Very often when women are in perimenopause they are bewildered and mystified by what appears to be a sudden and unexpected onset of symptoms.  Night sweats, hot flashes, raging mood swings, uncontrollable crying, depression and anxiety seem to come out of nowhere.

That is because despite the obvious symptoms of hormonal changes, they are likely still experiencing relatively normal and regular menstrual cycles, which leads them to believe they are not in perimenopause.

What they may not realize, however, is that the shift in hormones which sets perimenopause in motion has likely occurred years before they even began to notice the symptoms.  For most women, changes in their hormone levels begin as early as their mid to late thirties, though they may not be noticeably symptomatic until their early to mid forties.

What is Perimenopause?

The Greek prefix “peri” means around.  It is used to describe something that is marginally close or on the edge of, like the word perimeter or peripheral.  Perimenopause then, literally means “around the time of menopause.”  Menopause occurs once a woman has gone twelve consecutive months without a menstrual period. Until that time, she is in perimenopause, experiencing the hormonal changes that bring about actual menopause.

During the perimenopause phase, a woman’s body is producing less progesterone with each passing year.  In addition, her estrogen levels are rising and falling erratically as well.  These hormonal changes bring about great physical and emotional discomfort for many women and can last anywhere from five to ten years or more.

What are the Symptoms of Perimenopause?

Perimenopause symptoms vary among women not only in intensity, but in the types of symptoms as well.  While each woman’s experience is different and unique to her, there are many symptoms that are relatively common, such as:

  • Irritability
  • Rage
  • Feeling overwhelmed
  • Feeling revved
  • Depression
  • Anxiety
  • Mood swings
  • Reduced self-esteem
  • Hot flashes & night sweats
  • Insomnia
  • Fatigue
  • Crying easily
  • Shorter cycles, closer together
  • Heavy bleeding with blood clots

Perimenopause or PMS?

Due to the commonality of symptoms, many women confuse perimenopause with PMS and vice versa. Both PMS and perimenopause are the result of fluctuating progesterone levels. However, PMS symptoms are cyclical and directly correlate with a woman’s menstrual cycle.  They also disappear once a woman gets her period.  Not so with perimenopause.

Perimenopause symptoms typically continue throughout a woman’s monthly cycle and do not disappear once she gets her period. They are also much more erratic, unpredictable and intense. So much so that many women feel they are losing control or as if they are going crazy.

Meet Brenda

Brenda is forty-three-years-old mom with a thirteen-year-old daughter and sixteen-year-old son. Until a few months ago, she had regular twenty-eight day menstrual cycles. In the past, she suffered from PMS symptoms (feeling angry and out of control) a couple of days before her period began, but as soon as she flowed she felt normal again.

Now her periods are coming a little closer together (23 to 25 days instead of 28), are heavy with some clotting, and she is bleeding more days than before. She complains of intermittent night sweats and hot flashes. Her breasts are tender much of the time and she feels that her PMS symptoms are more intense, and are accompanied by rage and irritability.

She emphasizes that when her period starts she does not get the kind of relief from her symptoms that she used to. Now she suffers from crying spells, insomnia, and extreme fatigue during her menses and a week after. Brenda lives in an irrational and erratic zone, swinging from crying to rage to guilt.

Her gynecologist did not diagnose her as perimenopausal, but said a hysterectomy may be in order if her periods become much heavier. He also thought her emotional problems might be from depression or bipolar disorder, and he referred her to a psychiatrist for evaluation. Brenda began taking an antidepressant, but claimed her anxiety and insomnia actually increased. There was no change in her menstrual cycle.

The Hormone-Brain Chemistry Connection

I spoke with Brenda about her symptoms and performed an exam. Based on her recent history of heavy clotty periods, shorter cycles, and the lack of relief of symptoms once her period began, I determined she was perimenopausal. Although she was quite distraught, I knew from experience that I could normalize her cycle, and she would feel much better once she began her program of using bioidentical progesterone.

After only one month on her treatment plan, which also included nutritional supplements for her emotional type, Brenda returned to her follow-up visit with a smile on her face. She was amazed at how quickly she responded to the treatment. Her menstrual cycle was now back to twenty-eight days, her periods were normal, with no clotting, and her days were filled with less anxiety and more peace.

It’s important to understand that the relationship between Brenda’s hormones and her brain chemistry created her mood, and that treating her with progesterone alone would not take care of her discordant symptoms. In addition, she needed nutritional supplements to normalize her brain chemistry.

You are not going Crazy!

While the intensity, unpredictability and erratic nature of perimenopause symptoms is certainly disconcerting, the good news is you are not going crazy.  Like Brenda, by simply addressing the hormone imbalance, in addition to understanding the role of nutritional needs and the importance of reducing stress in your life, you will not only get relief from perimenopause symptoms, but you will bring a calming harmony and wellness back into your life!

