Welcome to No Sweat, Jenny’s advice column, where experts answer all your burning perimenopause questions (submit them here). This month, we’ve got Dr. Mindy Goldman, chief clinical officer at Midi Health—a virtual care clinic created by specialists in perimenopause and menopause—and Sue May, a menopause and midlife transition coach at Midlife Evolved, to help shed some light on a frequently asked question.
Dear Jenny,
It seems like everyone is talking about perimenopause these days, but many of the symptoms I hear about are things I’ve been dealing with for years. I mean, don’t we all have brain fog and mood swings? My periods are still pretty regular, but I have been waking up with sweat-soaked PJs more often lately. So, is this it? Is this perimenopause? How do I know for sure?
—Eleanor, 46
Dear Eleanor,
We hear you! One of our friends recently described perimenopause as “a laundry problem, above all else,” because she’s constantly having to wash her bedding and her beloved granny nightgowns. But like you, she wasn’t entirely sure if this meant she was perimenopausal, as it had been going on for quite a while. She was also still getting her period like clockwork (more or less). Maybe she was just a sweaty sleeper?
We asked a couple of experts, Dr. Mindy Goldman and Sue May, to weigh in. We’re sweaty, we’re emotional, we’re forgetful, we can’t sleep: How do we know when it’s perimenopause? (And are we the only ones hearing Van Halen in our heads right now?)
“We get many women asking this question,” Goldman says. “It’s difficult, as there’s no special testing that can be done to determine that someone is in perimenopause.” How can this be, in the year 2024? Isn’t modern medicine better than this? “The problem is that hormone levels vary on different days of the month,” she explains. “Some have proposed that checking serial hormone tests at the same time in the cycle could be helpful for comparison, but since cycles are often irregular, measuring at the same time of the cycle can be difficult.”
But does that mean there’s truly no way to know for sure if we’re in perimenopause? Goldman says the best way to determine whether our funky moods and sweaty necks are due to perimenopause is to do some simple math. “We know that the perimenopausal transition typically lasts four to six years, and can last as long as 10 years. The average age of menopause is 51. That means most women in their mid-to-late 40s are in perimenopause.” Don’t get too comfortable if you’re not yet in your mid-40s, though: “About five percent of women will experience early menopause at 45 or younger, and for those women, perimenopause can start in their 30s,” she says.
May echoes Goldman, emphasizing that while on average, perimenopause starts in the mid-40s, it can come for some women much sooner. “I’ve heard clients say things like, ‘So-and-so is my age, and she’s not in perimenopause yet. I feel like I’m too young for that.’ It’s important not to compare your experience to a friend’s.”
But even though there’s no single blood test that can “diagnose” perimenopause, Goldman says that doesn’t mean we can’t seek out treatment. “Having menstrual changes and symptoms is enough to know perimenopause is happening. Many treatments are available and can be offered based on symptoms alone. Both hormonal and non-hormonal therapies, lifestyle, integrative, and herbal options can be used to help manage the symptoms of perimenopause and menopause.”
So what are the perimenopause symptoms we should be on the lookout for? “One of the first signs is irregular periods,” May says. “During perimenopause, the hormones that control the menstrual cycle are wildly fluctuating. You may have been someone who has a reliable 28-ish-day cycle, and suddenly, you have a period, then nothing for two months, then another one in two weeks. The unpredictability is so frustrating. One period is so heavy it has you in bed; the next is so light you barely notice it.” Tell us about it!
Other common symptoms, May says, include the aforementioned mood swings and brain fog, as well as vaginal dryness and sleep difficulties. “We can use a symptom tracker or journal to track our symptoms and period changes,” she suggests. “Just like menopause, every individual has their own unique experience of perimenopause.”
Unlike perimenopause, menopause has a clear definition: going 12 months without a period. But even with menopause, May cautions, we’re likely to get thrown for a loop. “We think there are specific ‘rules’ and things that will happen, and then bam! Something goes awry and makes our head spin—which, along with the brain fog, is not a good combo.”
She says that, like her, even after marking 12 months without a peep from Aunt Flo (sorry, that’s what our grandmas called it, and it stuck), one sneaky period can decide to make an appearance. “I have no idea why, and neither did my doctor,” she says.
May is passionate about spreading the message that women need to understand our bodies, pay attention to what’s happening with them, and document our feelings and symptoms. “We’ve got to educate ourselves in order to advocate for what we need to feel our best,” she says. “Too many women are dismissed or quickly offered the Band-Aid of an anti-depressant or another ‘quick-fix’ when we only have 10-minute appointments with our doctor. If we go in having done our due diligence—tracking symptoms, periods, and moods—we can understand that this is perimenopause, and work in partnership with a practitioner.”
The bottom line, Eleanor? If you’re 46 and waking up in a puddle of sweat on the regular, congrats—you’re in perimenopause! Get yourself a little handheld electric fan and a nice set of bamboo sheets, but most importantly, start really paying attention to what’s happening in your body. If you don’t have one already, find a doctor or menopause coach, who will listen and work with you, to help mitigate your symptoms and make this wild ride as manageable as possible. We’re right there with you.
Meet the experts:
Dr. Mindy Goldman is a nationally recognized expert in the management of women’s health issues, including menopause. She has received numerous recognitions, including: San Francisco Magazine: Top Doctors (2015-2022), America’s Top Doctors for Cancer (7th-10th Edition) and Exceptional Women In Medicine (2019-2021).
Sue May is a Menopause and Midlife Transition Coach. She specializes in coaching Gen X women who want to understand what happens during this challenging life phase (peri-and-post menopause). She uses her expertise in nutrition, HRT, mindset, and lifestyle to support women in feeling their best so they can thrive in their personal and professional lives.
Don’t miss our previous installments of No Sweat, on perimenopausal brain fog and weight gain. Got a perimenopause question? Submit it here.
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