Is this perimenopause? I’ve been asking myself this question for many years. And also wondering how long perimenopause lasts. Not just because I’m ready to be done with the hormonal surprises my body keeps throwing at me, like mood swings, vaginal dryness, and sleep problems, but I’ve worried that I would run out of time before I found a medical provider that has the time and knowledge to help me with my perimenopause symptoms.
How is Perimenopause Diagnosed?
Perimenopause describes the time lending up to the final menstrual period, and is also known as the menopause transition. Technically perimenopause also includes the one year window after the final period. This time leading up to menopause is when we face that long list of 30+ potential perimenopausal symptoms all related to fluctuating, and overall dropping, levels of hormones in our body – it’s not just hot flashes and night sweats.
The word menopause actually refers to just one day—the first anniversary of your last (or final) menstrual period. The tricky thing is, you don’t know your last period is your last period until 365 days have passed without one.
There is no definitive test for when perimenopause occurs and how long perimenopause lasts. Some doctors may order a follicle stimulating hormone blood test as high follicle stimulating hormone levels may indicate menopause, but given how hormones fluctuate daily it is unreliable at best. Everyone’s menopause transition is unique. Diagnosis is based on perimenopausal symptoms and ruling out other potential underlying health conditions. And here is an unnerving bit of data from a trusted resource: Perimenopause may begin as early as age 35 and end as late as 59. Don’t panic; the average length of perimenopause is considered 6-to-8 years, but frankly 10 years wouldn’t surprise me given that many women start experiencing changes even when their cycles remain regular. In short, it can be a long ride.
Is This Perimenopause?
Is this perimenopause? Probably. And while other causes should be ruled out by a qualified medical practitioner, if you’re asking this question it probably is perimenopause. The problem is that perimenopausal symptoms are so numerous and varied, and the education on perimenopause so sparse, most of us don’t even know to ask the question. And even when we do, it often doesn’t get answered. I’m speaking from experience.
I had a rather scary episode on a Wednesday several months ago. Early in the afternoon, I had to cut short the errand I was running as I was suddenly nauseous with a headache and mild stomach pain. This is something I would normally ‘push through’, but I also started to get dizzy and became concerned that vomiting was imminent. I am sadly a grin-and-bear-it type, but I draw the line at public vomiting. I made it home and lay down on the couch. After about an hour, I felt well enough to pick up my children after school. By the time the kids and I got home, I felt like someone was stabbing knives into my lower abdomen and could not control the tears streaming down my face.
When my husband came home he found me in the bedroom on the floor struggling to open a bottle of ibuprofen. The pain in my lower abdomen and radiating down my thighs was so intense, I couldn’t get back into bed after getting up to find painkillers, nor could I manage to open the bottle. My husband gave me an above-recommended dose as requested and put me back to bed. Going to the emergency room and having to sit upright in the waiting room for 12 hours was not gonna happen. So we agreed that since I didn’t have a fever and the pain was not ‘appendix like’ according to Doctor Google, I would stay home as long as the pain didn’t get worse. The ibuprofen worked, but I had to keep taking an above-average dose throughout the night in order to sleep.
In the morning I was still in the same condition, except now I had fairly significant diarrhea; perhaps from the excessive amounts of ibuprofen necessary to keep me from wailing like a wild animal. (Click here to read about the time I took enough ibuprofen to take down an elephant for another perimenopausal hormone surprise.) I needed help. While my state warranted a trip to the emergency room, again the thought of sitting for 12 hours in triage was unbearable.
My husband called his new medical clinic to see if I could join immediately and by some miracle, one of the doctor’s could see me that day. My husband drove me to the clinic and came in with me to the appointment. His support was wonderful, and although he did his best to hide it, I could tell he was scared. Just sitting on a chair in the office and in the car was insufferable; it was like someone or something was jamming metal rods into my sit bones.
The doctor was kind, and concerned. After I answered his ‘let’s-rule-out-the-need-to-call-an-ambulance’ questions, he did an exam and ordered bloodwork and ultrasounds – abdominal and transvaginal. I’ll save you the details, but thanks to my husband’s and my doctor’s efforts, I got the tests completed within 24 hours. Yes, in Canada. If I’m being honest, I paid for some of these services; the rest I attribute to my husband’s persuasiveness, the doctor going above and beyond, and perhaps a minor miracle.
My Own Diagnosis
My own diagnosis was PMS. Yes, PMS. After the first big dose of ibuprofen on Wednesday evening kicked in and I could speak again, my husband asked what the pain felt like. I said, it was like late-stage labor. Eyebrows up. Way, way up. I also said that based on the reading and research I had been doing about perimenopause, I thought this might be PMS ‘on steroids’. I added that without this knowledge, my assumption would be that I was dying of something rotten. He was silent, but the look on his face said he had assumed the same.
