Welcome to perimenopause. (Sorry we couldn’t warn you in time—but please share with friends so they’ll be prepared.) That’s the name for the transition a woman goes through as her ovaries start shutting down their baby-making operation, causing the hormones they produce—estrogen, progesterone, and testosterone—to fluctuate and decline. As they do, you might notice heavy bleeding and other symptoms like hot flashes, intense breast tenderness, longer/shorter menstrual cycles, acne, loss of libido and/or vaginal dryness, extreme PMS, anxiety, depression and trouble sleeping. (You see why no one wants to talk about it.)
“The hot flashes of menopause capture all the attention, but the perimenopause transition is much harder,” says JoAnn V. Pinkerton, MD, NCMP, executive director of the North American Menopause Society and Professor of Obstetrics and Gynecology at the University of Virginia. That heavy flow? “We call it opening the floodgates,” Pinkerton says. “As estrogen surges you bleed very heavy and often unpredictably—and unpreparedly—then it slows back down again.”
Women generally enter perimenopause around age 40 (give or take), and experience it for an average of four years but as little as a few months and as many as 10 years, says Pinkerton. There’s no medical test that determines if you’re in perimenopause; it’s diagnosed largely by its symptoms. (Your doctor may offer to check your hormone levels to see if you’ve entered perimenopause, but since they fluctuate during this time, Pinkerton says experts have agreed it’s not a reliable test.) Perimenopause ends 12 months after your last period, which is the sign that you have officially entered menopause.
Managing the symptoms: Seventy-five percent of women experience at least some perimenopause symptoms, says Pinkerton. If you fall into that group, be sure to talk to your practitioner about it. “You shouldn’t have to go through unpleasant symptoms like heavy bleeding and others that interfere with your life,” says Anne Moore, DNP, WHNP, the women’s health clinical trainer at the Tennessee Dept of Health and a clinical advisor for the Association of Reproductive Health Professionals. Heavy bleeding and other typical perimenopause symptoms are also sometimes a sign of an overactive or underactive thyroid. “Your clinician can test to make sure thyroid dysfunction isn’t a contributor, and make these episodes less frequent or prevent them from happening altogether.” Here’s what to expect, and how to ease the transition.