Menopause is definitely having its moment, as more women talk openly about their experiences at this hormonal turning point (occurring at age 51, on average) and discover what is and isn’t typical.
Menopause’s little sister, perimenopause, is also getting attention. Women are learning more about this years-long transitional phase leading up to menopause and what it means for their physical and emotional health.
But a knowledge gap persists. A recent Perimenopause Awareness Month event at the Everyday Health offices brought thought leaders together for a discussion about how to help women access more of that much-needed information. The event was organized by the digital wellness platform Perry and featured a reading by Kelly Casperson, MD, author of the new book The Menopause Moment.
Dr. Casperson and a few of the other healthcare providers in attendance also answered questions submitted by the Everyday Health audience. Those experts included:
Here are some of their responses, edited for clarity and length.
1. What Exactly Is Perimenopause and Why Haven’t We Heard Enough About It?
Kelly Casperson, MD: In order to define perimenopause we need to define menopause, because people don’t even know what that is. Menopause means one year with no natural periods. So menopause, technically, is one day after a full year of no natural periods.
Perimenopause refers to the years when the ovaries are starting to, for lack of a better word, fail — meaning they’re starting to run out of consistent, cyclical hormone production. This can start to happen anywhere from 2 to 10 years before menopause.
2. How Do You Know if You’re in Perimenopause?
KC: That’s hard because menopause is in the future and you don’t know when that’s going to happen. I can’t X-ray you and tell you that you’re in perimenopause.
But I can make a clinical diagnosis and say, listen: If you’re in your forties or your late thirties, you’re in the part of life where the ovarian function is starting to falter. So clinically, if you’re having symptoms, that’s perimenopause.
3. What Are the Top Symptoms of Perimenopause and Menopause?
KC: Symptoms are variable because every body responds differently to the change in hormones. But there are some very common symptoms in perimenopause. “Not feeling like myself” is one. That’s very common, affecting 40 to 60 percent of women in this age range who say, something’s off.
Then there are symptoms like decreased energy. Trouble sleeping. The classic hot flashes and night sweats, which are nighttime hot flashes — they’re a sign of low hormones even if a woman is still having periods.
Hot flashes are actually associated with heart disease. They’re a bellwether of changes happening inside your body that might not be good for your overall health. So hot flashes and night sweats aren’t something to just blow off. They’re certainly not funny.
There are a lot of pelvic symptoms, like peeing more frequently at night. Recurrent urinary tract infections. Sex changes related to arousal and lubrication, and pain with penetration. People don’t understand that the pelvis has hormone receptors and that as those hormones go down, the body starts changing. And it’s different for everybody.
4. Is ‘Menopause Rage’ Real?
KC: Changes to mood in perimenopause and menopause are common. One that we don’t often talk about is rage. You’re angry.
Remember, ovarian hormones like estrogen, testosterone, and progesterone modulate our brain. So as those hormones decrease, the neurotransmitters in our brains like dopamine and serotonin change as well, and that can affect mood. Rage can increase, anxiety can become a big problem, too, and there’s also an increased risk of depression.
5. Why Does Weight Gain Happen During Perimenopause and Menopause and What Can Be Done About It?
KC: Many women will say they gain weight in perimenopause. And sometimes it’s not even weight gain, but a change in body composition, meaning the weight is the same, but the clothes are feeling different.
What happens as we age and our hormones go down is that our body composition will shift from more lean body mass to more fat, and that can have profound effects on our metabolism and our overall health.
To combat that you need to dial in the basics: a protein-based diet, exercise, and really watching your calories — a lot of us don’t estimate correctly. Once you have that, you can find out if pharmacologic options might be for you, like trying hormones that improve metabolism and possibly GLP-1 weight loss drugs.
Nothing’s a magic bullet. It isn’t one size fits all. But if your weight or body composition are bothering you, understand that healthy options are available.
6. Can Supplements Help With Perimenopause or Menopause?
KC: Nobody thinks about caffeine as a supplement, but I take that every single day. There’s also creatine, which is good both for muscle mass and brain health, and fiber, vitamin D, omega-threes — lots of things that, if we’re not getting enough in our diet, we can healthfully, safely supplement to help out our bodies.
7. If Perimenopause and Menopause Are ‘Natural’ Parts of Aging, Why Treat Them? Isn’t It Better to Age Naturally?
KC: When you get a cavity, do we say that’s natural and you should just live with it? When your appendix bursts, do we say that’s just something that happens in nature, so live with it? I really think people need to wake up and say, why are we picking the ovaries as the one body part we don’t treat when there’s dysfunction?
As a society we have created an unnatural environment — with antibiotics, clean water, buildings that protect us from the elements — that has allowed us to live longer. We’re surviving well into our eighties, and that’s not natural. Today we’re living 40 years past our ovarian lifespan. Why wouldn’t you treat issues related to that?
8. Can Estrogen Hormone Therapy Raise Breast Cancer Risk?
Corinne Menn, MD: The vast majority of evidence tells us that menopausal hormone therapy does not increase your risk of getting breast cancer. Specifically, the largest study ever done on hormone therapy showed that estrogen alone actually decreased the risk.
If you’re also taking progesterone or progestin [a synthetic form of progesterone], any increased risk is probably modulated depending on which of those two forms you’re taking. Even if we believe studies that suggest a small increased risk with progestin, that significance is less than having an extra glass of wine a day or living a sedentary life, or living with obesity. So we have to keep risks and benefits in perspective.
9. What Do Women Need to Know About Testosterone Therapy?
Jackie Giannelli, RN: Testosterone is just as important a female hormone as it is a male hormone. In fact, women have more testosterone by volume in our bloodstream during our reproductive years than we have estradiol [the most common natural form of estrogen].
The reality is that men and women both have estradiol and testosterone. In fact, one reason men have less Alzheimer’s dementia is because they have testosterone that converts to estrogen. Later in life, women lose their estrogen and they’re kind of already low on testosterone. And that helps explain why, again, we’re seeing more chronic diseases like neurodegenerative disorders in women.
Testosterone is, I think, important for women. So if women are kind of done with the menopause transition and feeling a loss of energy, loss of lean muscle mass, loss of confidence or vitality, testosterone therapy really sits nicely in that space.
10. What Are the Best Foods to Eat During Perimenopause and Menopause?
Robin Noble, MD: Without a doubt, across the world, we know that a more plant-based diet is healthier for us. So I’d recommend more plant fats and a more Mediterranean-based diet. I think we all need to move away from processed foods and ultra processed foods. That’s probably better for longevity, not to mention the health of the planet.
But I think ultimately we have to be kinder to ourselves. And I think we have to do what’s livable. So very often it’s about small wins, like adding something to our diet like Brazil nuts, which can be incredibly helpful for people’s cholesterol profiles.
