Perimenopause: A Second Puberty?
By: Dr. Angela Caswell-Monack
As and OB/GYN, I love taking care of women at every stage of life, but perimenopause (the period of about 10 years leading up to menopause) just might be my favorite.
Menopause is defined as 1 year without a menstrual period. The average age of menopause in the United States is about 51.5 years, and the timing is often similar between mother and daughter, older sister and younger sister. Some things can make the menopausal transition happen sooner such as smoking and particular chemotherapy drugs. But, menopause is a natural biological process.
Though we talk about menopause in terms of the uterus (menstrual bleeding) menopausal changes and symptoms are all a function of your ovarian hormones (estrogen, progesterone and testosterone.) Menopause marks the end of your menstrual cycles and your fertility as the ovaries quiesce (become quiet and stop ovulating), but it does not just happen overnight. (Except, of course, for women who have had surgical removal of their ovaries and uterus prior to their natural menopause.)
So, back to perimenopause. Usually, perimenopause begins in the early 40’s but sometimes starts in the late 30’s. The ovaries become erratic and start to sputter. At first, you may miss a period here or there, and your periods may change in nature and become heavier or longer. Your hormones start to go a little berserk: it may remind you of the hormonal rollercoaster of puberty. Some women experience hot flashes, fatigue, mood swings, trouble sleeping, changes in sex drive, breast tenderness, vaginal dryness, acne, thinning hair, weight gain, increase in facial hair, changes in fingernail, night sweats, difficulty concentrating, or forgetfulness. No two women will have the same exact perimenopause experience. But, we all have a lot in common, in times past, no one really talked about “the change of life,” but now, there is even an off-Broadway production about it. “Menopause, The Musical.” Some women only have a couple of years of symptoms, others have 12 or more years.
This all sounds so terrible, so why do I like this season of a woman’s life?
First, because this is perhaps the most empowered time in a woman’s life. Often, a woman has spent her whole adult life up to this point taking care of other people-her children, her husband or partner, her parents, her friends. Not to say that caring for your love ones is not rewarding, but many women put themselves on the back burner, so to speak, because there is always another priority-family, relationships, work, money, etc. The typical woman juggles so many things that her own physical and emotional needs get minimized.
Every day, I take care of women who have not seen a gynecologist in 20 years because they were just too busy: granted, going to the gynecologist is not something the average woman wants to do. But what I love about the premenopausal woman is that she is just plain human. By this age, she has enough life experience to stand up for herself, speak her mind, and not worry what other people will think, By the time I see her in my office, she is ready to make herself a priority, too.
The second reason I love perimenopause is because it is medically fascinating. The symptoms of menopause need to be sorted out from other medical conditions such as thyroid disorder, unexpected pregnancy, diabetes, uterine or ovarian cancer, mood disorders, etc. This type of investigation is part of why I became a doctor. Sometimes, the evaluation includes just taking a thorough history, and sometimes blood tests, hormone tests, ultrasound of the pelvis, biopsies or other tests might be needed. But, once everything else is ruled out, treatment can be tailored to the particular woman’s perimenopause concerns. There are plenty of medical, surgical and alternative medicine treatments available. Hormonal treatments and nonhormonal treatments abound. Sometimes, a woman will say, “I’d rather just deal with it, now that I know what it is.” It is rewarding either way.
The third reason I like perimenopause is because historically in our culture, in folklore and stories and even in traditional academia, the menopausal transition is described as “the end of femininity,” “a time of female hysteria” and “the madness.” At one time or another, women were locked away in asylums for “climacteric insanity,” they underwent clitoridectomies, they accepted bizarre treatments like vaginal injections of lead. I think this misunderstanding is funny and sad at the same time. There is so much that we still do not understand about the female experience of menopause or even how to ameliorate the symptoms: yet we have come so far in the last 100 years. Perhaps some days for the individual woman, perimenopause is madness and sometimes she probably does feel hysterical. But, as a society and a medical profession, we need to take it seriously and continue to learn about it. Half of the population experiences menopause, and women are spending more and more years of their lives postmenopausal. On one hand, we should embrace the menopausal transition as a natural part of life, and on the other hand, we seriously need to figure out how do help women get through it and give them more options.
I hope that if you are going through perimenopause that you will talk with your women’s healthcare provider about your experience. There are many conditions that have overlapping symptoms. And, you don’t have to go it alone.