Perimenopause and the Emotional Rollercoaster

20 thoughts on “Perimenopause and the Emotional Rollercoaster

  • August 29, 2011 at 1:18 pm

    Hi Mia,
    Thank you for a very intelligent article on a very confusing subject! I am 44 and have been in perimenopause for 4 years. It took about a year for me to figure out why I was having night sweats, mood swings, migraines, etc. The very silver lining is that I have met a lot of wonderful women who are working hard to make the peri and menopause transitions easier to understand and deal with. This article is more than helpful toward that end.

  • August 30, 2011 at 1:29 am

    It’s good to see a case study which includes periods coming closer together during menopause – mine certainly are starting to do so. I find that most women (and most articles) assume that periods in the run up to menopause will get further and further apart until they eventually stop altogether. In fact, it varies from woman to woman.

    For me the key thing is that perimenopausal women often don’t ovulate as often in the middle of the cycle (called anovulatory cycles). Not great if you want to get pregnant in your forties, but this is the cause of the declining progesterone which you refer to. And when one thing’s out of balance, so is the rest: hence out-of-whack oestrogen too. Cue hot flushes, night (or day) sweats, plus all the symptoms we know and love from PMS, like irritability and depression.

    As you point out, it makes sense to up your natural progesterone during the second half of your cycle in order to balance things out. Self-care, good nutrition and – especially important for mid-lifers – exercise are also important during this stage.

    Thanks for a stimulating and informative piece.

  • December 1, 2011 at 5:45 am

    Irritability, Rage, Feeling overwhelmed, Depression, Anxiety, Mood swings, Reduced self-esteem, Insomnia & Fatigue, Crying easily

    “Your not going crazy”. Ummm, I beg to differ. But you are driving everyone around you (children, husband, coworkers) right up the blasted walls. WE can do nothing for your biology, that is your responsibility. If you externalize all this (moody unstable snarling) well..

    Do a quick search on the symptoms of BiPolar & Borderline Personality Disorder. Symptomatically & cognitively you are in La La Land. Taking care of yourself is your responsibility. Keeping your hormonally driven abuse to yourselves is also your responsibility too.

    But alas, asking a woman to take responsibility is like peeing into the wind. While you are looking up crazy symptoms, do some statistics & cross correlate divorce initiated by women & age. Call it what it is.

    • March 12, 2012 at 4:52 am

      I am sure glad my husband is more understanding and tolerant than you are. Do you think we LIKE feeling like we have gone nuts? I am pretty sure we are doing our best. Sorry, maybe this is my out of control hormones speaking, but you are a dick. it is not an excuse, but it is a reason and I bet most of us are not lazing around waiting to be coddled for, enjoying the attention and waiting for the symptoms to go away. I have a friend who, according to her, miraculously went into menopause overnight in her mid-40s. i would give a lot to be her right now.

      • March 22, 2012 at 2:16 am

        Amen! I know that men don’t understand, that’s fine. But a good man would not point fingers and be helpful and support. Which would make a very difficult time more bearable.

      • December 28, 2012 at 9:11 pm

        Tara, you said it best, “MAN you are a DICK” and thank god there are good men out there who do try and understand.

    • November 20, 2012 at 5:39 pm

      What a jerk! More then likely your lady just had enough of your crappy attitude.

    • December 20, 2012 at 11:55 am

      The rant this fella went on is not all that unlike the ones we endure and yet he is a “dick” for it?
      He may be a dick at the moment because he is completely frustrated, discouraged and unable to help his wife. He may actually hate seeing her in misery as I do my wife and completely unable to help or even fathom what to do to help her. We are basically at the mercy of nature yet we have no biological reason for our actions. Most men actually do want to do the right thing and do care. It is not our bodies changing but we are asked to understand, cope and wait. I share his frustration if not his words. At a minimum I would recommend on your good days, let your men know you at least understand their pain and that you appreciate them for trying to help.

    • February 13, 2013 at 2:16 am

      You’re a sad representation of a Canadian. Most of my Canadian friends are lovely, understanding sensitive and wonderful people. You sound angry and unintelligent. So sorry for you. This is a real medical issue, but ignorance like yours doesn’t help. Do a quick search on ignorant and pathetic and you’ll find “Robert in Toronto”

  • April 26, 2012 at 2:04 pm

    to robert in toronto…yes, you are a dick. if you are divorced, blessings to your ex-wife. if you are married, i hope she has a good support system out there, because she sure isn’t going to be able to count on you, mr. “life partner”

  • August 24, 2012 at 3:30 am

    Hate to tell you girls, but there is a cycle even in menopause! It’s just
    Longer than when you are menstruating. As frustrating, embarrassing and confusing!
    And to the man who wrote that denigrating piece of vitriole, may you return as a woman for your next couple of lives as penance!
    I found remifemin helped to a point, progesterone cream, meditation, exercise. And if it all gets too hard, anti anxiety meds and even antidepressants help! You might have to try a couple of different formulations before you get the right one for you.

