10 questions every woman should ask before symptoms start
By Dr. Eve A. Ashby / Beaufort Memorial Lowcountry Medical Group Specialty Care
Perimenopause is the natural transition leading into menopause, occurring when hormone levels –mainly estrogen and progesterone – begin to fluctuate and decline.
How much do you know about perimenopause? Here are 10 answers to questions you may be having about the hormone changes ahead.
When does perimenopause typically begin?
Most women enter perimenopause between age 40 and 51, although some hormonal changes can begin earlier. The transition may last several years, and some women experience symptoms even when their periods remain regular.
What are the early signs of perimenopause?
Symptoms vary by individual, but they often include changes in sleep patterns, menstrual cycles, mood changes, hot flashes, night sweats and shifts in overall energy levels. These symptoms may be subtle; many women don’t immediately recognize that their hormones are changing.
Can women prepare for perimenopause before symptoms begin?
Yes! Building healthy habits before hormonal changes become noticeable can help women manage this transition more confidently and comfortably. Key areas to focus on are strength training, sleep, cardiovascular health, preventive screenings and establishing care with a women’s health provider.
Why is family health history important?
Family history can offer context and information about what a woman may experience in perimenopause (and menopause, too). Ask your female relatives about when menopause occurred, whether they experienced significant symptoms and whether there is a family history of osteoporosis, heart disease or breast cancer. This information can help guide your conversations with your healthcare provider.
Why is strength training important before perimenopause?
As estrogen levels decline, women naturally lose muscle mass and bone density more quickly. Strength training helps build a foundation that supports metabolism, balance, bone strength and overall health while reducing the risk of osteoporosis and fractures as you age.
What types of exercises are best during this stage?
A combination of strength training and weight-bearing activities such as walking, jogging, exercises with resistance bands, Pilates and yoga. Women should also aim for at least 150 minutes of moderate-to-vigorous cardiovascular activity each week.
Why is sleep so important during perimenopause?
Hormonal fluctuations can affect sleep quality and in turn can make it harder to either fall asleep or stay asleep. The result can impact your day-to-day life: poor sleep can be a contributor to mood changes, issues with memory, weight gain, cardiovascular risks and low energy levels throughout your day. Establishing healthy sleep habits before symptoms begin can make these changes easier to manage.
Can labs help make the diagnosis of perimenopause?
Laboratory evaluation of estradiol and progesterone can be helpful if periods have stopped for longer than six months, but typically if periods are still occurring, there are fluctuations in these hormones and labs cannot diagnose perimenopause.
Occasionally, testing testosterone can help uncover the reason for some symptoms, but typically labs for these hormones offer little insight into the perimenopause transition. Cortisol levels also fluctuate throughout the day, but if there are symptoms of an adrenal tumor or adrenal insufficiency, then an 8 a.m. cortisol level may help diagnose adrenal disease. Diagnosing perimenopause is based on identifying recurring symptoms and ruling out other possible etiologies such as thyroid disease or insulin resistance.
Can pregnancy still occur during perimenopause?
Yes – pregnancy is still possible during perimenopause, even if your menstrual cycle becomes irregular. Speak with your healthcare provider about contraceptive options if you don’t wish to become pregnant.
When should women talk to their healthcare provider about perimenopause?
Don’t wait until your symptoms disrupt your daily life. Women in their late 30s and 40s can benefit from establishing a relationship with a women’s health provider to discuss family history, preventive screenings, lifestyle habits and what to expect as they transition into this new stage.
Eve A. Ashby, DO, FACOOG, is a board-certified gynecologist with Beaufort Memorial Lowcountry Medical Group in Beaufort and Okatie. Dr. Ashby is also an Assistant Professor and Regional Director of Medical Education for A.T. Still University School of Osteopathic Medicine.
