive these days. Up to almost half of women experience a sleep disorder during perimenopause, most often waking up frequently, waking up early, and having trouble going to sleep. Estrogen and progesterone help you get enough high-quality sleep to wake up refreshed the next day. Progesterone, in particular, is a calming, sedative hormone that acts on GABA receptors in the brain to help you sleep. Common perimenopause symptoms like night sweats (hot flashes that occur during the night), which affect about 75 percent of women, can also disturb your sleep. Increased stress or mood problems during this time may make it difficult to go to (or stay) asleep.
Musculoskeletal changes leave your body vulnerable as you age
When entering perimenopause, observational studies show that the risk for muscle or joint pain jumps by 35 percent compared to your premenopausal years due to the decrease in estrogen. As a hormone, estrogen has anti-inflammatory properties. As levels decrease, you may be more prone to cartilage degeneration, promoting osteoarthritis development. Estrogen declines may also impair muscle function, reduce collagen production (an important component of connective tissues), and leave you more susceptible to injury.
With age-related muscle loss, your odds of having sarcopenia in your older years also rises. Sarcopenia is a loss of muscle mass and strength and it’s something that can begin in your 30s. Along with muscle, skeletal health is a concern. Bone loss seems to occur along with the decline in ovulation in perimenopause, and over time, lower bone density can progress to osteoporosis, a condition that is associated with fall risk and fracture.
Why perimenopause can be a confusing stage of life
There is no test that tells you if you started perimenopause. Your doctor can help determine if you’re approaching this new midlife phase by talking to you about your symptoms, menstrual changes, and health history.
Even knowing if you’re perimenopausal is a challenge. Many of the symptoms are non-specific, meaning they can be chalked up to many different things, even leading doctors to a misdiagnosis. For example, symptoms like mood swings, brain fog, and fatigue can also be due to stress, aging, or poor lifestyle habits.
Then, there’s the reality that many of us aren’t menopause-informed. The majority of women say that they were never taught about menopause in school or felt informed about this stage of life, and many healthcare providers don’t feel confident in treating it. And don’t forget that menopause itself is a diagnosis after-the-fact. It’s a moment in time that doctors only know happened when you haven’t had a period for a full year.
Understanding your body better during transitions in life
Perimenopause marks a pivotal point in a woman’s life. Hormonal changes and lifestyle habits can leave you vulnerable to health problems as you age. You can get a better understanding of what’s going on beneath the surface with proactive health screenings, such as a whole body MRI screening, which looks across major organ systems, Body Composition Analysis to provide intel on your body fat percentage and muscle mass, and advanced blood panels to check and track hormonal and metabolic markers.
For women in perimenopause, Prenuvo’s screenings such as the Advanced Heart Health Scan and Advanced Brain Health Scan can help provide insight on where the health of these major organ systems are today. With this well-rounded information, you can develop a plan with your healthcare provider on treatment and lifestyle changes that will protect your future health and help lessen perimenopausal symptoms. Use repeat annual testing to track your health progress, make adjustments where needed, and possibly catch small, simmering problems before they become bigger deals.
To learn more about the benefits of Prenuvo Membership, book a call with a member of the Patient Services Team.
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