Am I in Perimenopause? Hormones, Testing & the Late Reproductive Stage

Q: Should the average woman over 40 get her hormones tested?

Dr. Gillian Goddard:
I’d love to have a straightforward answer to that question, but the answer really isn’t straightforward. The answer is really: it depends.

Most of the time when it comes to reproductive hormones, we base the decision to treat, whether that’s with hormone therapy or something else, on symptoms and how those symptoms are affecting you.

But if there’s something going on that might be related to other hormones—perhaps insulin and blood sugar or thyroid hormone—then we really would think about getting some blood work and really exploring what those levels look like.

Q: How do I know if I’m in perimenopause?

Dr. Gillian Goddard:
I think that this is really confusing to people because the conversation in the zeitgeist uses a very broad definition of perimenopause, and doctors use a really narrow definition of perimenopause. So we’re not necessarily speaking the same language, and this leads to lots of miscommunication.

From a medical point of view, the definition of perimenopause is that you have irregular periods. But a lot of women start having symptoms that we associate with perimenopause in their 40s while their periods are still regular.

It turns out that there’s this bridge stage between perimenopause and our peak reproductive years called the late reproductive stage. And that is when a lot of times women are starting to have symptoms.

They go to their doctor, their doctor asks them one question, which is, “Are your periods regular?” They say, “Yes, they are.” And their doctor’s like, “Nope, not perimenopause.”

But really, they’re in this stage, the late reproductive stage. And ultimately, the specific stage matters less than making sure that we’re treating the symptoms that brought women to the doctor to begin with.

Q: Can hormone fluctuations cause things like anxiety, brain fog and insomnia?

Dr. Gillian Goddard:
Absolutely. What I think is confusing to people is lots of different hormone fluctuations can cause those same similar changes.

Certainly fluctuations in estrogen and progesterone can cause mood changes, 100%. But we’ve got all these other hormones that can fluctuate, and those fluctuations can cause similar symptoms.

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