Feeling a Bit Out Of Sorts in Your 40s? It Could Be Perimenopause

This is it. This is the year that I hit the big 4-0.

I don’t feel any different.

All right, that’s a lie that I need to stop telling myself. Even if it’s mainly a result of pregnancy and childbirth, I absolutely do feel different. To be perfectly honest, most days, the milestone means nothing to me. But sometimes, while I’m contemplating my life, simultaneously thinking about my looming deadline coming up in 15 minutes and ordering groceries online, while my toddler wails at me for not letting her eat her third helping of ice cream of the afternoon, and my second grader complains that I haven’t visited the make-believe “café” that she’s set up, I can feel my blood pressure start to rise, and am struck with the reality that I’ve never given my blood pressure a second thought until now.

As it turns out, the rising blood pressure may not actually just be in my head. Hitting my 40s means slowly wading into a realm full of bodily changes, and a slight elevation in blood pressure is not uncommon, due to many hormonal changes that are beginning to take place within, in a phase known as perimenopause.

“Perimenopause, you say? What in the TikTok trend is that?” ask the rest of my 40-something sisters out there. Truth is, it’s not just a buzzword you find online. Perimenopause is an actual stage a woman’s body goes through, in preparation for the onset of menopause. It begins sometime in your 40s, and ends when menopause begins, and, like a lot of the phases and transitions a woman’s body goes through, can be confusing to experience.

To pull back the curtain on perimenopause, Allure Philippines spoke to the experts: OB-GYN and pelvic floor specialist May Anne Tabaquero, MD, FPOGS, FPSURPS, of St. Luke’s Medical Center, and OB-GYN and reproductive medicine specialist Marie Josephine Almaria, MD, MSc, FPOGS, FPSRM, also of St. Luke’s and Cardinal Santos Medical Center.

What is perimenopause?

For Filipino women, both Dr. Almaria and Dr. Tabaquero explain that menopause generally begins at around age 47 or 48, up until age 52. It basically means your body is giving up its ability to reproduce, which means the end of your monthly period. Perimenopause, to put it simply, is the stage before menopause during a woman’s 40s, in which the body starts transitioning into the state of menopause.

“Perimenopause is an actual stage before a woman’s last menstrual period,” Dr. Almaria says. “Some women may have symptoms, others may not. But regardless, it’s actually a very important phase, health-wise.”

Dr. Almaria says that it’s a good time to assess a patient’s overall health, to better prepare for the massive bodily changes that menopause itself will bring about. 

Dr. Tabaquero, on the other hand, also notes that because the topic of perimenopause has begun to receive more hype and attention, it’s important to educate oneself on what really goes on. “It’s good, actually, that we have more women coming to us and recognizing that they are going through perimenopause, but because of social media, mis- and dis-information abound, and these can lead to unnecessary anxiety and dangerous interventions.”

What are the signs and symptoms that perimenopause has begun?

If you’re suddenly experiencing irregular periods around your 40s—whether your period is delayed, early, or more frequent for no reason, or your menstrual flow is heavier or lighter—that could be a sign that perimenopause has already begun.

Other signs may include “hot flashes and night sweats, insomnia or difficulty sleeping, irritability or mood changes,” says Dr. Almaria.” Women may also lose interest in sex, and may also complain of vaginal dryness or pain during sex.”

If you’re thinking that these signs already sound like symptoms of menopause, you’re not wrong. “The signs and symptoms of perimenopause overlap with the signs and symptoms of menopause,” says Dr. Tabaquero. “It’s bits and pieces of temporary changes leading up to the more permanent changes.”

What exactly happens to a woman’s body during perimenopause?

Many things, to be frank, but at the core of all the changes are the facts that a woman’s hormones begin to change during perimenopause, and the quantity and quality of her eggs decline. These all have implications on organ systems and functions within the body.

“A woman’s estrogen and progesterone levels begin to go down in perimenopause, and that means changes,” explains Dr. Tabaquero. Estrogen, in particular, has its hand in many functions. “It doesn’t only play a role in reproduction, but also in cardiovascular, bone, cognitive, and urinary health,” Dr. Almaria chimes in. That means that all of these systems and organs may experience changes as estrogen levels decline. “Estrogen actually protects women from early onset strokes and heart attacks,” Dr. Tabaquero adds, explaining that women may become more susceptible in the process.

Are there any complications or conditions that may arise from going through perimenopause? 

As a matter of fact, Dr. Tabaquero says that the cardiovascular system undergoes some of the greatest changes because of perimenopause. “We actually call estrogen, and to a lesser extent, progesterone, ‘cardioprotective,’” she says. “So during perimenopause, blood pressure may have mild elevations, and there may be metabolic changes that can make it difficult for women to lose weight if they need to, especially if it’s necessary to control their blood pressure and blood sugar.”

