Menopause Symptoms versus Perimenopause Indicators

May 1, 2023

Menopause symptoms are used as indicators for diagnosis.

They are signs that the tipping point of ovarian aging has been reached, and accelerated hormonal decline has begun – aka early perimenopause. 

Let’s put a symptom list into context. The symptoms indicate a change. A shift in the hormones that suggest the tipping point of hormonal decline has begun.

Think of symptoms as first-line hormone detectives, rather than a list of obstacles you need to overcome.

What the symptoms do is give us insight into how the ovaries are operating. When the ovaries have been regularly active, for typically 30 years, they start being less predictable (obviously there are exceptions, this is a general outline). A characteristic of the ovaries reaching the tipping point is when ovulation does not occur at the menstrual cycle midpoint as often as it used to. This kind of cycle is called anovulatory.

A menstruator before perimenopause can expect to experience 2 to 3 anovulatory* cycles a year, which creates a different kind of bleed or no bleed. If you track your cycles and tune in you will learn the difference between an ovulatory and an anovulatory cycle, for you.

A menstruator in the midst of early perimenopause can expect to experience perhaps double the number of anovulatory cycles.

When ovulation does not occur, there is no way to produce ovarian progesterone during that cycle.**

Why do you need to know this?

Here’s just one example of an indicator of perimenopause …

Progesterone has many talents, but one of them is to promote fat metabolism (whilst in a dynamic relationship with estradiol). Both too much and too little progesterone can impair your body’s blood sugar regulation.

Therefore, if you have a sudden drop off in progesterone levels due to a flurry of anovulatory cycles, and keep everything else equal in your life with regards to food and movement – 

  • yet suddenly gain weight over a few months 
  • your cycles feel and look different

… it’s an indicator that your ovaries are potentially reaching the tipping point of hormonal decline

Hence why menopause symptom lists should say sudden weight gain – which is quite different from weight gain for other ovarian ageing reasons, which can take place over a longer period of time, normally linked to a change in body shape as well.

As a stand-alone symptom ‘sudden weight gain’ is clearly not conclusive that you are perimenopausal, which is why you would then look at other indicators such as menstrual health changes or psychological changes that are occurring ‘out of character’ or ‘suddenly’ for you.

*Anovulation is not quite the same as an irregular cycle. That’s a whole other symptom.

**Progesterone still gets made in the adrenal glands, you just have a lot less than if you had ovulated.

The psychological impact is real

Whilst many ongoing symptoms are interrelated, the initial indicators that a hormone shift is occurring are stand-alone features that must be acknowledged and not grouped alongside one another as a ‘consequence’ of menopausing. 

For example, loss of confidence, feelings of sadness, and a strange disconnected sensation are all part of the psychological gambit when anovulatory cycles start to occur more frequently and the hormone ratio is disturbed. They appear as uncharacteristic patterns for that person. You will often hear people saying that they know they are not depressed because that feels different, but they feel sad and low as if they were depressed. 

The symptom paradox

After the initial indicators of perimenopause, some of those early symptoms may disappear for a while and come back later on in the journey. Some will disappear for good and be exchanged for new ones. The ongoing symptoms that ebb and flow are ones that can be managed more effectively if they are tracked. Keeping a journal, period tracker, with a food and mood diary helps to build a picture of which symptoms are intermittent and have a trigger, and those which seem to be there at a baseline level most of the time.

You can read more about the mechanics involved in the following research articles. Click on the article title to open each as a.pdf – 

“Estrogen is a fundamental regulator of the metabolic system of the female brain and body. Within the brain, estrogen regulates glucose transport, aerobic glycolysis, and mitochondrial function to generate ATP. In the body, estrogen protects against adiposity, insulin resistance, and type II diabetes, and regulates energy intake and expenditure. During menopause, decline in circulating estrogen is coincident with decline in brain bioenergetics and shift towards a metabolically compromised phenotype”. – Estrogen: A master regulator of bioenergetic systems in the brain and body

“Women are at a higher risk than men to develop mood disorders and depression. The increased risk is associated with fluctuating estrogen levels that occur during reproductive cycle events, particularly during the menopausal transition, a time characterized by drastic fluctuations in estrogen levels and increases in new onset and recurrent depression. – Neurobiological Underpinnings of the Estrogen – Mood Relationship

“Although our understanding of the exact timeline or definition of peri-menopause is limited, it is clear that there are two stages to the peri-menopause. These are the early menopausal transition, where menstrual cycles are mostly regular, with relatively few interruptions, and the late transition, where amenorrhea becomes more prolonged and lasts for at least 60 days, up to the final menstrual period. Emerging evidence is showing that peri-menopause is pro-inflammatory and disrupts estrogen-regulated neurological systems.” The peri-menopause in a woman’s life: a systemic inflammatory phase that enables later neurodegenerative disease

Fiona Catchpowle

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