​My appointment notes: understanding perimenopause

​I had an appointment with an OB/GYN nurse for a vaginal swab and ended up learning a lot about perimenopause.

​For about 10 days, I experienced significant joint pain, most likely due to hormonal changes - even though I have a progestin-releasing IUD in my uterus that magically topped my periods (God bless IUD!!). The nurse noted, "It could be a sign you're entering perimenopause, too."

​From our 20-minute conversation, I learned that:

1. ​Definitions: Menopause is clinically defined as the point 12 months after your final period. However, there can be a transition period of 7 to 10 years of perimenopause before reaching that point.

2. ​Timing: On average, menopause occurs between the mid-40s and early 50s; therefore, perimenopause can start as early as age 35.

3. Testing Limitations: If you take hormonal level tests, a hormonal IUD can impact the results. To get a perfectly accurate "natural" reading, you would have to remove the IUD, though this is often unnecessary.

4. Fluctuations: Hormone levels don't always reveal where you are in the transition because everyone has different baselines. Perimenopause involves a gradual, erratic decrease in hormones over the span of a decade.

5. ​Symptom-Based Diagnosis: Doctors generally do not use "hormone levels" as the primary indicator to determine if you have entered perimenopause. To qualify for Hormone Replacement Therapy (HRT), diagnosis is based on unbearable symptoms such as hot flashes, insomnia, and joint pain.

6. HRT Duration: Hormonal therapy lasts an average of five years, and doctors typically try to keep the duration under ten years.

7. ​Symptom Tracking: I should start keeping a journal of unusual bodily changes, such as joint pain or night sweats. With the help of a journal, doctors can better determine if I have entered perimenopause and prescribe the appropriate therapy.

8. ​The HRT/IUD Combination: You can keep a hormonal IUD while undergoing hormone therapy. Standard therapy for those with a uterus requires two hormones: estrogen and progesterone. Because the IUD already provides progestin, you only need to add estrogen to your regimen.