Perimenopause: The What, When, How, Why

Bloating. Heavy periods. Weird mood swings. It could be perimenopause.

By Alice Lesch Kelly

What is perimenopause?

Type the word into most computers and spell check will correct you with either per menopause or Peru menopause. Perimenopause isn’t even in the database — a symbol, perhaps, of how poorly this phase is understood. But it’s not that complicated. Technically, perimenopause is the span of six to 10 years during which your body moves toward menopause. And menopause is really just one day in your life: the 365th day from the date of your final menstrual period.

"Perimenopause is not a disease, any more than adolescence is. It is a physiological life stage," says Marcie Richardson, MD, director of the Harvard Vanguard Menopause Consultation Service, in Boston. That said, it’s important to note that all the drugs or hormones in the world won’t prevent perimenopause; they’ll merely change how you experience it.

Can I predict when mine will begin?

No, but look for it somewhere between the ages of 45 and 55. A few factors are believed to hasten its arrival: smoking, never having had a baby, exposure to toxic chemicals, and a history of heart disease, pelvic surgery, epilepsy, or depression. There is no clear correlation between age at perimenopause and that of your first period, or your use of birth control pills. And you can’t bank on starting early or late based on your sister’s or your mother’s timing.

Can testing tell me where I stand?

Generally, measuring blood hormone levels is not a reliable way to determine whether you’re in perimenopause, because levels tend to be erratic in women who are still menstruating. "Estrogen and other hormone levels fluctuate widely, largely because the ovaries are starting to fail," says Lila E. Nachtigall, MD, professor of obstetrics and gynecology at NYU Medical Center. Although your estrogen level gradually declines during these years, it can at times be higher than it was before you entered perimenopause. While testing can provide some information about fertility, it can’t necessarily determine whether you’re in perimenopause. "Most of the time, even doctors have to go by symptoms," Nachtigall admits.

Why do I need to know whether I’m in it?

"You benefit from knowing what’s normal and what’s abnormal; it’s one of those areas where some baseline knowledge will save you a lot of worrying and wondering what is going to happen," says ob-gyn Jan Herr, MD, a menopause expert at Kaiser Permanente Northern California. For example, if you begin to experience vaginal dryness, knowing you’re in perimenopause can help you understand that discomfort during intercourse may be caused by physical changes, not problems with your romantic relationship. (Although it could be that too. Be honest: Perimenopause is not an excuse.)

"It’s good to know, just so you can get emotionally prepared for the endgame: not getting periods anymore," says Jerilynn Prior, MD, director of the Centre for Menstrual Cycle and Ovulation Research at the University of British Columbia, in Vancouver.

Perimenopause should also send up the red health-alert flag: Your risk for certain illnesses, such as cancer and heart disease, increases with age, and once you start toward menopause, you should consider making risk-lowering lifestyle changes and scheduling early-detection screening exams. Realizing you’re in perimenopause can be the starting gate for being more vigilant and proactive about your health.

What will my periods be like?

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