If you're a woman in her 40's, you've probably heard of perimenopause. Let's take a quick moment to define it.
Perimenopause, also known as the menopause transition, is the time leading up to menopause. For some women, it can be as long as 10 years.
In contrast, menopause is defined as 12 months with no menstrual period.
Perimenopause can be a time of dramatic fluctuation in your symptoms, volatility in your hormones, your mood, and your cycles, and for some, it can feel like a loss of control. One of the most common ways my patients describe this is, "I just don't feel like myself".
This can feel alarming, and many are desperate to find answers and relief.
What is happening during perimenopause?
This is a period of change. Early perimenopause is defined as a change in your menstrual cycle of 7+ days. Late perimenopause is defined as a change in 60+ days. However, many people can experience changes in how they are feeling (brain fog, mood etc.) prior to noticing these shifts in their cycle.
During this time, ovaries become less responsive, and your brain responds by, as I like to say, shouting a little louder. This can result in a more intense hormone cycle (shorter, heavier cycles, with more PMS). But the ovaries aren't as efficient, and things often become erratic. Skipped ovulations, high FSH, and estrogen states resulting in shorter cycles (known as LOOP cycles). It's quite a volatile time.
Will testing my hormones tell me if I'm in perimenopause?
Simply put, no. This is a period of immense hormonal volatility. Lab tests done within the same day, or a day apart, will yield different results. It's just not clinically useful.
I will often get patients in my office who have had their doctors run their hormones and say "they're fine" and "have years before perimenopause/menopause", all while meeting the STRAW criteria (a criterion used by the Menopause Society to define the different stages of reproductive health, including perimenopause and menopause). This is false, misleading, and ultimately leaves you feeling confused and helpless as to why you're feeling the way you're feeling.
You don't need to have your hormones tested to tell you if you're in perimenopause. You don't need to have your hormones tested to have access to care.
The one circumstance in which hormone testing may be indicated is if you're experiencing early changes or loss of periods (i.e. premature ovarian insufficiency or early menopause).
Should I be running any bloodwork at this time?
While hormone testing may not be valuable, other tests are useful here. I do think this is a useful time to run baseline bloodwork if you haven't already. Things like iron deficiency can show up in perimenopause and make a lot of your symptoms worse, or even mimic perimenopause symptoms. Understanding your baseline metabolic health when you're entering your 40's is helpful to understanding your personal risk and what you want to get proactive about.
I also like my patient to have a good understanding of their personal risk factors, particularly cardiovascular health and bone health. These are baseline blood markers and a DEXA scan, respectively. I run these through standardized calculators so you understand your risk, and we build a plan to modify it. This is helpful not only for prevention, but also if and when you're ready for hormone therapy, we can understand if you're a good candidate.
What lab testing do I recommend during this time?
Every person is going to have a unqiue picture, and I'll always tailor the recommendation accordingly. With that said, there are several markers I'm routinely monitoring in this demographic. This includes:
1. CBC blood count
2. Ferritin
3. Vitamin D
4. Lipid panel +/- lipoprotein a, and apoB100
5. Fasting glucose
6. HbA1c
7. Kidney function
8. Liver function
9. Blood pressure
These provide a really good foundation for understanding your personal risks and mapping out your menopause care plan.
As your naturopathic doctor, I can run blood for you and walk you through your prevention and menopause/perimenopause plan.
If you'd like to learn more, schedule a free discovery call so we can chat.
In health,
Dr. Ashley Damm, BSc. ND, MSCP
Naturopathic Doctor - Vancouver BC
Women's Health & Fertilty