Perimenopause – It’s About Change: The transition into menopause, called perimenopause, may begin in our 30’s

Ready or not, here it comes

It’s inevitable: if we’re female, alive, and with uterus and ovaries intact, we’ll experience perimenopause. Yet many women have never even heard the word. It is the transition into menopause – those 10 to 15 years before our menstrual periods end. Caught off-guard and unprepared, we don’t even realize it has begun. When we are 35 to 45 years old we are focused, often overwhelmed, with career and family issues. We may be juggling care for our children as well as for our parents. Menopause is on the back burner – we’ll deal with that after we turn 50.

But then, out of left field, it hits us and we start scrambling to understand what’s going on. We might not even be able to pinpoint when it started – periods that are further apart or lighter than usual seem like a gift – we finally got a break. What we didn’t realize at the time was that that lighter period might not have been a true period, but rather an anovulatory cycle in which we did not ovulate. The next period may seem unusually heavy. This is because during the previous cycle the lining of the uterus, the endometrium was not shed. The current period is heavier because the endometrium was thicker, and there is more lining to shed.

Perimenopause - It's About Change

Who turned up the heat?

In addition to menstrual cycles that are shorter, longer, lighter or heavier, we may also have been experiencing hot flashes and night sweats. At first we think the heat is on too high, or there are too many blankets, or we are reacting to a food that is causing our face to get red. Our lives are so busy, it’s easy to push aside what are wider swings in our mood or periodic mental fogginess. With such hectic lives, who wouldn’t put the keys in the refrigerator and the milk on the counter?

For some women, these changes are manageable enough that their lives are barely disrupted. Dressing in layers that are easily removed when needed, or sleeping under light covers are adequate interventions. But for others, the changes can be significant. Irregular cycles can lead to thickened endometrium which sloughs off at random, flooding- or gushes of blood, and passing large clots that can lead to visits to the emergency department. Months of heavy bleeding can result in anemia, which may often go undiagnosed and be experienced as fatigue or episodes of dizziness or lightheadedness. Mood swings may be experienced as periods of depression and anxiety. Night sweats may mean waking up five times a night in soaking pajamas and crawling out of bed in the morning exhausted from insufficient sleep. Hot flashes may rattle you as start sweating profusely in the midst of a business presentation. Severe symptoms can lead a woman to lose faith in her body, feeling uncertain about what is coming next. How do you schedule important events if you can’t count on your body behaving in a predictable way?

To regain a sense of control over your body take the following steps: become an informed consumer, consider experimenting with lifestyle changes, and connect with a qualified physician who shares your view that perimenopause is not a disease, but a transition from one phase of our lives to another. Each woman experiences this time in her own way. It is interesting how differently women in other cultures experience these times. For example, Japanese women report fewer menopausal symptoms, and have no word for hot flashes. It is suspected that this may in part be related to their high consumption of soy-containing foods.

Arm yourself with information and a mega-dose of humor

While information on perimenopause is often scanty, or buried in chapters on menopause and aging (even though the experience happens primarily in our 40’s!), here are two books written by female physicians: Dr. Judith Reichman’s I’m Too Young To Get Old. and Dr. Susan Love’s Hormone Book. Love addresses lifestyle approaches, alternative treatments such as accupuncture and herbal remedies, and medications and surgeries. Both emphasize the importance of exercise and the use of soy products. Registered Dietician Debra Waterhouse has written Outsmarting the Midlife Fat Cell. In a style that is both humorous and informational she addresses the issue of weight gain during this time period. She outlines how changes such as weight gain assist the body in producing additional estrogen at a time when the ovaries are producing less. Soy is brought up as a tool you can use to outsmart the fat cells, provide phytoestrogens (plant-based estrogens), reduce disagreeable perimenopausal symptoms and lose weight. The above-mentioned books also have lists of resources – national organizations, newsletters, etc. for more information. Earl Mindell’s Soy Miracle discusses how soy is helpful for women, men and children at all stages of life, and includes recipes. Dolores Riccio’s Superfoods For Women contains over 300 recipes for the special nutritional needs of women, throughout the life span. The American Yoga Association Wellness Book discusses special yoga exercises to help women during this transitional time. For more information, investigate the health education programs offered by your local hospitals.

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