•Your menstrual cycle varies by seven or more days from one cycle to the next.
•An increase in irritability and PMS-like bloating.
Hormonal changes: Your body is making lots of estrogen but less progesterone, explains Steven R. Goldstein, MD, professor of obstetrics and gynecology at New York University’s Langone Medical Center. “It’s the paradox of perimenopause,” he notes. “Estrogen levels go up before they go down.”
How long this stage lasts: Usually 4 or more years.
STAGE 3: Late Menopausal Transition
The second full-fledged phase of perimenopause often occurs at about age 49. Santoro calls it the hot spot, because this is when you may start to be really affected by symptoms.
•Hot flashes are common.
•Sleep disturbances get worse.
•Skipped periods; you may go 60 days or more without menstruating and you frequently don’t ovulate.
Hormonal changes: There can be dramatic fluctuations in levels of hormones, including estrogen and progesterone, but the overall trend is that estrogen declines. “Ovarian function doesn’t just stop on a dime; it sputters,” Goldstein explains.
How long this stage lasts: Generally 1 to 3 years.
STAGE 4: Early Postmenopause
At this stage, you’ve recently crossed to the other side of menopause; in other words, you’ve gone more than a year without a period.
•During the first part of this phase, hot flashes and night sweats are likely to worsen or start.
•Toward the end of this phase, most menopausal symptoms recede, though hot flashes may continue for several years and vaginal dryness and thinning become more common.
Hormonal changes: After your period finally ends, estrogen and progesterone decline to very low levels.
How long this stage lasts: First part: 2 years. Remaining part: 3 to 6 years.
FEEL NORMAL AGAIN WITHOUT HT
Even if you’re not a good candidate for HT (see “Should You Take Hormones?”), that doesn’t mean you must put up with symptoms that interfere with your life or disrupt your sleep, says Andrew Kaunitz, MD, professor in and associate chairman of the Department of Obstetrics and Gynecology at the University of Florida College of Medicine–Jacksonville. While they’re not as effective as HT, a number of therapies can help assuage your discomfort. And remember: How you feel now is not necessarily how you will feel in two years. Unlike many other things in life, hot flashes and other perimenopausal concerns will get better as you age.
Here’s the latest on managing your symptoms.
SYMPTOM: Hot Flashes and Night Sweats
An estimated 75 percent of women experience hot flashes during the menopausal transition, and for about a quarter of those affected, the internal temperature shifts are seriously distressing. Night sweats—hot flashes that occur while you’re sleeping—are also very common; these two discomforts are classified as vasomotor symptoms. Interestingly, during menopause, obese women are more likely to get hot flashes because the fat tissue makes their bodies warmer; after menopause, obesity is protective because the fat tissue produces a small amount of estrogen, which may prevent hot flashes.
How to Handle