While there’s a huge amount of variability in the timing of peri-menopause, it may be much earlier than you think. “It’s amazing to me the number of women who come into my office in their late 40s completely freaked out because their periods have changed and they didn’t think of this as a possibility,” says Ellen Whitaker, a gynecologist at MedStar Washington Hospital Center.
She explains that while the median age of menopause is 51, there is a “very wide range of normal” when it comes to peri-menopause, usually starting in the late 30s and occasionally stretching into the late 50s. Whitaker says that factors such heredity, diet, smoking and exercise play a role, and that there is no definitive blood or hormone test for peri-menopause. Instead, a diagnosis is generally made by “looking at your age, menstrual pattern, other symptoms and saying, ‘Yeah, it looks like you are peri-menopausal,’” she says. “It’s not particularly precise.”
So what, exactly, happens during peri-menopause? It starts with age-related hormonal fluctuations that indicate that the ovaries are “starting to sputter,” says reproductive endocrinologist Michelle Warren, director of the Center for Menopause, Hormonal Disorders and Women’s Health in New York. There is an extreme variability in women’s experiences. One of the first signs is a shift in your menstrual pattern, even if it is simply that your period arrives more than a week early or a week late.
“That’s usually the first thing, and then you could go to skipping cycles and then finally stopping completely, but in between everything is possible,” adds Gass. “Some women have normal cycles until one last one and that’s it, while some go through a more protracted stage of irregularity.”
The rise and fall of these hormones can cause other delightful symptoms, such as hot flashes, night sweats, sleep disturbances, mood changes and vaginal dryness. Although it’s not strictly related to hormonal changes, many women gain weight in the years leading up to menopause, particularly around their midsection.
New research also backs up my mom’s favorite peri-menopausal grumble: forgetfulness. “The data suggests that there may be some very mild problems in verbal memory and processing speed in later stages of [peri-menopause]. So the great number of women who report [them] should know there really is something to their complaints, and they are not alone or going crazy,” says clinical neuropsychiatrist Miriam Weber, an assistant professor at the University of Rochester, who has studied this issue. “The good news is that it looks like [they] are a temporary hit and that things rebound at some point in the first year following the final menstrual period.”
Still, not everyone will experience this. “It’s really a situation of expect the unexpected, because we just cannot predict who’s going to have a lot of symptoms,” says Gass, who adds that the length of the experience also differs widely from woman to woman. “You may not have much of a peri-menopause phase, or the irregularities and symptoms may go on for five or six years before you actually stop having periods.”
She also points out that the mood changes, fogginess and sleep issues of peri-menopause can be common for women who have PMS or are dealing with such other typical midlife stresses as parenting and caring for elderly parents. “How you feel is a combination of a number of things coming together,” says Warren, who notes that there can be an increased risk of depression during peri-menopause, particularly if there’s a prior history.
While peri-menopause is a change that often comes with at least some annoyances, it is not usually something requiring specific treatment. “A lot of women have something they notice going on but do fine; some women seem to have no problems whatsoever; and maybe 20 percent have terrible symptoms that require some intervention,” says Whitaker. She says this last group often includes a minority of women who experience heavy or erratic bleeding, which can be treated with an oral contraceptive that helps regulate hormones. “It’s a quality-of-life issue, primarily,” says Gass, who warns that very heavy, frequent periods or breakthrough bleeding can signal a more serious medical issue and should be discussed with a medical practitioner.
“Are these hot flashes really disruptive to your life, very annoying and distracting?” Gass asks. “Then there are certainly things that can reduce the occurrence and other bothersome symptoms.” For example, she notes that although hormone therapy with very low doses of estrogen has mostly fallen out of favor because of health risks, it is still occasionally prescribed to treat hot flashes, sleep problems and other related issues for women who find the symptoms hard to manage. (Still, she says she wouldn’t recommend it for women with blood clots, increased risk of breast cancer, heart problems or several other health issues.)
If you are still feeling slightly apprehensive after this peri-menopause primer, don’t fear: “The good news: It is a phase,” reiterates Gass. “As we’ve all experienced when in the middle of a challenging time in life, it feels as though it’s going to last forever, but it does not.” Additionally, the experts stress that peri-menopause can also be a cause for celebration. “For a lot of people, it’s a signal that you’re getting older and it’s very upsetting — there’s a definite stigma. But some women are just so happy not to have periods anymore; they’re ready to be done,” says Warren. “It’s all how you look at it.”