Am I in Perimenopause? First Symptoms and Changes

"But doctor, I still have my period."

I hear this phrase a lot.

Many women imagine menopause as something that happens from one day to the next: menstruation disappears and then symptoms begin.

But before reaching menopause, there is a transition period called perimenopause, during which ovarian function begins to change.

And yes: you can be in perimenopause and continue to have your period.

"I don't feel like I used to"

Sometimes the first thing that changes is the menstrual cycle. Periods may start to arrive early, late, or change in length or amount.

But that is not always what leads a woman to consult.

Many come to me saying:

• "I sleep terribly."
• "I wake up in the middle of the night and can't go back to sleep."
• "I'm much more irritable."
• "I have trouble concentrating."
• "I don't have the same sexual desire anymore."
• "I've started having hot flashes."

And some have been wondering what is happening to them for months.

There is no single way to experience perimenopause

You don't need to have all those symptoms.

One woman can have severe hot flashes and another none. In some, insomnia predominates; in others, menstrual changes, mood, or joint pain.

Changes in intimate health can also start: less lubrication, dryness, discomfort during intercourse, or certain urinary symptoms.

That is why perimenopause is not diagnosed by counting how many symptoms you have.

We have to assess your age, how your cycle has changed, your symptoms, history, and clinical context.

"So do I need a hormone blood test?"

Not always.

This is a very frequent question and deserves its own article.

In women aged 45 or over with typical symptoms and changes in the cycle, we can often identify perimenopause clinically without needing a hormone test to confirm it.

Also, hormones fluctuate during this stage. An isolated determination can reflect what is happening at that moment and not necessarily represent the whole process.

That does not mean I never request blood tests. There are situations where it is useful to study other causes or assess different aspects of health.

Blood tests are requested when they provide information we need, not simply because you have reached a certain age.

Do I have to wait for my period to disappear to consult?

No.

And you also don't need to wait until you feel terrible.

If you have started to notice changes in your cycle, sleep, sexuality, mood, or well-being and want to understand what is happening, we can assess it even if you continue to menstruate.

Sometimes it will be necessary to treat certain symptoms and other times simply to monitor and make some changes.

The important thing is not to assume that everything that happens after a certain age "is normal and you have to put up with it," but neither to automatically turn every symptom into a hormonal problem.

First we understand what is happening. Then we decide if you need to do something.