Perimenopause: Awareness as Menopause Approaches
By Melissa Gorley, FSI Coach and Staff Writer. Originally published in Family Foundations.
“In my experience, hormone testing has confirmed the signs my body is giving me,” longtime TC, CCL Staff Member, and FSI Coach Stacey Nagle shared in a recent conversation about perimenopause. “The problem for me was that I wasn’t trusting myself. It gets harder to remember what true slippery mucus feels like, as time progresses and you start having less mucus. You actually can even begin to suspect that all your mucus is slippery and more-fertile.”
Menopause, Perimenopause, & Premenopause
Menopause is the cessation of menstrual periods for one year. Understanding perimenopause, literally the time “around menopause” or the transition time leading up to that definitive change, is often a source of uncertainty and confusion, even for women who know their bodies and fertility cycles well. Symptoms and cycle charting challenges reflect the underlying reality of fewer and aging ovarian follicles, hormonal changes, and less responsive reproductive tissues.
According to the North American Menopause Society, perimenopause is divided into early and late stages of premenopause depending on the extent of cycle length variation a woman experiences. Many of the typical symptoms and cycle changes associated with menopause- night sweats and hot flashes- occur during late premenopause.
According to Marilyn Shannon, “The years of declining fertility are part of a continuum, and the strategies for optimal reproductive health are not essentially different from what they were in your earlier years…. You should also not be too quick to accept any cycle irregularity as an inevitable part of perimenopause, especially if you are only in your early or mid-forties!”
Responding to Changes in the Mucus Sign
During perimenopause, observations of the mucus sign will ebb and flow as estrogen levels do with estrogen generally remaining in the normal range or higher for much of perimenopause until it abruptly drops the last year prior to menopause. Charting becomes a true necessity again with brief descriptions of mucus being valuable, as they were during the postpartum time. Phase I guidelines for marital intercourse should be kept in mind to help with accurately determining the appearance and observations of mucus.
Early perimenopause is the time when CCL sympto-thermal method-using couples can begin to take advantage of premenopausal transition rules, the same as those used during the postpartum transition. These are the Mucus Patch Rule and the Basic Infertile Pattern Rule for finding a return to Phase I infertility as taught in CCL’s Perimenopause Class and FSI Coaching Program. CCL’s CycleProGo app can also accurately apply the perimenopause rules to your daily, charted observations.
Any spotting or breakthrough bleeding, caused by slightly elevated estrogen, must be treated as a potential sign of fertility, like mucus, so continued temperature observations become all the more valuable to the perimenopausal couple for recognizing a true post-ovulation menstrual bleed.
Responding to Changes in the Temperature Sign
During perimenopause, after ovulation it is possible to experience short luteal phases, long luteal phases, and weak temperature rises. In our experience, many women also observe delayed temperature rises, which is consistent with the poor progesterone production expected in perimenopause.
Especially when combined with mid-cycle spotting or continued mucus, a weak or delayed temperature shift is confusing. The additional, optional cervix sign may be of help here for applying the sympto-thermal rule. Again, brief mucus descriptions could help confirm any basic infertile pattern of mucus in the situation of continued mucus when a thermal shift is not present. Finally, in the coaching setting, we have found an additional confirmation, or not, of ovulation with urine progesterone test strips can serve to confirm sympto-thermal observations and build confidence.
Hot flashes and Night Sweats
Marilyn Shannon recommends vitamin E (400-800 IU/day) together with flax oil (5-10 1 g capsules or 1-2 teaspoons of liquid) for “reducing the incidence and severity” of both hot flashes and night sweats. She notes that the vitamin E “protects the essential fatty acids in the flax oil from oxidative damage.”
For herself, Stacey Nagle has found that adding an omega-3 source to her diet has been the most consistently helpful change she has made during perimenopause. She takes 500 mg of krill oil daily (120 mg EPA + 60 mg DHA = 240 mg total omega-3 fatty acids). She has found that it helps to eliminate spotting and to give her more definitive mucus characteristics. “My number one tip for women in perimenopause would be to add an omega-3 source,” Stacey shared.
How to Determine the Start of Perimenopause for Purposes of Charting
Early perimenopause begins when there is a persistent difference of 7 days or more in the length of consecutive cycles, where “persistence” is defined as recurrence within 10 cycles of the first variable length cycle.
To determine the start of perimenopause for purposes of applying the perimenopause transition rules available as a part of CCL’s sympto-thermal method of NFP:
- Begin by making a list of your cycle lengths in the last year.
- Calculate the difference between each.
- Find the first cycle that is 7 days longer or shorter than its preceding cycle. This is your first indicator of possible early perimenopause. Exclude cycles influenced by stress, illness, etc.
- Determine if a second indicator has happened again within 10 cycles. If it has, you are in early perimenopause.
Check out the FSI Coaching for Perimenopause for fertility support and education.