CLEVELAND — You’d never guess by her brisk walk that Heather Schario had been suffering from joint pain.

What You Need To Know

  • One local woman described her perimenopause symptoms

  • Perimenopause is the stage leading up to menopause

  • A University Hospitals certified nurse practitioner said most women begin to experience perimenopause symptoms in their 40s

"Turns out, there’s estrogen receptors in our joints," Schario said. "Who knew?"

But Schario doesn’t have arthritis or an injury. She has recently gone into perimenopause. She said her biggest change has been waking up in the middle of the night and not being able to fall asleep.

"Insomnia, which is not an issue I’ve ever had before, and waking up really hot in the middle of the night," she said.

Perimenopause is the stage leading up to menopause. It has similar symptoms and can last an average of four years. In addition to hot flashes, Schario had what she described as intense PMS-type symptoms, physical symptoms and mood challenges.

Schario said she knew there would be changes but didn’t expect them to come on so early.

"And I certainly didn’t know what age to expect any sort of changes," she said. "I thought it would all start much later."

Despite the similarities, menopause and perimenopause are different.

"Menopause is when you go 12 months in a row without a cycle or a period, and so we diagnose it retrospectively," said Jean Marino, a women's health nurse practitioner with University Hospitals. 

She said most women begin to experience perimenopause symptoms in their 40s.

"Women have estrogen receptors everywhere, so everything's affected," she said. "Tons of changes in the brain, so hot flashes, night sweats. There can be trouble sleeping, falling asleep, staying asleep, brain fog, difficulty concentrating. Mood changes are gigantic."

Marino said one thing does distinguish the stages. Women may experience longer PMS symptoms during perimenopause. One group in particular had worse symptoms. 

"Black women tend to enter into the menopausal symptoms earlier, and they tend to have a longer transitions," she said.

She said a study performed in 2002 left a lot of women feeling scared to take hormone replacement therapy, commonly referred to as HRT, for fear of developing cancer.

"Actually, I prefer MHT, for menopausal hormone therapy because menopause is not a disease or an illness," she said. "We don’t have to replace it."

She said the rate of breast cancer for those who seek treatment is low. The risk is higher for someone who is overweight or has two or more alcoholic drinks a day.

Schario has started taking low-dose estrogen to alleviate symptoms. She said she wishes people talked more about women's health issues.

"It should be very normal to talk about birth control, menopause, perimenopause, the whole gamut of women’s health," she said.