You might hear the word “menopause” and think, ‘That sounds far off for me.’ But the reality is that your body can start gearing up for menopause as early as your mid-30s. It’s called perimenopause. That’s not a bad or good thing. Just an important thing to know about the way your body transitions naturally as you get older. Especially when society has long seen anything related to menopause as taboo.
Because there’s a lack of discussion about perimenopause, many people don't understand what's happening to their bodies when they begin experiencing symptoms. That’s according to OB-GYN Dr. Suzanne Gilberg-Lenz, a partner at medical practice Women’s Care of Beverly Hills in California, and author of the forthcoming “Menopause Bootcamp.”
“Patients were mystified… and worried. Then resentful or angry,” she says. They came to her puzzled — complaining of hot flashes, anxiety, and vaginal dryness.
We called up Dr. Gilberg-Lenz so she could help us explain what’s going on, and how you can prepare for perimenopause.
Let’s start with the basics: What is perimenopause?
Perimenopause is the term often used to talk about “the time leading up to menopause,” Dr. Gilberg-Lenz says. And it can last around four years. FYI: menopause is defined as going 12 months straight without a period. Average age of menopause in the US: about 51. Dr Gilberg-Lenz describes menopause as the “puberty of midlife.”
A time when there’s a lot of fluctuation in hormones and symptoms. It’s when levels of estrogen and progesterone drop, leading to a number of possible side effects, including unpredictable menstrual cycles.
A stage of life that’s not discussed enough. Possibly because women, especially “older” women, have long been made to feel shame over their body parts and functions. A problem related to the scarce amount of info about menopause. One study of medical residents found that only about 7% felt “adequately prepared” to help women going through it. The good news: More people are being open about their menopausal symptoms. We see you, Michelle Obama.
Not a disease. Dr. Gilberg-Lenz doesn’t love using the sometimes-stigmatized word “perimenopause.” Because she thinks doing so “pathologizes it” and “plays into patriarchal and ageism stigma.” Perimenopause isn’t a disease and going through it doesn’t mean there’s something wrong. It's a disruption of what seemed normal before and a part of your body’s natural transition, she says. But at the moment, she says she doesn’t have a better word to use.
What are the most common signs of perimenopause?
Hot flashes. They can feel like heat moving down the body, followed by cold.
Sleep problems. This can be linked to hot flashes, because those interrupt your sleep.
Brain fog. Think: cloudy thoughts, trouble remembering words.
Depression and anxiety. One study from 2000 found that 38% of women in late perimenopause reported symptoms of depression.
“Gnarly” PMS. At least that’s how Dr. Gilberg-Lenz describes the heightened PMS symptoms. “I'm talking everything from bloating to breast tenderness, to mood and anxiety issues.”
Vaginal and urinary concerns. Women might experience vaginal dryness, painful sex, low libido, UTIs, and bladder leakage.
Irregular menstrual cycles. Your periods could get closer together or more spread apart. And they can change from being heavier to lighter — or the other way around. Some have said their periods looked like “crime scenes.”
Weight gain. Changes in women’s metabolism that might lead to weight gain can occur during the perimenopausal period, according to a study published this year. But fluctuating hormones aren’t the only causes. Aging, along with lifestyle and genetic factors, can also play a part. (But quick reminder: The number on a scale isn’t necessarily a measurement of health.)
Are there any risks associated with perimenopause?
Chronic Illness. When you're in perimenopause, you could be more at risk for metabolic syndrome. Which signals that some chronic illnesses might be on the way. Think: heart disease, stroke, and diabetes. Not trying to sound the alarms, but you might want to consider prioritizing your health in this stage, if you aren’t already.
Osteoporosis. Dropping estrogen levels can cause bones to lose strength. But it’s hard to know whether you have osteoporosis before those weakened bones fracture, because there aren’t many symptoms related to the disease. So it’s probably not a bad idea to start strength training before you experience perimenopause symptoms.
Dementia. A new study suggests that women who entered menopause before the age of 40 were 35% more likely to develop dementia later in life. And “the rates of dementia in women is two to three times higher than [in] men,” Dr. Gilberg-Lenz says, adding that she’s encouraged by the fact that this kind of research is at least coming out. “The information is much more available now than it was 22 years ago when I finished my residency.”
What should I do if I think I have perimenopause?
Find out if you have a family history of early/late menopause. If you can ask your mom about when her symptoms started, go for it. It could give you a better idea of when you can expect symptoms. Dr. Gilberg-Lenz says she only learned recently that late menopause ran in her family. “At the age of 56, I'm weirdly still perimenopausal,” she says.
Find a doctor who’s knowledgeable. If you’re not comfortable talking to your PCP or OB-GYN about perimenopause, you can use the North American Menopause Society (NAMS) to find a Certified Menopause Practitioner (like Dr. Gilberg-Lenz) in your area.
Consider hormonal treatment. But keep in mind “there’s no one-size-fits-all solution,” Dr. Gilberg-Lenz says. Some people manage hot flashes and brain fog with supplemental progestin or estrogen pills and patches. And there are estrogen creams or tablets that could help with vaginal dryness. Thing to know: Although studies show that Black, Latina, and Native women might experience hot flashes and other perimenopause symptoms more often than white women, they’re less likely to be offered effective hormone replacement therapy. Of course: You should consult with your doctor before trying out a hormonal treatment.
If you’re into herbs, ask about botanicals. Doctors have mixed feelings when it comes to whether herbal supplements help women in perimenopause. Partially because supplements are regulated in a different way than other drugs. But Dr. Gilberg-Lenz, who’s a medical advisor for perimenopause and menopause wellness company Kindra, recommends chasteberry extract for PMS symptoms and Kindra’s vaginal lotion for dryness. “Magnesium, B complex, Vitamin D, Omega-3 fatty acids — these all can be beneficial to us in general,” she says. Again: This is something to discuss with your doc.
Be open to cognitive behavior therapy. Talk therapy can help you work through mood and sleep problems. And really could benefit people during any major life transition.
Prioritize movement and healthy eating. Because perimenopausal women can be more prone to certain diseases and changes in body composition than other people.
Know that there are several new perimenopause brands out there. Menopause has become a growing femtech market. We mentioned Kindra, which just launched a quiz to help women prepare for menopause. But there’s also wellness community Elektra Health, incontinence brand Hazel, menopause wellness company Evernow, telehealth company Gennev, and menopause care company State of Menopause, to name a few.
Follow new accounts on social. Dr. Gilberg-Lenz’s account is a good start. She also recommends taking a look at accounts including Hot Flash Inc, Queer Menopause, Menopause Society, Dr. Arianna, Getting Hotter, Dr. Sharon Malone, Hello Revel, Menopause Nutritionist, Coach Jolinda, Gabriella Espinosa, Mona Eltahawy, Wise Pause, and Loom.
Reframe the way you think about perimenopause. Reminder: Perimenopause is a normal life stage and, as Dr. Gilberg-Lenz says, not a disease to cure.
It’s understandable to be concerned about perimenopause. It’s a disruptive life event. But you don’t need to feel shame for hitting a normal stage that — when including menopause itself — can last from a third to half your life. Instead, continue to learn about your aging body (reminder: there’s nothing wrong with getting older) and seek care early on. Because that can be truly empowering.