Are You In Peri-menopause?

Are You In Peri-menopause?

I often get asked, “How can I know if  I’m in peri-menopause?”  It seems like a simple question, but the answer is not so straightforward!

What exactly is peri-menopause anyway? 

Before you go through menopause, there is a period of time (up to 10 years!) where things start to change.  The changes can be subtle or not so subtle.  We call this phase of life “peri-menopause”, and it can be one of the most difficult transitions in a women’s life. Often women are told that they are too young to be in peri-menopause.  Sadly, some women are told to tough it out and that it will pass.

Addressing the hormonal symptoms of peri-menopause can dramatically improve quality of life for many women.  Let’s talk about what is going on.

Estrogen and progesterone levels are changing…

Estrogen levels usually start to decline around menopause (average age of menopause is 52), but progesterone levels start to decline much earlier!  In fact, progesterone can decline by as much as 80% during the decade of your thirties, so it is common to have relatively lower progesterone levels in your forties.

When progesterone levels start to decline because of age, and symptoms of hormone imbalance become noticeable, we call this “peri-menopause”.   Later, when estrogen levels also start to drop, symptoms can become even more problematic.

How will you feel when you’re in peri-menopause?

 Because progesterone levels naturally vary over the menstrual cycle, the symptoms vary as well.  

Typically the week after a period is the “good” week; you’re eating your broccoli, exercising regularly, and cleaning out your closets.  Then as you get closer to your period, symptoms get worse – including irritability, anxiety, and interrupted sleep. You may feel more negative, critical, impatient, and easily frustrated – and this can affect how you behave towards your family, friends and co-workers!

Progesterone is a natural anti-anxiety compound, helps with sleep and is calming – sort of like nature’s version of valium or a glass of red wine.  So if you don’t have enough, you may not feel like your best version of yourself during that time in your cycle.

This variation in symptoms is a big clue that hormones are the problem.  If your mood symptoms or insomnia are exactly the same every day in your cycle, it is less likely that hormones are the cause.

What symptoms can you expect in peri-menopause?

Here is a checklist of symptoms that you may experience if your progesterone levels are declining:

  • Insomnia (especially wakening in the night)
  • Night sweats
  • Anxiety
  • Irritability
  • Mood swings
  • Weight gain
  • Increased PMS
  • Pre-menstrual headaches
  • Heavier periods
  • Shorter cycles (periods coming less than 28 days apart)

Are there lab tests to tell if you’re peri-menopausal?

A blood test called FSH (follicle stimulating hormone) can be done.

When you’re pre-menopausal your FSH level will be quite low (often in the range of 2-10).  When your ovaries are no longer functioning their best, your FSH level will increase (typically women who are postmenopausal will have FSH levels above 25, and even over 100).  If your FSH level is starting to go up, you’ll know that you are peri-menopausal.

Your doctor may tell you that you’re “menopausal” if your FSH is over 25.  This causes so much confusion!  Technically, you are menopausal once you go for 12 months without a period.  Often FSH levels go up in the “menopausal” range several YEARS before you stop having a period. 

So if you are still having periods, you technically aren’t menopausal (even though your FSH is in the menopausal range), you are peri-menopausal.  Your FSH level doesn’t tell us exactly what is going on with your estrogen and progesterone levels,  just that ovarian function is changing.

What if you don’t have a period, but still have functioning ovaries?

Here’s where things get even more confusing.  Some circumstances where you may not have periods but still have functioning ovaries include:

  • You’ve had a partial hysterectomy (your uterus was removed, but you still have at least one ovary)
  • You’ve had an ablation (a uterine procedure that may stop you from having a period)
  • You have an IUD

If your ovaries are still producing estrogen, then you aren’t technically menopausal even though you haven’t had a period for at least 12 months – see how confusing this gets!  But you certainly could be peri-menopausal.  We’ll mostly need to go by symptoms to tell, and an FSH can be helpful.

Do you have to put up with the symptoms of peri-menopause?


If you are having symptoms and would like help, the first step is to have your hormones measured.  This is another thing that sounds easy, but turns out not to be so simple.

If you ask your primary care doctor or your gynecologist, they will typically be happy to order the FSH level, but do not typically order estrogen, progesterone or testosterone levels.  If you push, you may be able to convince them, but it’s very important that the hormone levels are checked at the right time of your menstrual cycle.  We want the levels done approximately day 19 of your cycle (day 1 is the first day of your period).  Since hormone levels fluctuate over your cycle, the timing of the test is very important. 

If you aren’t having a regular period, you can try to guess when your next cycle will be or just do the test anytime if things are completely unpredictable.  Your hormone levels will be very different if the test is done while you are on a period, the week after a period, or right at ovulation.  So you can see it’s not so simple, and the test results will need to be interpreted properly.

Another problem with having your primary care doctor or gynecologist order the test, is that they’re going to look at the “normal” range from the lab.  You are almost certainly going to land somewhere in the normal range, because the range is very wide, and mostly developed to identify things like tumors (which you almost certainly don’t have).  It can be very frustrated to work hard to have the test finally done, only to be told that everything is normal!  If it is normal, why do you feel so bad?

A Functional Medicine doctor can do a more comprehensive hormone panel to look at your sex hormones, and the other hormones that influence them, like thyroid and cortisol (your stress hormone).  Hormone levels can be measured in blood, urine, and saliva, and the best test for you depends on your personal history and circumstances.   

How can you get your hormones back into balance?

Depending on your test results, you may benefit from trying some natural progesterone.  Progesterone can help you sleep soundly, feel more relaxed and prevent PMS symptoms.  It can also help regulate your cycles, reduce night sweats, and helps reduce breast cysts and tenderness.

It’s important to use the natural, bio-identical progesterone (an exact match to  your body’s own progesterone).  There are many synthetic drug forms of progesterone (called progestins) that are used in things like birth control pills.  These are man made chemicals that are never naturally found in a woman’s body.  They can help prevent a pregnancy, and may help with things like menstrual problems, but there are health risks associated, like blood clots.

What are other natural treatments for peri-menopause?

You also want to consider your nutritional status, stress levels, and lifestyle habits, as these affect your hormone balance.  Many common chemicals are hormone disruptors, so it is important to gently flush these toxins from your body so your hormones can do their job.  If your symptoms are mild, making some lifestyle changes may be all that you need to get back to feeling great!

Don’t be held hostage by your hormones for one more day!

If you think that you may be in peri-menopause, and are having symptoms that are interfering with your health or quality of life, please know that help is available.  You don’t have to suffer! Together we can get you back to feeling like the best version of you again, because you deserve to LOVE the way you feel!

Yours in Health!

Dr Deb

PS.  Here are some ways you can learn more:

  1.  You can find more information at our website
  2. You can read my book, This is NOT Normal, A Busy Woman’s Guide to Symptoms of Hormone Imbalance.  It’s available on Amazon.
  3. If you are in the Charlotte area you can come to one of our FREE informational dinner seminars.  Call the office for details about our next seminar and to RSVP 704-752-9346
  4. If you would like to learn about becoming a patient you can contact the office to talk to one of our patient care coordinators about how we may be able to help you.  Call at 704-752-9346,  email us at, or contact us online here:

About Signature Wellness

Known for her successful treatment of mystery illnesses, Dr. Deborah Matthew and her team at Signature Wellness combine an integrative, functional medicine approach with the appropriate lab testing.

Our unique approach to diagnosing and treating diseases and disorders recognizes that lasting health depends on resolution of the root causes of your disease. Click here to learn more »

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