You are not alone: Challenging what we know about perimenopause symptoms and treatments

An estimated 10 million people over the age of 40 in Canada are going through perimenopause, a phase that may last between 2 and 10 years until menopause officially begins—12 months after the last menstrual period. While millions in Canada experience this natural transition, an alarming 40% feel alone and 50% feel unprepared in a long journey.

“At least, now we are talking about perimenopause,” says Dr. Jerilynn Prior at the University of British Columbia, who has been working for over 20 years to overcome the confusion surrounding what we know about perimenopause and how to treat symptoms such as mood swings, increased menstrual flow, headaches, and in some cases, disruptive night sweats and hot flushes. “Perimenopause has been defined as low-dropping estrogen like menopause, but perimenopause needs to be understood and treated as different from menopause,” she explains.

Going through perimenopause means that there are fewer eggs remaining in the ovaries, and estrogen levels fall and rise, often to unpredictably high levels. “Very few health professionals recognize these high and wildly swinging levels of estrogen in perimenopause, which may be even higher than in the sexiest 20-year-old,” explains Dr. Prior.

Hormone therapies typically used to treat people who have reached menopause—estrogen and progestin—are still prescribed to those in perimenopause even though research has not shown that they are effective or safe to treat perimenopause symptoms. Believing that hot flushes and night sweats occurring during perimenopause required a unique therapy, Dr. Prior investigated progesterone—a hormone that decreases during perimenopause.

From 2012 to 2017, she led a CIHR-funded randomized controlled trial to test the efficacy of oral micronized progesterone in alleviating perimenopause symptoms. Primary results from Dr. Prior's study did not show a difference between participants taking progesterone and those on placebo.

However, secondary results and an end-of-study questionnaire confirmed the practical effectiveness of progesterone in decreasing the impact of perimenopause interference with women’s daily lives. Participants on progesterone perceived significant decreases in night sweats, decreases in the intensity of daytime hot flashes, and reported improved sleep quality compared with those on placebo. Dr. Prior’s findings could inspire health researchers and medical students to continue learning about perimenopause and possible treatments.

An advocate for translating research into medical practice, she founded the Centre for Menstrual Cycle and Ovulation Research at the University of British Columbia in 2002 to share practical resources with patients, health care providers, and researchers. And when Dr. Prior faced challenges in her mission to demystify perimenopause through science, she turned to creative writing. Published in 2005, her novel Estrogen’s Storm Season: Stories of Perimenopause follows the lives of diverse and busy midlife women undergoing perimenopause. “I wrote the book because I wanted to educate and help women to not feel alone in this journey, and I wanted to share the message that there are many ways they can help themselves,” says Dr. Prior.

At a glance

Issue

In Canada, 4 in 10 people are experiencing perimenopause and menopause symptoms. Perimenopause is an understudied topic with little practical guidance for those experiencing this phase of life.

Research

Dr. Jerilynn Prior’s research showed that progesterone is a clinically practical and safe way to support women experiencing difficult perimenopause symptoms.