Menopause has a clear definition that helps women know when they’re on the other side of their fertility. It’s the point when menstrual cycles permanently cease, and you’re considered to be menopausal when you haven’t had a period for a year.
But perimenopause, the transitional time before that happens, when reproductive hormone levels begin to fluctuate, can feel much less clear cut.
That’s because experiences can vary widely; a woman may start perimenopause in her 30s, or not until her 40s or even 50s. Symptoms typically last 4–8 years, but can also go on for longer than a decade or for only a few months. She may experience a breadth of effects similar to menopause — such as hot flashes, insomnia, mood problems and fatigue — or nearly no symptoms at all apart from menstrual changes.
But there are commonalities, according to Dr. Lila Nachtigall, professor of obstetrics and gynecology at NYU Langone Health.
“This is a time when there’s a feeling of transition,” she says. “It’s good to recognize that and be mindful of the ways it might affect other aspects of your life.” For example, your weight may fluctuate in ways it hadn’t before, and you may experience weight gain even though your nutrition and exercise are the same.
Here are some signs you may be going through perimenopause, along with a few tips on how to deal with potential weight-gain issues:
As the body gets ready for menopause, it begins reducing the function of the ovaries, and that kicks off a process of lowered hormone levels, especially estrogen. That makes ovulation more unpredictable, and the result is usually periods that are different from what a woman has experienced in the past.
For example, the length of time between periods could become longer or shorter, and the flow could get lighter or heavier. If there are 60 days or more between periods, that’s often considered late perimenopause, with menopause likely to occur soon after.
As hormones change, mood can follow. You might feel irritable for no reason, sad without knowing why or both at the same time. This is very common, and can be deepened by other changes happening around you, such as the entry into midlife and seeing children get older, for example.
Focusing on healthy habits like getting more sleep — not always easy to do in perimenopause, but worth the effort — eating nutritious foods, lowering stress levels and increasing physical activity can all be useful for mood shifts, says Dr. Sinem Karipcin, a reproductive endocrinologist at TopLine MD. She suggests that if the mood swings become more of a struggle than an annoyance, it’s useful to check in with your doctor.
Your brain’s estrogen receptors become very active in the early part of your period, particularly in the first couple days just before menstrual bleeding and just after you start. When you aren’t producing enough of the hormone for them to receive, the receptors give off a substance that hasn’t yet been isolated enough to be named, Nachtigall says. But it acts like adrenaline — a stress hormone that influences your fight-or-flight response.
One part of the brain most affected is the hippocampus, which contains estrogen receptors, Nachtigall says. “We say that this is where the nouns are stored,” she notes. A small study that used MRI scans noted structural changes in the hippocampus during different phases of the menstrual cycle — noting that verbal memory decreases right before your period and increases afterward.
That means when estrogen fluctuates, as happens with perimenopause, it can temporarily affect your cognition.
BELLY WEIGHT GAIN
One of the most common complaints among women in perimenopause is weight gain around the midsection. This happens because the decline in estrogen causes fat cells in the abdominal area to begin storing more fat, and it can also make it harder to reduce fat in the area.
Research shows that as menopause continues, this issue can continue, and even if women lose body weight, the amount of body fat — and especially intra-abdominal fat — can continue to increase with age.
Are you doomed to sport the “menopot” of belly fat once you hit menopause? Not at all. Perimenopause is actually a great time to put more healthy habits in place so you can not only reduce the amount of fat gain you see in this transitional time, but also prevent some of the menopausal weight gain later.
TOP COPING STRATEGIES
In addition to focusing on the type of nutrition that works at any age — limiting processed foods, lowering sugar intake, increasing fruits and vegetables and staying hydrated — it can be helpful to kickstart a training program you actually enjoy, advises Aaron Leventhal, NSCA certified personal trainer and owner of Fit Studios in Minneapolis.
He suggests strength training that involves progressively lifting heavier loads, since that can also help bone density as you’re heading into menopause, a time when osteopenia becomes a concern. This can also be a good time to try out high-intensity exercise if you haven’t already, he adds.
“The research is clear that this type of training has a hormonal benefit that can help increase or stabilize some of the hormones that are declining during perimenopause,” he says.
It’s a good idea to talk to professionals as well, such as registered dietitians and physicians, about what symptoms seem to bother you most and what you can do to handle them. Many women feel a loss of control during perimenopause, says Nachtigall, but by taking charge of your health at every level, you can not only prevent weight gain but also transition in a happier, less stressful way.