  • November 9, 2012 at 3:34 am

    I have been having symptoms exactly like Brenda’s for about a year now and have been taking anti-depressants which to be honest aren’t doing much at all and I can’t take the SSRI’s that are supposed to be great for my symptoms. I am completely at my wits end and have been backwards and forwards to the doctors as my moods have been horrendous and I’m sure it’s related to my hormones. I have had two blood tests and they have come back OK. I’m extremely anxious, crying and feel like I’m so sad inside it’s really hard to put a brave face on and pretend I’m OK. I;m currently doing a mood chart for my doctor for two months so he can investigate further

    • February 3, 2013 at 12:40 am

      Hi Andrea I have been the same and have no patience at all at the moment. My tests came back normal! We do know our bodies all we want is guidance in what we can do to ease the symptoms and some talc cause it does feel overwhelming sometimes.

  • November 20, 2012 at 5:51 pm

    Hang in there, there is hope. I’ve been on sertraline (Zoloft) forever. Upped the dosage, but still losing my mind. Tried Xanax – it works well for anxiety but did nothing for mood, anger, confusion, night sweats, stinky-ness…( really how much can a gal take?!). In 2 days of taking Mia’s bio-identical hormones (I’m the revved-up type), I feel 99% better. Like a lady again. The extreme night sweats stopped, my brain fogginess is reduced, and I think my husband might still like me…, :)
    It is worth a try! Don’t fuss about the cost, I spent $115 (apx) for 5 products. Progesterone cream, GABA, 5-HTP, L-theanine & L-phenylalanine. This order will get me through apx 45-60 days. Worth every penny! Works & works fast! Good luck to you and your health

    • December 26, 2012 at 11:36 am

      5 yr old son is waking up at night swianetg and shaking.?My 5 yr old son has been having some issues at night lately. At first I just thought it was a virus or something but now it is occurring more often and seems to be getting worse. He will go to sleep normal and then about 2 to 4 hours after falling asleep he will be profusely swianetg but feel ice cold to the touch. Last night when this was happening we took his temperature and it was right around 94 degrees. His teeth will chatter and he will say that his stomach hurts. He will also appear VERY pale. But then after about 5 minutes he will lke snap out of it and everything will go back to normal.I thought maybe he was having night terrors but after doing some research the symptoms really are not the same at all. During one of my sons episodes it almost appeared that he was having a small seizure,( rigid body, extreme shaking, drooling) but it only lasted about 30 seconds and then he appeared to be ok. He never lost consciousness but he also had trouble speaking, it was like he knew what he wanted to say but the words just came out as mumbles.I know this probably sounds absolutely insane but I have no idea what this could possibly be. I am going to schedule him to go to the Children’s Hospital here in our town (which is one of the best in the country) but I feel like an idiot going in and describing this. He is fine during the day, this only occurs at night. If anyone out there happens to be in the nursing field or anything of the sorts please let me know what this sounds like. I am really worried about my son and any information will help. I would like to try and figure out what this is exactly. Thanks for your time!

      • January 2, 2013 at 10:44 am

        Hi i dnt think they will say iir crazy he is your son and maybe they will monitor him overnight.When it comes to children i wouldnt wait get him straight up thre video him if you cant explain u must but just get him seen soon.

  • January 8, 2013 at 7:47 pm

    Robert from Toronto….. unless you are MENstruating or MENopausal there is no good “excuse” for you to speak like that… YOU ARE OBVIOUSLY NUTS.

  • February 3, 2013 at 8:30 pm

    ok,.. I am 44 years old and my periods stopped last Oct. Since then, I have had extreme hot flashes, confusion, irritability, and I feel like my brain has left me. Today, I can’t stop crying. It seems like everything makes me weep. I am already on celexa and tramadol for pain and panic attacks… but I still think my hormones are off balance. Does anyone have any advice about trying a hormonal creme or something to regulate hormones. I just want my life back. Really, I am a nice person, help me put this monster away!

  • February 18, 2013 at 8:13 am

    I am 41 and have been in perimenopause for the last year and a half. I am not married nor am I in a relationship. Some nights I just sit on my couch and cry. I never thought I would still be single with no children during this phase of my life. The reality that I most likely will never give birth to my child has made this even harder for me. It would be nice to have some support. Robert’s comment that we are in La La Land is so mean and insensitive. All of his words are so very insensitive. I feel sorry for his wife. I’d rather go through this by myself, than living with an insensitive jerk.


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