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- Perimenopause causes wild hormone fluctuations, so there is no reliable test to diagnose it.
- Common symptoms include hot flashes, irregular or heavy periods, and anxiety; symptoms can peak during perimenopause.
- Beware marketing hype; treatment is complex and misinformation often pushes immediate HRT or unnecessary tests.
- Seek individualized medical advice instead of doctor-shopping for quick prescriptions; symptoms deserve careful, personalized evaluation.
Today, information about perimenopause is more prevalent and accessible than ever. If you’re a woman in your 40s and you’re not feeling 100%, chances are there’ll be someone online ready to tell you you’re in perimenopause. And that you might want to start spending your money on blood tests, apps, and supplements or demanding hormone replacement therapy. But as regular readers might have guessed by this point, it’s not that simple.
Perimenopause tends to start around the age of 46 or 47. It’s during this time that many women start to experience some symptoms like hot flashes, irregular or unusually heavy periods, or anxiety, for example. And it can be heavy going. “Often symptoms are at their worst in the perimenopause,” says Mary Ann Lumsden, former president of the International Menopause Society.
That’s because hormones can fluctuate wildly. Levels of estrogen, progesterone, luteinizing hormone, and follicle-stimulating hormone can roller-coaster before leveling off after menopause. And that’s why, despite what some marketers will claim, there is no test for perimenopause.
“You can’t interpret hormone [measures] because they change so much,” says Lumsden. “And that is quite normal.”
That doesn’t mean women should have to put up with symptoms. But exactly how those symptoms are treated is another topic that has been clouded by misinformation.
Last week, I told a friend about some unusually bad pelvic pain I’d experienced. Her immediate advice was to find out if I was perimenopausal and, if I was, to request hormone replacement therapy (HRT) as soon as possible. If my doctor wouldn’t prescribe it, she continued, I should simply find another doctor who would.
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