“I’m losing my mind.”
“I’m falling apart, and I have no idea why.”
“My own family can’t even stand to be around me.”
Those are the types of sentiments Dr. Mindy Frimodig often hears from women in the throes of perimenopause. At any given time, millions of women are experiencing perimenopause. Despite that, getting clear answers on common problems proves challenging for many women.
To help provide some clarity, we spoke to Dr. Frimodig, a Family Medicine Physician with ThedaCare Physicians-Shawano, and Jessie Schnell, a Nurse Practitioner with ThedaCare Behavioral Health.
Defining Perimenopause and Menopause
The confusion can start with understanding what perimenopause and menopause are and when they happen.
Perimenopause, also sometimes called the menopausal transition, is the two- to 10-year window at the end of a woman’s reproductive life cycle. During this time, women’s menstrual cycles often become irregular. They may experience shorter or longer cycles or skip a period altogether.
“Women’s hormones are going all over the place, Dr. Frimodig says. “It’s what we call the predictably unpredictable time in a woman’s life that leads up to menopause.”
Menopause, on the other hand, is just one day. It’s defined as the day 12 months after a woman’s last menstrual period. Menopause marks the end of the reproductive cycle. Any time after that milestone, a woman is considered post-menopausal, Dr. Frimodig says.
The average age for menopause for women in the United States is 51. However, a woman may go into menopause in her mid- to late 40s or well into her 50s. Women may experience symptoms starting in their 30s all the way through their 50s.
Understanding the Why
The fluctuating hormone levels that come with perimenopause can bring many physical and emotional symptoms. The levels of the female reproductive hormones estrogen and progesterone can change day to day and even hour to hour, Dr. Frimodig says. That variance can wreak havoc.
“The more we learn, the more we know that there are estrogen and progesterone receptors in all the tissues of the body,” Dr. Frimodig says. “That includes the brain, the heart, the muscles, the joints, the uterus, the ovaries, and even the salivary glands.”
The number and intensity of symptoms can vary widely person to person. Some women may experience severe discomfort and disruption throughout perimenopause, while others may have few to no problems.
Exploring Common Symptoms
There’s no universal when it comes to experiencing perimenopause, and the list of possible symptoms is long. We talked with Dr. Frimodig and Schnell about some of the most common complaints.
Sleep Troubles
From night sweats to insomnia to anxiety, perimenopause can disrupt sleep in several ways. The treatment of these symptoms depends on what women are experiencing.
Hormone therapy can help with symptoms, Dr. Frimodig says. However, women also can try non-hormone therapies. These could include practicing good sleep hygiene and considering anti-anxiety or anti-depressant medications.
The best proven insomnia treatment remains CBT-I Cognitive Behavioral Therapy for insomnia, Dr. Frimodig says.
Schnell echoes the recommendation of adopting healthy sleep habits. These include:
- Having a winding-down routine
- Following a sleep schedule, even on weekends
- Turning off smartphones and other devices at least an hour before bed
- Avoiding eating or drinking close to bedtime — this especially includes caffeine and alcohol
“If you’re still having struggles, then it’s a good idea to talk to your health care provider about other treatments that could help,” Schnell says.
Women of perimenopause age also are more prone to developing sleep apnea, Dr. Frimodig says.
“They often don’t look like typical sleep apnea,” she says. “They don’t necessarily have the big neck, the obesity, or the heavy snoring.”
Thus, it’s important for women to talk to their doctor if they suspect sleep apnea.
Mood Swings
That rollercoaster of hormone levels comes into play in a big way when it comes to mood.
“Mood changes are known to occur in perimenopause and menopause,” Schnell says. “Things like irritability, sadness, anger, and sudden periods where you feel like you’re snapping at everybody can happen in perimenopause and be totally normal.”
Complicating matters, women of perimenopausal or menopausal age also are likely facing many other stressors, Dr. Frimodig says. These can include other physical health difficulties, career demands, parenting, and caring for older loved ones.
It can help for women simply to understand why they feel moody and to talk to their loved ones about what they’re going through, Schnell says. However, sometimes they may need more support.
“If you’re concerned about your moods, talk to your primary care provider or seek the help of a mental health clinician,” she says.
Mental Health Struggles
About 15 to 20% of women receive a new diagnosis of depression during their perimenopausal years, Dr. Frimodig says. That rate can be two to four times higher in women who previously experienced postpartum or other forms of depression.
In addition, people may experience a relapse or worsening of symptoms of previously well-controlled mental health conditions such as bipolar disorder, depression, or anxiety, Dr. Frimodig says.
“The highest risk for suicide in women in their life is in the perimenopausal years,” she says. “It’s a sevenfold increase in those years, so the problem is real.”
Schnell stresses the importance of paying attention to symptoms.
“Take notice if you’re feeling sad all the time,” she says. “If there’s an underlying depression that’s occurring, that would be important to share with your health care provider.”
Cognitive behavioral therapy, medication, or a combination thereof can be helpful for many, Schnell says.
Getting Help
Dr. Frimodig acknowledges that for many women, it can feel tough to get help for perimenopause symptoms. This is often because most physicians receive very little training on the condition, she says.
It’s important for women to advocate for themselves and to keep searching if they don’t initially get the help they need. For example, if a woman’s own doctor or advanced practice clinician isn’t an expert, they can ask for a recommendation of someone who is, Dr. Frimodig says.
“It’s also important that you seek treatment from a provider who’s treating based on the evidence, which does not require thousands of dollars in labs and supplements and creams,” she says.
Because perimenopause can be a topic with many concerns, Dr. Frimodig says it’s often helpful for women to schedule an appointment outside of a routine wellness visit. This can allow more time to discuss the many symptoms of perimenopause a woman may be experiencing.
Treatment Options
Treatments such as hormone therapy, when indicated, can make a huge difference for women, Dr. Frimodig says. However, if menopausal hormone therapy (MHT) is what a woman needs, they need to start it within a specific window of time relative to the start of menopause.
“Research now shows us that starting MHT within that window can actually decrease many health risks,” Dr. Frimodig says. “However, waiting until a later age can bring increased health risks, so it’s important to talk to your primary care provider or OB/GYN as soon as you have concerns.”
For women suffering through this life stage, Dr. Frimodig shares a final word. “The good news is a lot of perimenopause symptoms will get better either with treatment or time.”
