From Early Symptoms to Mental Health Challenges: What Women Should Expect During Perimenopause
Updated: Sep 8
A woman will go through many seasons in her life. From the early age of 10 all the way through her golden years, her body is changing. These years feel beautiful, terrifying, and altogether new, but not every shifting phase will be a welcome one. This is how many of us feel when it comes to perimenopause. And when all the signs are there, it's only natural to wonder what you can expect and how to prepare.
Unfortunately, perimenopause is not one-size-fits-all. No two women experience it in the same way. While there is fear in this, there's also comfort in knowing you're not alone. Dr. Stace Nelson-Hicks, DACM, Doctor of Acupuncture and Chinese Medicine, believes that talking about perimenopause is the first step to treating it.
Early Symptoms and How They Can Present
“Perimenopausal symptoms vary from woman to woman. They can be as unassuming as your usual PMS, but maybe a bit stronger. Meaning, maybe your emotions are even more heightened, your breasts slightly more tender, your tendency to cry at sappy commercials becomes more frequent!” Hicks tells us. She adds that some women may even go buy a pregnancy test after skipping a period for the first time.
Or, you may even consider buying hospital-sized menstrual pads because your usual flow is the heaviest it's ever been. “Others may begin to have migraines or gentle waves of heat or ‘misting,' even when the air conditioner is going. It's difficult to tell which of the grab bag of symptoms you may experience,” she explains.
There's also no definitive age range for experiencing perimenopausal symptoms. Some women may notice them as early as their early 30s, while others don't notice changes until their 50s. Estrogen doesn't follow a timeline for when it rises and dips, but it can cause varying period lengths. This often comes with sudden unexplained mood changes, hot flashes, vaginal dryness, and poor sleep quality. These are typically the first signs.
Once perimenopause starts, there's another thing to contend with: Its time frame. Some women enter menopause after only a few months, while others deal with symptoms for years. So, how do you cope?
Perimenopause Is No Longer Taboo, and Neither Is Treatment
According to Hicks, mindset, awareness, and self-care are absolutely necessary during these years. “As a post-menopausal breast cancer survivor, this topic hits home for me. Watching your body, the one you've lived in and known your entire life, change and react in ways that are new, uncomfortable, and many times difficult, is not an easy journey,” Hicks shares in a moment of vulnerability.
“I'm so glad we are having discussions about perimenopause. So many of us grew up during a time when even periods weren't discussed, much less menopause,” she tells us. “Just like our bodies were changing from pre-pubescence to menarche, we begin another transition. Our hormones shift, and occasionally the bodies we have inhabited for decades begin to feel not entirely unrecognizable, but definitely different.”
She points out that many things women have only ever heard about quickly become their reality. “Things we thought would never happen to us begin to: the ‘menobelly paunch' eases in — it seems like when we are younger, we could turn down a cocktail and lose three pounds, and suddenly just looking at a margarita puts weight on — tricep ‘batwings' wiggle in as building muscle becomes a much heavier lift, if you even feel like making it to the gym,” she says. “I've been in practice nearly 30 years, and many of my patients are aging right alongside me.”
Take Comfort In Needing a Village
Hicks adds that something her patients find comfort in is how unexpected these changes are. “Because I practice holistic, natural medicine, the discussions are more focused on acknowledging and understanding that this is a natural process. When we are 35, we don't expect to look and feel like we did when we were 15. So why at 55 would I expect to look and feel like I did when I was 35?” she poses.
“What I want to guide my patients towards is being healthy and feeling well in the face of these changes, to focus on what is truly important and makes us happy and fulfilled. Do we want to spend the post-menopausal years chasing a dress size or rather lifetime experiences we were too busy to enjoy while building careers and being caretakers?”
Understanding and Treating Physical Changes
As discussions surrounding perimenopause become more natural, so, too, do its treatment options. Hicks' background includes many holistic practices, but she also provides a timeline for women to know where in their bodies they need support and at what age.
“As a Doctor of Chinese Medicine, I have not only personally experienced the benefits of acupuncture and customized herbal remedies, but have also supported hundreds of women through this journey. Traditional Chinese Medicine (TCM) is thousands of years old, developed before the discovery of hormones or neurotransmitters. Women needed support, and the tenets of the medicine were, and are still used, to holistically balance our bodies,” she shares.
“So, when asked what we can do to help women, we use this paradigm and work throughout a woman's reproductive life to support each phase with herbs and acupuncture. Acupuncture has been proven in many studies to reduce hot flashes and relieve joint pain,” Hicks reassures.
Combination Medicine Is Also An Excellent Option
She also suggests that women in perimenopause seek out a combination of Western medicine and TCM for all-encompassing treatments that target more than one symptom.
“We know that with the loss of estrogen comes bone loss, so staying physically fit, building muscle and flexibility should be a priority for all menstruators,” Hicks explains. “A diet rich in protein and fiber, low in sugar and additives, will protect your liver, brain, and heart, as cholesterol is known to rise in the post-menopausal years.”
Mental Health During Menopause Matters
Some experts would argue that mental health matters just as much as physical health during perimenopause. Studies show that depression rates often increase by the time a woman hits menopause, with as many as 35.6% feeling its heavy hand. Women with a family history of depression are even more at risk, with these chances increasing to about 58%.
“Working on mental health is important. With hormonal changes, brain changes can occur as our ‘feel good' neurotransmitters become disrupted. Meditation, Vagus Nerve exercises, time in nature, and prioritizing joyful experiences may help with anxiety and depression. Support groups or private therapy may be recommended,” shares Hicks.
She also adds that plant-based remedies may offer some relief for both physical and mental ailments. This is also a natural option for cancer survivors or those who are unable to use HRT. “People with periods are no longer made to believe they should be ashamed or embarrassed about what our bodies have done for millennia. Just as we recognize and celebrate the hormonal changes leading to menarche, I believe we should embrace menopause in much the same way,” Hicks shares. “Because if we are lucky enough to have lived long enough for our cycles to stop, we are ahead of the game compared to the thousands of generations before us."
“It seems to me that spending time on making sure you're Instagram ready every minute seems like a precious waste of time when you realize there's more behind you than in front. And, that the meaningful things in life, friendships, love, passions are more important than whether your eyelashes are long enough, your
cheekbones high enough or your belt matches your shoes.
Looking from the other side of my menopausal trek, I do feel more like me. I appreciate a good night's sleep, the ability to swim miles every week, look in the mirror and see the differences the years have brought but love that I am whole and healthy and plan to be for many years to come.”
Stace Nelson Hicks, Licensed Acupuncturist and Nationally Certified Herbologist
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