Are You in Perimenopause or Menopause?

The terms perimenopause and menopause are often used interchangeably.  But in actuality, they are two very different experiences.

The word menopause comes from the Greek words mens, meaning monthly, and pausis, which means cessation.  True menopause, which occurs on average, around the age of fifty-two, is the time of life when a woman no longer ovulates, no longer produces progesterone, or has a monthly menstrual cycle.

When a woman has gone approximately twelve consecutive months without a menstrual cycle, she is said to have reached menopause.  Until that time, she is in perimenopause, a time of intense hormonal fluctuations and changes, which are part of the transition into actual menopause.

But, it’s important to note that some women can still have regular periods – either lighter or more sporadic – and still be considered menopausal due to an estrogen deficiency.

The Change of Menopause

For many women, menopause signals the onset of aging and transitioning into a time of life where she may feel useless or unimportant.  No longer able to ovulate or get pregnant, she may question her value or worth.  If she has raised children, they are often leaving home at this time.  She is not actively parenting and her roles in life are changing.  She may feel lost and confused, unneeded, or without purpose.

Marital relationships often suffer at this time as she questions what is important to her or even if she wants to remain married at all.  While it can be difficult, menopause doesn’t have to signal the end of life as you have known it. It is a natural part of the aging process.  If understood and treated properly, the exuberance and vitality for life that is sometimes lost during menopause can be restored.

Menopause – Am I there Yet?

Symptomatically, perimenopause and menopause can sometimes be hard to differentiate.  Hot flashes, night sweats, mood swings, and irritability are common symptoms of both.  In addition, blood estrogen levels, along with FSH (follicle stimulating hormone) levels – a common measure of menopause – fluctuate a lot during both perimenopause and early menopause, making it difficult to determine exactly where a woman is during her hormone phases. While I still rely on FSH and estradiol levels to diagnose menopause, I also take into account the unique emotional symptoms of menopause as well.

The Flat Zone

Many of my menopause patients often complain of feeling emotionally flat, like their world has lost color. “I feel dry, like cardboard. I look like cardboard and my brain feels like cardboard,” they may say.  Some women feel so emotionally drained they tell me that they “just don’t care anymore, and that they don’t care that they don’t care!”

There is often a sadness and lethargy in menopause that remains day after day.  That is because, unlike perimenopause where the symptoms are erratic and unpredictable, menopause symptoms are consistent and tend to linger.

In addition to the emotional symptoms, women complain of joint pain, difficulty focusing, pounding heart, weight gain, anxiety, and vaginal dryness during menopause. Pale vaginal tissue, short-term memory problems, and insomnia are common symptoms as well. Is it any wonder then that so many women dread getting older and reaching menopause?


When Francine, a forty-nine-year-old, stay-at-home mom came into my office, she complained that her “world seemed to lack color or delight.”

“I no longer feel joy anymore,” she said. “I cry for nothing.  I can’t sleep.  I’m exhausted all the time, and my brain feels like it belongs to someone else. My daughter is leaving for college in a year and I’m in a panic.  What will I do? I have been a mom for so long I don’t know what my purpose is anymore.

My marriage is suffering too. I used to love my husband, but I’m not so sure I want to stay with him.  I have no desire for sex and feel repulsed when he touches me.”

Francine also told me she had had only one period in the previous four months, and that it was very light.  When I examined Francine, her vaginal tissue was very pale and thin looking, consistent with low estrogen during menopause

I started Francine on a bioidentical estrogen patch and a cycle of bioidentical progesterone. I also started her on the Basic Supplement Program.  When she came back to see me the following month, she reported that her entire world had changed.

“Within hours after I applied the estrogen patch, I felt an instant lift and so much happier.  Within a couple of nights, I was able to sleep again and started to feel more energetic!”

In addition to feeling better, Francine also reported that her relationship with her husband had improved dramatically.  With the children going off to college, they were excited at the prospect of having their lives and house to themselves again.  Francine felt like her old self once again and was even considering going back to nursing part-time.

Restoring Hormone Balance

Francine’s story is not unique.  It is a perfect example of how drastically the symptoms of menopause can improve with the correct treatment.  By identifying nutritional needs, reducing stress, making lifestyle changes, and introducing bioidentical hormones to restore hormonal balance, you too can reclaim your life!

Tags: , , , ,