In general, the entire phase is a “period of vulnerability,” as Dr. Almaria calls it, which explains why she insists on monitoring a woman’s health while she is in perimenopause. “It’s associated with several diseases, like metabolic syndrome, diabetes, atherosclerotic cardiovascular disease or the buildup of fat and cholesterol in arteries, obstructive sleep apnea, thyroid dysfunction, anxiety, and depression. During this time, it is also best to screen for breast cancer, continue cervical cancer screening, and initiate colon cancer detection,” she enumerates.

Other perimenopausal symptoms may also cause complications, Dr. Tabaquero notes, such as sexual dysfunction, vaginal, and urinary tract infections as a result of vaginal dryness. “Anxiety can also lead to difficulties in personal and professional relationships, or hot flashes and mood swings may affect one’s quality of life. It’s very important to note that it’s not just about functional changes in one’s organs that have a bigger impact, but how one’s daily activities can be affected.”

Can a woman still get pregnant during perimenopause? What are the chances of having a healthy baby and pregnancy?

“Yes, but the chances of getting pregnant are very low,” says Dr. Almaria frankly. “Egg quality declines, so the risk of a miscarriage also increases.”

Dr. Tabaquero echoes this, explaining that the decrease of natural estrogen and progesterone is enough to prevent ovulation and fertilization. “We need to remember that women are born with a finite number of eggs that are in ‘suspended animation,’ to put it lightly. These eggs have already also gone through the wear and tear of age, so that decreases the chances of a healthy pregnancy and baby.”

But that doesn’t mean pregnancy—and a healthy baby—is impossible. Dr. Almaria recommends turning to reproductive medicine or fertility specialists. Dr. Tabaquero says that there are various methods that can be used, including in vitro fertilization (IVF), and freezing eggs and sperm. And if pregnancy does occur, “a healthy baby and pregnancy is still possible with good prenatal care and thorough discussion of risks,” she says.

Does perimenopause change a woman’s appearance?

Sometimes, you just gotta ask the hard questions, and for anyone currently going through, or on the cusp of, perimenopause, this question has probably popped up in your head: Will going through perimenopause change the way I look?

The answer is: Yes, there will be a bit of a change in your outward appearance.

“There will be skin changes—more wrinkles, dark spots, and skin dryness. Some may experience hair thinning. These may all worsen as women age,” says Dr. Almaria. Or it may be a bigger midsection, says Dr. Tabaquero, with the weight becoming harder to lose no matter how much exercise or dieting is done.

But more than the outward changes, Dr. Tabaquero says that it may become apparent to others that a woman is going through perimenopause because of the intangibles, such as social anxiety, difficulties at work, or even an altered sense of perception.

Embracing a new chapter

As confusing as perimenopause may be, with its scary symptoms and anxiety-inducing changes, it’s a fact of life, and a natural transition for a woman. “It should be something that we look forward to, and not fear!” says Dr. Tabaquero. There are also certain things that can be done to mitigate its effects.

Hormonal therapy

To manage symptoms, she shares that hormonal therapy can be done in perimenopause, as it’s done in menopause, to increase estrogen and progesterone. However, she stresses that there are both risks and benefits to this, “and they should be properly explained, and the patient should be evaluated to see if these medications would benefit her more than put her at risk of possible cancers of the breast, ovaries, and uterus.”

Lifestyle changes and a support system

There are, of course, many ways to deal with the effects of perimenopause without resorting to medicines or hormone therapy. Dr. Tabaquero underscores the importance of proper diet and exercise, of group activities and mindfulness. “It is also good to have a support system,” she says. “By preparing for it ahead of time, proper diet and exercise, regular OB check-ups, and curating your own tribe to help you with the changes that you will experience, perimenopause—and eventually menopause—will be easier to go through.” 

A change in mindset

Why do we, in fact, fear perimenopause, menopause, and getting older? Why do we view it as a such a bad, horrible, terrible thing, when, really, what it signals is the privilege of getting older and living—and enjoying—life?

Dr. Tabaquero likens the entire period to the time a caterpillar spends inside a cocoon. “Perimenopause is your caterpillar era,” she says, “and soon you’ll transform into a menopausal butterfly.” Menopause, she reasons, is not called the “golden age” for nothing, and shouldn’t be looked at as a time of decline, but rather, as a time of celebration and freedom. “Do not be afraid to talk about it, to ask for help, and to know your options. It is your prelude to a beautiful song, and it’s a time to be enjoyed, because this is the time when you can be at your most beautiful.”