The perimenopause transition—the time in a woman’s life when her hormones are fluctuating leading up to her final menstrual period—can come with a variety of symptoms like irregular periods and hot flashes. This phase of life often coincides with other major changes: children growing up and leaving home and parents facing health issues, for example. Understanding what’s really going on in your body—and your mind—as you approach menopause is the first step to navigating the transition well. That means preparing to minimize symptoms, protecting your future health and, for some women, exploring opportunities that this new life stage opens up.
How you approach menopause—your attitudes and expectations—could make a difference in how you experience it. “There’s been a paradigm shift in how we look at menopause,” says Cynthia Geyer, M.D., medical director at Canyon Ranch in Lenox, Mass. Where once menopause was seen as an ending, today more women are looking at it as a rebirth of personal vitality. “It’s a time to reconnect to what resonates in you,” Dr. Geyer says. “Menopause can be an opportunity to take a look at your life—what’s working and what’s not—and reflect on how you’re going to find your joy and passion.”
What Causes Menopause?
The shift that marks the end of fertility takes place gradually. You may begin to notice subtle changes in your periods in your 40s or even your late 30s as your ovaries, two small glands on either side of the top of your uterus, begin to put out fluctuating levels of estrogen and lower levels of progesterone. As you approach menopause, your ovaries will start to get smaller and will produce lower levels of both estrogen and progesterone. Although you can still get pregnant during this time, your menstrual cycle will become less regular and more variable as you go through menopause, and you might experience some longer, heavier periods than you did in the past. Eventually your period will stop completely.
What’s the Difference between Perimenopause, Menopause and Postmenopause?
When women say they’re going through menopause, what they almost always mean is that they’re going through perimenopause, the time of declining egg and hormone production. Another name for perimenopause is the menopause transition. “Perimenopause are those years in which your hormonal levels have started to shift but you still get your periods,” Dr. Geyer says. “This is the time when your symptoms are often the most intense.” The average duration of perimenopause is three to five years, she says, “but it can be as long as a decade.” It’s not possible to predict when the menopause transition will begin for you, although many women tend to experience it at around the same age as their mothers did.
Menopause itself refers to the time when you haven’t had a period for 12 consecutive months. The average age of menopause for an American woman is 51, but it’s considered normal anytime between 40 and 55. Once you’ve gone through menopause, you are in postmenopause. When this happens, you can be fairly certain that you won’t ever have another period again, and you can no longer get pregnant. When life expectancy was lower, this may have been a fairly short phase, but these days you can expect to live 30, 40 or 50 years after your last period. That makes menopause a perfect time to make changes that can improve your vitality for the long run.
What Causes Early Menopause?
Menopause is considered early if it happens before age 40. The reasons aren’t always known, although genetics play a role.
If you’ve been treated for cancer, radiation or chemotherapy may affect your ovarian function, leading to symptoms of early menopause. In a small percentage of women, autoimmune diseases (like rheumatoid arthritis and thyroid disease) or genetic factors can lead to “premature ovarian failure,” which mimics menopause and can cause similar symptoms. In some cases, though, women with this condition may still get occasional periods, and can even get pregnant.
If you have a hysterectomy—removal of the uterus—you may experience menopause symptoms, too. Your body will still produce estrogen if the surgery leaves your ovaries intact, but your risk of going through menopause early following a hysterectomy goes up. If you have both ovaries removed along with your uterus, you will go into menopause immediately. In this case, your symptoms will likely be more dramatic compared to women who enter menopause over the course of several years.
What Symptoms Should I Expect—and When Will They Pass?
“Hot flashes and night sweats are probably the most common symptoms,” Dr. Geyer says. “Most women in perimenopause get these.” They vary in intensity, duration and frequency, though. “Some women feel the thermostat has just nudged up a degree, while for others it’s pretty dramatic. They turn beet-red, break out in sweats and feel like they want to tear their clothes off.” Five years after menopause, only about 15 percent of women still experience some hot flashes. Here are other common symptoms:
- Mood swings and irritability. A woman’s risk of depression risk is three or four times higher than normal during perimenopause, but once you’ve been through menopause, your likelihood is the same as before you started the transition, says Dr. Geyer, who adds that the idea that postmenopausal women are particularly prone to depression is a myth.
- Sleep issues. Night sweats may wake you up. The condition sleep apnea also becomes more prevalent in menopause for a variety of reasons, including a loss of elasticity of the tissues that hold the airway open. Sleep problems can affect your mood and concentration, and can contribute to weight gain and other health problems.
- Skin and hair changes. Your skin may become drier and more likely to flake, and you may even experience adult acne. Some women experience thinning hair, too.
- Vaginal and pelvic changes. The tissues of your vagina may become drier and thinner, making sex uncomfortable without a lubricant. Urinary infections may become more frequent. Some women feel an urgent need to urinate at times, and may have trouble holding urine, which can leak, especially during exercise.
- Low libido. This affects some but not all women. If perimenopause makes sex painful, that can inhibit desire. On the other hand, some women feel liberated by not having to worry about pregnancy and birth control.
- Concentration problems. This is sometimes called “menopause brain.” Sleep deprivation plays a role in it.
- Weight gain, especially around the middle. The hormonal changes you go through make it more likely that your body fat will be distributed around your abdomen rather than your hips and thighs. This increases your risk of cardiovascular disease. Insulin resistance, which causes diabetes, also can also result.
A Trigger for Renewal
While navigating the symptoms of perimenopause can be challenging, this can also be an opportunity to make changes that will improve your life now and into the future. “A lot of women have put their own needs on the back burner while they take care of their kids, their partners, their jobs, their coworkers,” Dr. Geyer says. “When they go through menopause, many women finally say, ‘You know what? My kids are leaving home, I can really get back to what makes me tick, what my passions are.’ It’s a time to reclaim your life.”