Hello! I’m glad you’re here. Take a second to adjust your thermostat and your layers of clothing. Maybe you’d rather read this lying down? Let’s do everything we can to help you feel more comfortable. Since you found your way here, there’s a good chance you’re in perimenopause. I know how exhausting and uncomfortable that experience can be—especially when you’re not even sure if you’re allowed to say you’re going through it. After all, you don’t have any proof yet. But you’ve heard a few things here and there and you’re thinking: “Maybe? Possibly? Please, I just need an answer!” If this is you, you’re in the right place.

1

It’s not a disease. Just like puberty and pregnancy, the menopause transition (AKA perimenopause) is not an illness or a disorder. It’s simply a stage of life that, if we live long enough, all cisgender women will experience. Since most of my clients are cis women, I will be speaking primarily to them here. However, some trans men and nonbinary people who were born with uteruses will also experience menopause; this depends on whether and how much hormone therapy they are using for gender affirmation. Trans women can also experience menopause if/when they stop or reduce their hormone use later in life. You can learn more about the trans/enby experience with menopause in What Fresh Hell Is This? Perimenopause, Menopause, Other Indignities, and You by Heather Corinna.

2

Just as you didn’t need any test or procedure to “prove” you were going through puberty, you also don’t need to know your hormone levels to “prove” you’re in perimenopause. If your doctor insists on getting blood work before being willing to consider perimenopause, they are not up-to-date on the latest research. You can point them to Dr. Jen Gunter’s work to help them catch up, but if they’re not willing to learn, know that you deserve a doctor who will actually listen. You are allowed to fire your doctor.

3

The same way we know that most tween and teen girls are somewhere in the puberty process, we know that if you’re a cisgender woman between 45 and 52, and you still have your uterus and ovaries, you’re probably in perimenopause. If you’re 53 or older, you’ve likely completed the menopause transition and are considered postmenopausal, but it can take longer for some women.

4

If you’re younger than 45, but you’ve had a hysterectomy (even if you kept your ovaries) and/or other surgeries or physical trauma near your ovaries, there’s a good chance you could also be in perimenopause. This is what happened to me (at 39). No one warned me it could happen before I had my hysterectomy or mentioned that it might have happened when I started having symptoms after the surgery. It took me more than two years to figure it out on my own and then convince a doctor to listen. I can’t get that time back, but I want to help you never need to lose it in the first place.

5

Just like the puberty transition is for some teen girls, the menopause transition is relatively easy for some women. If this is you, hooray! I’m so happy for you! Like puberty, even though it’s a normal stage of life, perimenopause can lead to major challenges for many women. These include the infamous hot flashes/flushes and sweats, but there are many more. Did you know that some women get cold flushes instead of heat? I didn’t, and I couldn’t figure out what was happening to me, especially since I’ve always been ”hot-blooded” and dreaded living anywhere without air-conditioning. There may be changes to your hair, skin and other soft tissues, nails, and teeth. You may have new or worsening sleep problems or crushing chronic fatigue, which can lead to brain/cognitive fog and trouble with memory/concentration, among other things. This is not an exhaustive (pun somewhat intended!) list.

6

If you’re struggling, there’s hope. Today’s menopause hormone therapy (MHT) is not your mother’s or grandmother’s HRT (hormone replacement therapy, a term that is being phased out). The warnings about the risks of estrogen have been greatly exaggerated in many instances (women with a history of or who are at high risk for breast cancer should discuss their situation with their medical team), based on old and unreliable studies. Plus, today MHT is available in a variety of methods (patches, creams, pills, lozenges, etc.) and in much lower doses than in the past. The right dose for you, even if it is a very low dose, can really help a lot. (Again, not everyone can or needs to use MHT; definitely consult with doctors and other reliable sources, like the ones I’ve recommended here, to help guide your decision.) My experience won’t be exactly like yours—it might not be much like yours at all—but you should still know that it’s possible: Now that I’m using a low-dose estrogen patch and low-dose progesterone* lozenges, I was able to crank out this blog post in under an hour. I haven’t been able to write a blog post at all in over a year, and the last one definitely took a lot longer.

I hope this leaves you feeling confident about your next steps but also eager to learn more. I’ll be back with more posts related to perimenopause in the future. Until then, I recommend checking out What Fresh Hell Is This? and The Menopause Manifesto by Dr. Jen Gunter for further reading. And if you live in or around Seattle, WA, or in or around Portland, OR, and are looking for a therapist who gets what you’re going through, I’d love to help. Click here to get started.

*I have since stopped using the progesterone lozenges because of side effects (mostly digestive). There was no harm in my trying progesterone—but if you’ve had a hysterectomy, you don’t need to take it, since you no longer have a uterus to protect from the effects of estrogen. If your doctor doesn’t know this, you have the right to educate them or to move on to someone else.