Perimenopause: The What, When, How, Why

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

By Alice Lesch Kelly

Erratic, to say the least. Ninety percent of women experience four to eight years of irregular periods before menopause. For most of us, periods start occurring closer together: A 28-day cycle turns into a 27-day cycle; then it’s 26 days, then 25. "You feel like you have your period all the time," says Jan Shifren, MD, director of the Vincent Menopause Program at Massachusetts General Hospital, in Boston. Then you might start to skip some cycles, and perhaps you’ll go 40 to 60 or more days between periods (which is why continuing to use contraception is important). Premenstrual syndrome often gets worse during this time because of unstable hormones, and bleeding may become heavier or lighter, notes Leslee Kagan, director of the menopause program at the Benson-Henry Institute for Mind Body Medicine at Massachusetts General Hospital, in Boston.

Although bleeding changes are normal during perimenopause, some merit a doctor’s assessment to rule out the presence of cancer or other diseases. Consult your doctor if or when you:

  • first notice a change in your cycle
  • experience very heavy bleeding
  • have bleeding that lasts longer than normal
  • bleed more often than every three weeks
  • spot or bleed after sex or between periods

Do I still have to use birth control?

Yes, unless you don’t mind having a baby when you’re in your 40s or 50s. Although ovulation is erratic during perimenopause and fertility steadily decreases, unprotected sex can still lead to pregnancy. "There are more unplanned pregnancies as women get older, because they’re assuming they’re less fertile," Richardson says. In fact, some 75 percent of pregnancies in women over 40 are unexpected. (The rate is second only to that for teenagers.) The chance of becoming pregnant diminishes with each year; nonetheless, record numbers of over-40 women are having babies: In 2005, the birth rate for women over 40 was the highest it’s been since 1970.

However, maternal age does increase the risk of medical complications for mothers, which can include gestational diabetes, high blood pressure, miscarriage, and stillbirth, according to the March of Dimes. Babies born to such women have an elevated risk of premature birth, low birth weight, genetic disorders, and other birth defects. If you don’t want to get pregnant, "be sure you use birth control until you have gone one year without periods," Richardson recommends.

Will I gain weight?

Probably. "As you approach 50, your metabolism drops," Herr says. That means your body needs fewer calories. The average daily calories needed by a moderately active woman to maintain her body weight goes down from 2,000 in her 40s to 1,800 in her 50s — a difference equivalent to two Oreo cookies and a glass of fat-free milk every day.

Even if you eat the same amount of food and do as much exercise during perimenopause as you did before, you’ll end up gaining weight. To avoid it, you have to ramp up exercise or reduce calories. "You basically have to run to stay in place," Shifren says. Two (painless) moves: Burn 10 extra calories an hour by doing two minutes of moderate activity, such as stair climbing, jumping jacks, or walking lunges. At each meal, try to leave two bites on your plate.

Even if you don’t gain weight, your body mass may redistribute, with fat accumulating more around your middle. Not only is excess belly fat cosmetically undesirable, it can raise your risk of cancer, heart disease, and diabetes. Belly fat promotes insulin resistance and reduces your ability to use blood sugar effectively. Your risk is elevated to unhealthy levels if your waist measurement (at the level of your navel) is 35 inches or more.

Gauging Your Perimenopausal Status

If you’re not sure whether you’re in it or not, keeping a diary can help. Prior has developed a daily diary format that helps you track your body’s changes over time. To download a copy of Prior’s diary, go to her Web site:

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