Are These Perimenopause Symptoms?
I had asked the doctor at the new clinic if this could be perimenopause related. He said, maaaybe, but we need to rule out other things. I said, like what? He said, endometrial cancer, blah, blah, blah, blah…I stopped listening after he said endometrial cancer. I no longer felt confident about my own diagnosis.
Maybe It Is Perimenopause
On Friday afternoon my doctor called to say that my blood work was normal except for my c-reactive protein, which is an inflammation marker. It was at 99. He said if ANYTHING gets worse or I get a fever, go to an emergency room or call an ambulance.
On Friday night, my period started. I dared to breathe a small sigh of relief and regained a glimmer of my former swagger.
By Saturday morning I no longer needed ibuprofen. When I got my blood taken again on Monday my c-reactive protein was at 12. In case you are wondering, 12 is close to normal, 99 is outrageous. Relieved, and also now feeling a little smug about my diagnostic capabilities, I was fairly certain my diagnosis was the correct one. Well actually, it was the only one.
On Tuesday, I saw the doctor again. I drove myself this time. The ultrasounds didn’t show anything. He marveled at the big drop in my inflammation marker from 99 to 12. I was to call the clinic immediately or go to the nearest emergency room if the pain returned, particularly with a fever. He had made a referral to an OBGYN. He had no idea what had just happened, and frankly I think he was terribly relieved that I would be assigned to the female doctor in the practice going forward. I felt better, but it took almost another week to get over feeling like I had been hit by a truck. Like most women, I don’t have time to be out of commission for 10 days.
I got an appointment with the OBGYN 16.5 weeks after the onset of my episode. I arrived 10 minutes early for my appointment and waited for 90 minutes. The nurse who did the initial screen when I finally got into the treatment room, told me that Doctor X doesn’t always explain things and if I had any questions, she could answer them afterward. Uh huh. I should mention here that I Googled Doctor X prior to my appointment, and he is quite polarizing according to RateMD.com; patients either love him or hate him. It’s about 50/50. I was intrigued.
Doctor X was outgoing and very direct. He was also rushed (see 90 minute wait time above). Overall I liked him. After introductory pleasantries, he did a quick internal exam.
Estrogen Therapy: A One-act Play
(The following conversation occurred at a staccato pace, set by Doctor X.)
Doctor X: ‘Hot flashes or irregular periods?’
Doctor X: ‘The polyp shouldn’t be removed unless you’re spotting. Are you spotting?’
Doctor X: ‘Good. Has the pain come back?’
Me: ‘ No.’
Doctor X: ‘Good. What do you use for birth control?’
Me: ‘Other than being 49 and monogamous with a husband who’s had two vasectomies? Nothing.’
Doctor X: (Laughing and funny banter about how I must have given my husband an ultimatum) ‘Any other questions?’
Me: ‘I would like to talk about adding systemic estrogen therapy to the vaginal estrogen and cyclical progesterone I am already…’
Doctor X: (Ever so slightly surprised and cutting me off) ‘‘Why do you want estrogen therapy?’
Me: ‘I have started feeling very irritable, uncharacteristic crying, rage, brain fog, depression, I read…”
Doctor X: ‘The studies show it won’t help depression.’
Me: ‘But I…’
Doctor X: ‘We can stop your period from happening.’
Me: ‘How would you do that?’
Doctor X: ‘You’d have to take a pill everyday.’
Me: (mistakenly pausing to consider) ‘Oh.’
Doctor X: (jumping at my pause) ‘Let us know if that’s what you want to do. We’ll be sending a note to your doctor.’
(Doctor X leaves the room.) Nurse: ‘Do you have any other questions?’
Me: (Chuckles) ‘No. Thank you.’
The New Doctor
My new female doctor is thorough, skilled, and most importantly, listens. When I first met her she did an in depth new-patient exam. Since I had been referred to an OBGYN and the pain had not returned, we agreed to wait for the expert opinion.
Doctor X’s report said the following:
- Polyp removal unnecessary;
- Don’t understand why the patient is taking the progesterone in that dosage; and
- We are glad the pain is resolved.
Terrified of My Menstrual Cycle
Disappointed? Yes. Surprised? Not really. And neither was my doctor. She asked how I had been feeling, and I told her honestly that I was just not myself. While the debilitating and scary pain had not returned, I remained secretly terrified that it would. I was gaining belly weight, I often can’t sleep, and the brain fog is…what’s the word?…Never mind. Every month I get irritable, sad, experience rage, have significant anxiety, and some days experience a level of depression that scares me. And then she said four little magic words: ‘You are in perimenopause’.
