When I was younger, I thought that women’s lives divided neatly into three parts: too young to have a period, too old to have a period, and all the period time in the middle. Puberty was the beginning of the time of periods and menopause was its end. When adults talked about menopause, which they didn’t very often, perimenopause and postmenopause were never mentioned.
When I was younger, most people also didn’t think much about women who don’t have periods at all. I know better now, but menopause for trans people is usually very different than it is for cis-women. I am still learning about which experiences are shared and which aren’t. I don’t know enough to talk about it yet, so right now I am speaking primarily to cis-women. When I know more, I’ll say more.
Menopause is defined as the end of a woman’s menstrual periods. It doesn’t count until you haven’t had a period in a year. If you are eleven months late and then get a period, it’s not menopause yet. You have to start counting all over again. But once you have gone twelve months without a period, that’s menopause. That day. That’s it. If you want to have some sort of menopause party (or croning ceremony, if that’s your thing), hold it right then. Because the very next day is not menopause anymore. That’s postmenopause. You are now officially done with your period.
But everything up until that day, no matter how many hot flashes, mood swings, or irregular periods you have, that isn’t menopause. That’s perimenopause, the menopausal transition. Some people also call this premenopause, but that can also include any time after puberty and before menopause. “Peri-” means “around,” so perimenopause can also include the time right after menopause.
Often we use the word “menopause” to mean the whole process of moving from a regular menstrual cycle to no periods at all, but more and more people are using the word “perimenopause” to talk about the unstable time before your final period.
Some women don’t have a transitional phase. Artificial menopause is abrupt, and usually more intense. It is usually caused by a medical disruption of the reproductive system. The sudden loss of hormones can be a shock since it doesn’t allow the body any time to adjust.
For most women, perimenopause begins 5 – 10 years before menopause. The average age of menopause in the US is 51. Often, women view menopause as a sign of aging and are uncomfortable admitting they are having symptoms. But if you do the math, having symptoms anytime after 40 is right on time. 35 isn’t too early to begin to notice subtle changes.
So what are those symptoms? And what causes them? And why, why, why, is my cycle now such a mess that I bled in my pants and had to go home and change? Is perimenopause really just like seventh grade?
A lot of the symptoms of perimenopause are similar to those that women continue to experience in postmenopause. Those symptoms are the ones associated with loss of estrogen:
- Decreased vaginal lubrication
- Loss of elasticity in vaginal tissue (leading to painful intercourse and increased risk of infections of the vagina and bladder)
- Decreased muscle tone in pelvic floor (increasing stress incontinence and causing weaker orgasms)
- Decreased sexual arousal and desire
- Loss of bone mass
- Altered blood cholesterol: high density lipoprotein (HDL), “good” cholesterol, decreases and low density lipoprotein (LDL), the “bad” stuff, increases
- Hair loss
- Dry skin
- Hot flashes or night sweats
Not on most official lists, but definitely high on most women’s lists: lush growth of facial hair. And chest hair. Plucking and shaving new areas can become a big part of perimenopausal and postmenopausal beauty routines.
Decreasing progesterone and estrogen dominance
But estrogen is actually the last of the big reproductive hormones to decrease. During perimenopause, estrogen levels can fluctuate widely, especially as it begins. Sometimes estrogen levels are low, sometimes they aren’t. Sometimes they are very, very high.
Progesterone, on the other hand, declines steadily beginning in a woman’s mid to late 30’s. This can lead to an imbalance between progesterone and estrogen called “estrogen dominance.” So, on top of the low-estrogen symptoms, perimenopausal women can also experience symptoms of elevated or imbalanced estrogen, or possibly symptoms of the wide swings themselves:
- Irregular periods – longer or shorter, heavier or spottier
- Tender or swollen breasts
- Increased vaginal lubrication and mucous
- Mood swings
- Increased cramping
- Increased pain at ovulation (mittelschmerz)
- Increased PMS
- Decreased fertility (but not enough to count as birth control)
- Increased stress and depression
So, in a way, perimenopause is just like seventh grade. Or puberty in general. Or maybe pregnancy. The complicated stew of hormones is unstable, so it is hard to get used to and difficult to plan around. Flexibility and a sense of humor may be vital to getting through to the new normal while feeling okay about yourself. That, and a lot of pantiliners.
Not every source agrees about which symptoms are caused by which hormones. The Centre for Menstrual Cycle and Ovulation Research has a detailed post about the different hormones involved. Christiane Northrup, M.D. breaks down symptoms of decreasing testosterone as well. Both are fantastic sources for further reading, if you want more details. The Centre for Menstrual Cycle and Ovulation Research is great if you want to geek out with cutting edge studies. Dr. Northrup is medically comprehensive, but more focused on supporting women through the changes in their bodies.