One of the first questions a woman asks when noticing changes linked to menopause is: “What is happening to my body?” Dana, thinking back to when she was thirty-nine, now realizes she was probably experiencing the beginning of perimenopause. She had noticed mild, infrequent hot flashes, but wrote them off to illness or fatigue. “I didn’t realize at the time that that’s what it was,” she recalls. “It had crossed my mind, but I thought, ‘oh, I’m too young.’” As the years passed, night sweats would come in spells, and then disappear for months.
Cheryl also recalls that her symptoms started subtly and lasted for many years. She became increasingly intolerant of heat of any kind. When she had her first hot flash, she simply did not know what it was. She also began having mood swings and cramps. “People used to just call it PMS. I think a lot of women are now realizing it’s the beginning of perimenopause.”
So how can you tell whether irregular periods, hot flashes, PMS, or insomnia are signs of perimenopause or something else?
The “menopause test”
Right now, there is no reliable test for perimenopause. Some clinicians may recommend a blood test to look for high levels of FSH (Follicle Stimulating Hormone). But this test isn’t reliable because FSH levels, like estrogen levels, often rise and fall unpredictably during the menopause transition. Because FSH levels can vary from month to month, a single test may not be enough.
Also, when the blood sample is tested at a random time during the menstrual cycle, a “normal” result can be misleading and be misinterpreted to mean that a woman’s symptoms are not linked to menopause. This can leave many women feeling as though “it’s all in their heads.” If an FSH level is recommended, it should be drawn on the third day of the menstrual cycle. Elevated FSH levels on this day have been shown to correlate with diminished fertility, which can be an indication of perimenopause.
There may not be a clear-cut test for perimenopause, but you can track important changes that you notice. Is your menstrual cycle noticeably different from a few years ago? Is your cycle shorter or your flow heavier? The answers to these questions will help you and your clinician determine whether you might be entering perimenopause.
Early on, your menstrual cycle may shorten, with periods beginning sooner than you expect. Maybe your periods used to come every twenty-eight days. Now, they come every twenty-three days. Any pattern is possible. Bleeding also may become lighter or heavier. Keep a calendar to record changes. The more accurately you can describe symptoms and irregularities, the easier it will be to pinpoint changes related to perimenopause.