What Exactly Is Perimenopause?

Medically reviewed by Dr. Tamara Neuhaus MD

Imagine you’re the center forward on, say, a world champion women’s soccer team. For years, you and your teammates have been working together to perform as a well-oiled machine. You’re an expert in your role and can anticipate how your teammates will respond during any given play. Now imagine one teammate slows down or starts playing erratically. The impact of this change would ripple through the entire team. Everyone would start scrambling to adjust to the change. The usual plays wouldn’t execute. Your team would enter into a state of chaos. 

Welcome to perimenopause.

This is what happens in our bodies when our ovaries start ramping down production of the hormones that we’ve relied on since puberty to keep us in a state of equilibrium (okay, relative equilibrium). Every system in our bodies touched by those hormones starts scrambling to make up for the imbalance. Hot flashes, mood swings, insomnia, joint pain, migraines, depression, incontinence, loss of libido—these symptoms are all results of the scrambling. 

Think of perimenopause as puberty in reverse. In your teens, your ovaries were ramping up, flooding your body with sex hormones. If you remember that experience, it lasted a few years and involved a lot of peaks and valleys that were weathered gracefully by a few, but were a rocky road for most of us. Perimenopause, which also lasts for a few years, can be just as erratic. 

Even though it's only your ovaries that are slowing down, there are sex hormone receptor sites all over your body—remember, team sport—so your brain, heart, liver, skin, and bones have to adjust when your ovaries start flagging. Your eyes, for example, are definitely not part of your reproductive system (unless you count love at first sight), and yet their tissues have estrogen receptors. So watery or itchy eyes can be a symptom of perimenopause.

The end game of perimenopause is menopause, which is the medical term for the 1st anniversary of a woman's last period—on average this happens around age 51. Every woman's experience on this journey is nuanced and unique, just like the 6,000 women who enter menopause every day in the US. If you’re like most women, you’ll enter perimenopause in your mid-forties. If you have your ovaries removed, or a medical treatment like chemotherapy that damages them, you will enter menopause immediately. If you reach menopause between the ages of 40-45, you’re among the 5% of women who experience early menopause. 

Traditionally, doctors have attempted to reassure women by telling us the depletion of our hormones in midlife “is natural.” But just because it’s natural, doesn’t mean it’s not a shock to our systems. Our bodies were designed to deliver peak performance with a full complement of hormones. But we’re living a third or even a half of our lives post-menopause and hormone-deprived. The loss of those regular hormone hits can have profound effects—physically, mentally and emotionally—even after the turmoil of perimenopause settles down. 

Thankfully, there are many different types of treatments for the symptoms of perimenopause, including natural remedies, prescription meds, lifestyle changes, and hormone replacement therapy. If you’re wondering whether or not you’re in perimenopause, our doctors at The Cusp can help you understand where you are in your transition and what your options are. Our goal is to get your inner soccer team back on track so you can live the second half of your life as fully as the first.

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The Cusp provides personalized menopause care. Our doctors have deep expertise and a broad treatment toolkit, offering natural and medical therapies to help you feel better.