Perimenopause is like puberty in reverse. For the second time in your life, your body is riding a hormonal roller coaster that features highly irregular periods and huge mood swings. But during this particular stretch, instead of cranking up so you can have babies, your ovaries are gearing down for the retirement called menopause (which technically arrives one year after your final period).
Perimenopause, aka the menopausal transition, can last anywhere from four years to 10 and is unnervingly unpredictable. “Some women have normal periods all the way through to their last one, and then that’s it. Others—and this is the classic pattern—have periods that come a week early or a week late for a while, then skip an entire month altogether,” says Margery Gass, MD, executive director of the North American Menopause Society and a consultant at the Cleveland Clinic Center for Specialized Women’s Health. “It’s normal to reach menopause between the ages of 41 and 55, with 51 being the average.” Smokers tend to experience menopause a year sooner than other women; a few heavy-duty exercisers are also on the early side.
The roller-coaster ride to menopause is divided into several passages, and women experience them differently in terms of when each phase starts, how long it lasts and what kinds of symptoms appear. If you’re lucky, symptoms—such as hot flashes, tender breasts, insomnia and headaches—are only a minor bother; if you’re further down the spectrum, you may have days when you feel smacked by a hormonal two-by-four. “Some women are just much more sensitive to the hormonal changes than others are,” notes Nanette Santoro, MD, chair of obstetrics and gynecology at the University of Colorado School of Medicine in Denver.
In other words, perimenopause is uncharted territory, one that this guide is designed to help you navigate. The tools: a map showing where you are now and where you’re heading, plus advice on handling the roller coaster’s curves and dips along the way.
YOUR HORMONAL GPS
If you’re in the midst of perimenopause, you may wonder how much longer this transition is likely to last. Why getting a heads-up is important: “If you know you’re close to the end and the relief of menopause is coming soon, you may be better able to tolerate symptoms,” explains Santoro. And the opposite is true: “When you realize you’re in the early stages and your symptoms are really unpleasant, you may want to be more aggressive about seeking treatment.”
Now, for the first time, identifying how far you’ve come in the menopausal transition is easy, thanks to a new set of criteria established by an international panel of women’s-health experts. Their findings, published last fall, are called the STRAW + 10 Staging System, with STRAW standing for Stages of Reproductive Aging Workshop. See if you can locate yourself in the following STRAW stages; then you’ll know how much longer you’ll probably be in perimenopause, and you can consult the informational boxes for help with whatever symptoms you’re experiencing.
Stage 1: Late Reproductive Years
A transition before perimenopause, this is the final stage of the baby-making years—a time when your ability to have a child declines rapidly.
•Lighter or heavier menstrual bleeding.
•More frequent (that is, shorter) cycles.
Hormonal changes: During days two to five of your cycle (day one is the first day of your period), there’s a larger-than-before jump in your levels of follicle-stimulating hormone (FSH), which stimulates an egg follicle to grow each month. Extremely elevated FSH, which your doctor can determine via a blood test, indicates your ovaries are aging. (See “Can I Still Have a Baby?”)
How long this stage lasts: Quite variable from woman to woman but can continue for up to 9 years.
STAGE 2: Early Menopausal Transition
This is the official beginning of perimenopause.