When the remaining eggs’ cells can no longer generate the response the brain demands for fertility, the hormones generated by the follicles begin to change in duration of maximum peak and in the ratio of one hormone to another. This is what kicks in the symptoms of perimenopause. Some of the symptoms include:
- Shorter cycles (shorter and earlier periods)
- Bleeding amounts changing: heavier or lighter
- Night sweats, especially before periods
- Decreasing vaginal lubrication
- Worsening PMS (more abrupt)
- Insomnia, worse premenstrually
- Adult acne
- Increasing facial hair
- Thinning head hair
- Symptoms of anxiety: racing thoughts, air hunger, feelings of unexplained worry
Handling some or all of these changes at once can be an incredible challenge when many in their forties are already dealing with parenting demands, spousal needs, aging parents, and professional expectations. What is absolutely clear is that no two women have the same way of experiencing perimenopause or its symptoms. Many women experience hot flashes, sleep disturbances, lessening of libido (sex drive), and vaginal dryness (usually associated with menopause), while some women experience no symptoms at all. Others may experience a short period of hot flashes, but as soon as they hit menopause (the actual cessation of menses), their hormones complete the transition and the symptoms stop.
The duration of symptoms also varies from woman to woman. Occasionally, symptoms that begin in perimenopause, such as hot flashes, may persist into the postmenopausal years indefinitely. Sometimes women suffer typical PMS associated with one cycle day, only to have hot flashes and insomnia the next month. Such is the roller coaster for many in perimenopause.
During perimenopause, estrogen levels may remain normal in your blood and saliva (or even slightly higher than average, in response to the brain’s signal for more) and the peak of estrogen that generally occurs right before ovulation (the midcycle) may remain, but the duration of the estrogen-dominant days is lessened by the aging follicle(s). This can be confusing to patients who are told that their hormone levels are normal when they feel so hormonally different. As the ovary ages, blood levels of estrogen may not reflect the health of your follicles until they (the eggs themselves) have nearly disappeared.
Much has been theorized about the various causes of “ovarian decline”; however, the truth is that it is not a disease, but a natural occurrence. As human women, we are programmed to stop reproducing long before our expected time of death, so that we can be around for an extended time to raise our youngest child. For some, ovarian decline begins somewhat early, but it happens eventually for all women. Again, the ovary is programmed to spend its follicles (beginning before birth), but ovarian decline is not often obvious until about age forty-three, when a woman may develop clear symptoms (such as those listed earlier).