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What is “Normal” in Perimenopause?

Sandy is scared to death. Her periods, which have always been like clockwork every 28 days are now coming randomly, sometimes as often as every two weeks. Her flow lasts for days and days and she has spotting in between. Sandy spends most of her day wrapped up in a straitjacket of anxiety… searching Dr. Google endlessly down every possible rabbit hole and has convinced herself that she probably has cancer.

Hormonal transitions can start as early as your mid-late 30’s. While you’re in the thick of raising kids (or considering having just one more), your ovaries may be looking toward retirement.  

Maybe you notice that you’re just a little grouchier or that your periods are all over the place. Your PMS symptoms, which were once mildly annoying, are now raging. You gain weight even though you’re exercising and eating right. Anxiety is your closest companion and you lie awake night after night, staring at the ceiling.

Let’s look at periods specifically. Longer, shorter, heavier, lighter, and spotting…it’s all fair game in perimenopause.

All of these experiences are very common and vary widely from woman to woman. There’s no way to predict who gets what.

How Can I know for Sure if I’m in Perimenopause?

The short answer is…you can’t. The physical symptoms you’re experiencing are the most reliable indicator. Many a woman has been dismissed with “your lab tests are normal” when she is, in fact, in perimenopause. Lab test are only one piece of the puzzle. You know your body better than anyone, so don’t settle for this if you feel like something is off.

If you do have blood tests, your doctor will most likely test your FSH (and maybe your estrogen or testosterone levels).  The closer your FSH is to 50, the closer you are to menopause. But that number varies and tells you nothing about your progesterone/estrogen balance. That’s what you really care about. The DUTCH test, which I use in my practice, gives information about hormone levels as well as a look at the way your body uses and eliminates them. Hormones are best tested on day 19-21 of your cycle (when progesterone should be highest). You can check out this video I made about the DUTCH test here.

Is it PMS or Perimenopause?

Many of the symptoms of PMS overlap with perimenopause. In both cases, hormone swings are the culprit. The difference is that PMS happens during the second half of your cycle. Perimenopause symptoms can happen at any time. Keep a journal of your symptoms may help you sort this out if you’re not sure what’s going on.

It’s a Hormone Problem, not a Prozac® Deficiency

It’s important to recognize when hormone imbalance is at play because many a woman has ended up on antidepressants or sleeping pills because she (and her healthcare provider) did not recognize that these problems were related to a HORMONES and not true depression. Antidepressants won’t fix the root cause of the problem. Neither will birth control pills.

Misbehaving hormones can often be corrected with lifestyle, herbal and nutritional supplements. In some cases, hormone replacement may be necessary, but that’s not usually the place to start. It’s a good idea to work with a practitioner who specializes in hormone imbalance. Doing so is an investment since most insurance companies don’t cover specialty testing, but having the wealth of information that DUTCH testing provides allows a very targeted approach that will get you feeling better much faster!


Tweet: Think you’re too young to be worrying about perimenopause? Hormone shifts can start in your mid-30’s.


Dr. Anna Garrett is a menopause expert and Doctor of Pharmacy. She helps women who are struggling with symptoms of perimenopause and menopause find natural hormone balancing solutions so they can rock their mojo through midlife and beyond. Her clients would tell you that her real gift is helping them reclaim parts of themselves they thought were gone forever.

Are you ready to get your midlife mojo back? Click the button below to schedule your call to talk to a hormone expert about your perimenopause symptoms.

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Perimenopause: The Savvy Sister’s Guide to Hormone Harmony

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