WTH?! (What The Health?!) is a Scary Mommy series answering health questions relevant to moms and women that we don't talk about enough. Think: "What is this weird pregnancy symptom? WTF is happening to me postpartum? Are these signs of perimenopause?" Let's normalize these and other women's health issues by talking about them more in a relatable, less clinical, and no-BS way.
When you look up the symptoms of perimenopause, a lot of them sound like what you may already experience as a busy mom: Fatigue. Sleep disturbance. Brain fog. Irritability. (Yep, check, check, check, and check.)
So, how can you tell if you're indeed going through perimenopause? Or are your symptoms just from the chaos of daily life, or are they signifying something else? Is there a test you can take?
Well, the answer isn't that simple.
There are some hormone tests you can take, but they won't for sure tell you if you're in perimenopause.
There are some blood tests you can get done to check hormone levels related to perimenopause and menopause, Dr. Suzanne Fenske, founder of TārāMD, tells Scary Mommy. For example:
- Estradiol testing: This measures the levels of E2 (one of the three major types of estrogens the ovaries produce) in the blood. If the levels are low, this could point to the later stage of perimenopause or menopause.
- Follicle-stimulating hormone (FSH) testing: FSH is a hormone that is involved in reproduction and affects the function of ovaries. High FSH levels can indicate perimenopause or menopause.
But because your hormones are constantly changing during your cycles, testing only shows a snapshot of what's going on with your hormones. It doesn't give you the overall picture, Fenske explains. "Oftentimes, the blood work can be normal, and you can still be in perimenopause."
Also, she says sometimes FSH does not elevate until very late into perimenopause — if not menopause itself. So, the FSH levels may only show up consistently high in these tests once you're already in menopause.
"When a woman's FSH blood level is consistently elevated to 30 mIU/mL or higher, and she has not had a menstrual period for a year, it is generally accepted that she has reached menopause," according to The Menopause Society (formerly The North American Menopause Society).
There is also now an at-home menopause test recently released by Clearblue that detects the changing levels of FSH. Based on this, your age, and your menstrual cycle history, it tells you the likely stage of menopause you're in. Many experts say while this could provide some helpful data for your doctor, it's important to consult with a healthcare provider since hormone levels are constantly fluctuating, and they're only one piece of the puzzle.
OK, so how do you know if you're in perimenopause?
Most menopause-trained doctors don't just rely on blood tests, but they also treat symptoms, says Dr. Somi Javaid, founder and CMO of HerMD. "The most important thing for me is how the patient is feeling and what symptoms [they are] experiencing."
Since there are so many possible symptoms of perimenopause, and they can really vary, it's key to know what they are and keep a log of how you feel. There are at least 34 symptoms, from well-known ones like hot flashes and night sweats to more unexpected ones like body odor and burning mouth (yep, this is really a thing). The most common symptom is irregularities in your periods.
"The only distinction truly between perimenopause and menopause is that, in perimenopause, there is still some type of bleeding and still some type of ovulation occurring. In menopause, we're not bleeding anymore," Javaid explains.
Fenske says you may be able to tell the stage of perimenopause you're in based on your symptoms. In early perimenopause, the progesterone hormone is declining before estrogen. This can cause heavier or longer periods, spotting, worse PMS, weight gain, and irritability. In later perimenopause, estrogen-deficiency symptoms are more common, like skipping menstrual cycles, hot flashes, night sweats, and brain fog.
Once you haven't had a period for 12 consecutive months, you generally have reached menopause.
In terms of when to expect perimenopause, many women may start experiencing symptoms in their 40s (although they may begin to occur earlier or later than that).
What should you do if you think you have symptoms of perimenopause?
Schedule an appointment with your doctor separate from your annual visit so you have enough time to discuss symptoms and possible interventions, Fenske recommends. You can also check out The Menopause Society to find providers in your area who specialize in perimenopause and menopause.
"I always tell my patients no one knows them better than they do," Javaid says. "If [symptoms are] impacting their daily life in the bedroom, at work, in their relationships, in their happiness, then I tell them it's time to come in."
Remember: Perimenopause is a natural life transition, and you don't have to just put up with the symptoms. Whether it's medications, hormonal replacement therapy, or simple lifestyle changes, there are so many treatment options that can help you navigate it.
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