I can’t tell you the relief and validation. I got teary. And then she turned her monitor towards me and said “And I think you may have PMDD”. I read the list of symptoms. Bam! It was like all of the light bulbs went off. The puzzle pieces started flying into place. I had hideous periods as a young teen. I suddenly remembered crawling upstairs to my parents bedroom and clawing at their door like an animal, begging them to stop the pain. Anaprox, and then the pill and Anaprox, had saved me back then. I’ve potentially had PMDD for 37 years, with some relief provided for a while after giving birth. And wait for it: PMDD (and PMS) can be exacerbated by perimenopause. Or in my words ‘perimenopause can bring it back with a vengeance’.
Is This Perimenopause?
Is this perimenopause? Fucking right it is. And despite having likely been in perimenopause for about 7 years, not one of the medical professionals I have seen during that time has proactively brought up perimenopause or really known how to answer ‘is this perimenopause’? Until now.
Does my new doctor know everything about perimenopause? No. And she will tell you the same. That is one of the many things that makes her a great doctor; she is not afraid of ‘not knowing’ and has the resources, wherewithal, and care to find answers. This is so important, especially if you are like me and present with complicated and sometimes severe perimenopausal symptoms.
Most importantly, my doctor’s approach is to listen, ask questions, reach out to her network of experts as needed, and provide me with options. Then I get to decide what would be best for my quality of life.
Controlling My Menstrual Cycle
This is what Doctor X meant. We are going to try stopping my period with a birth control pill that is FDA approved to treat PMDD. As with any medication there are risks, but at this point my doctor thinks I need something stronger than menopausal hormone therapy (also know as hormone replacement therapy). So I’m stopping the cyclical progesterone and the vaginal estrogen and saying a little prayer to the universe. I know the risks, and that this pill may not be the right fit for me, but I need to try because I can’t continue feeling this way. I should be enjoying my family and friends and thriving in my work. Not terrified to have my period and spending days every month feeling…hopeless.
The OBGYN Recap
Was I dismissed by Doctor X, the OBGYN? Sure. But after careful thought and my sleuthing on RateMD.com I have come to this conclusion: If I needed a baby cut out of me in under 4 minutes or we would both die, Doctor X is the guy I’d want wielding the scalpel. If you need internal organs removed, he’s the one you want doing the removing. Are there OBGYN’s who can be very skilled with the emergencies, balance an overflowing patient case load, and take the time to figure out why my insides were trying to crawl out of me four months ago and explain the intricacies of perimenopause? Yes, I suspect she does exist.
My point is, there is often a game of hot potato that happens when a woman’s perimenopausal symptoms are beyond a practitioner’s level of knowledge and frankly, can’t just be dismissed. We need all medical practitioners to be educated and up-to-date on perimenopause, the symptoms, and the choices that should be offered to every woman. Until this utopia exists, we need to take matters into our own hands.
Call to Action
Keep learning about perimenopause. Track your symptoms. Prepare and write down your questions to bring with you to your doctors’ appointments. Ask if you are in perimenopause, and keep asking until you get the support you need. And be prepared to find a new doctor. Both The Menopause Society and the British Menopause Society have search functions where you can locate menopause practitioners by geography.
Expect to have a choice. Good care looks like a meaningful discussion where you decide what option is best for you. The days of you providing a brief description of your concerns and your doctor saying this is what you will do, should be over. Especially when it comes to perimenopause.
Most women require 6 doctor visits before their perimenopause symptoms get addressed, if at all. Be proactive and do some research; check out our perimenopause symptom list as a starting point. Your doctor is the expert, but being prepared makes for a more meaningful and efficient conversation, especially if your doctor has a 10-minute time limit for appointments. If your doctor is short on time, see if you can book 2 back-to-back appointments for two different issues, e.g. vaginal dryness and heart palpitations. Yes, the latter can be a symptom of perimenopause.
We shouldn’t just have to grin-and-bear it. Getting an answer to ‘is this perimenopause?’ shouldn’t take an episode like mine or minor miracles. It should just be part of a well-informed practice, be that of an MD, ND, NP or CFMP. Until it is, we need to make being well-informed about our bodies, our practice. If we start showing up with better knowledge and the expectation of better answers and support, maybe we’ll start getting them.
The intent of this information is to provide the reader with knowledge to support more efficient and effective communication with their medical providers. This information is not intended as medical advice.