In movies, whenever there's a scene where a woman realizes she's missed a period, she's shown frantically flipping through a planner to see when she wrote her last one down. For many of us, when a nurse at a doctor's office asks, "And when was the date of your last period?" the response is more along the lines of, "Uh ..."
The woman in the film is no doubt about to be handed a wacky plotline involving an unexpected pregnancy, but there's a time in a woman's life when periods become less and less frequent before they stop altogether -- and it has nothing to do with having a baby on the way.
Perimenopause is a time of transition when a woman's ovaries start to slow down the production of hormones. It may be as soon as her 30s, or it may not be until sometime in her 40s or even 50s. Regardless of when symptoms begin, actual menopause may still be years away. That's a long time to be "in transition."
So, what to expect? First, you should know that no two women's experiences are exactly alike. Just because your best friend had one set of symptoms doesn't mean that yours will match.
And there's still a lot that science doesn't know about women's bodies. What we often chalk up to hormones is often more complicated than it seems. Estrogen is responsible for a lot more bodily functions than we generally give it credit for, and its slow withdrawal from the body has a set of side effects that sometimes even medicine can't quite explain.
On the following pages, we'll explore 10 possibilities for the years when your hard-working ovaries start to take a little break, starting with a symptom we already mentioned.
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When your period hasn't been showing up when it's supposed to, it might be related to perimenopause. After all, that's its hallmark.
But it's also possible that it's because of something else, like an indication that menopause is still a long way off: pregnancy. Women can actually get pregnant during perimenopause, so if you're concerned about infrequent periods, take a pregnancy test. You're not officially in menopause until it's been a full 12 months since your last period. Until then, enjoy the savings on feminine care products (which never seem to go on sale).
Periods during perimenopause can also get shorter and lighter -- or longer and heavier, or a combination of the two. If you notice anything that simply doesn't feel right, like heavy clotting, trust your intuition and make an appointment to get yourself checked out.
When you're really tired, getting through the day is enough of an effort to warrant at least a small trophy. And if you haven't been sleeping well for days -- or weeks or months -- you might feel like you're operating in full-on zombie mode.
Unfortunately, sleeplessness is one of the most common symptoms of perimenopause. With the withdrawal of estrogen, the brain sometimes releases the chemicals responsible for the fight-or-flight response [source: Booth]. That rush is necessary for escaping mountain lions, but less helpful for remaining blissfully asleep.
Late-night/wee-hours prowling around the house can be calmed with hormone replacement therapy (HRT) -- but it's not for everyone. Sleeping pills can help you nod off, but not all of them leave you feeling rested, either. Pick up some melatonin supplements, exercise daily and try meditation to see if you can get your snooze back.
Next, another reason that sleeping through the night requires more exertion than you'd like.
Hot flashes, hot flushes, vasomotor symptoms -- call them what you will (this writer prefers "power surges"), they're never convenient.
The sudden blaze of heat that can leave you soaking with your own sweat is the result of your hormones confusing the temperature regulator in your brain. The hypothalamus misreads the body's signals and puts its cool-down system in high gear. Your skin gets hot so the body's core temperature can return to "normal," and perspiration pours out to help regulate the heat.
Just about any woman approaching menopause can sympathize -- or at least 85 percent of them [source: BreastCancer.org].
The only place where any of us want to be caught sweating profusely is the gym. At the office, coffee shop or on a date, pit stains feel a bit uncouth. There are plenty of tips from other women about triggers and how to dress (hint: Avoid silk), but there are also some medical answers to the problem if your symptoms are severe. Hormone replacement therapy is an option, as are certain antidepressants, particularly Effexor. A soy-rich diet and black cohosh may help, too, if you're looking for natural remedies [source: Carroll].
If hot flashes have you frustrated, the next symptom will sound familiar.
Any woman who's experienced a bad bout of PMS knows the havoc it can create. Irrational anger, sudden irritability, long crying spells -- hormones can make you a little nuts.
Some women report mood swings and irritability during perimenopause, but it's hard to tell if it's hormones that are causing it or side effects of other symptoms, like a lack of sleep (which makes anyone cranky).
There is quite a bit of controversy in the medical community about whether depression is more common in perimenopausal and menopausal women. Some studies have shown a mood upswing in response to hormonal treatment of depression in perimenopausal women, suggesting that there's a link between this phase in life and the development of an affective disorder [source: Khine, et al.]
In general, however, women older than 45 are less likely to be depressed than women who are reproductively younger [source: Harvard Women's Health Watch]. It's important to know that depression is not a natural part of the aging process.
A woman's personal experience during perimenopause is very much her own. Some women feel irritable, anxious or depressed. Others feel just fine. If you're in the former group, talk to someone who can help you evaluate your health and manage stress.
On the next page, we'll discuss another symptom that may be affected by stress -- but can also stress you out.
Transitioning to menopause isn't the same for every woman. With the possibility of pregnancy removed and monthly periods a thing of the past, some women feel sexual freedom. Others, knowing that their time of fertility is over, feel they are less desirable. And for women who don't consider sex a priority, it may be a relief.
It's generally accepted that women's libido is more complicated than men's, whether that assumption is fair or not. Getting in the mood isn't necessarily solved by a dose of hormones, although testosterone has worked wonders for some perimenopausal women who miss their randier self.
But stress, lack of sleep and your own feelings about the onset of menopause can also affect how excited you are to get in the sack, as can a partner's actions and attitude.
Lowered libido may, however, be the result of the symptom on the following page.
When estrogen departs, it takes a lot of moisture with it. That hormone is responsible for a surprising number of jobs, and one of them is helping with the production of oil and sealing moisture in the skin.
And while women in perimenopause may have been prepared to add a rich face cream to their makeup bag, they may not have been expecting dryness in more intimate areas.
Vaginal dryness isn't a sign of sexual inadequacy or dysfunction on a woman or her partner's part. It's simply biological fact, the result of thinner, drier vaginal tissue. The problem is that it can make sex painful.
There are plenty of options to try for a woman who's looking to regain some of that lubrication, in pill, cream, ring, tablet and gel form -- whatever you need. Some are over the counter, such as a lubricant like Astroglide or a vaginal moisturizer like Replens. Others, such as a vaginal estrogen preparation, require a prescription. A gynecologist can help you find a treatment that works for you.
The symptom on the next page is another result of biology, one that many women don't enjoy.
Weight gain in the perimenopausal years is a well-documented symptom. The frustrating thing is that the weight doesn't distribute itself evenly: It settles right on your belly [source: Stoll]. Carrying extra pounds on the waistline is linked to insulin resistance, which leads to a greater chance of heart disease [source: Camillo].
As you get older, it's easier to gain weight and harder to get rid of it. Part of that is because our activity decreases. Whether you're on your feet or at a desk all day, it's hard to get excited about jumping around after work. But the simple truth is that in midlife and beyond, you have to stay active to win the battle of the bulge.
Your abdomen may not be the only part of your body feeling a little swollen. Go on to the next page for a clue.
Tender breasts can signal periods and pregnancy. And then there's the other P: perimenopause.
Hormone changes can cause water retention, as anyone with a case of period bloat who can't fit into her favorite jeans can attest. Your breasts can retain fluid, too, swelling the tissue and making them feel heavy and sore.
Breast pain, also known as mastalgia, is a very common complaint among women, perimenopausal or no. While most people agree that cyclic breast pain is hormone-related, one interesting theory posits a fatty acid imbalance in breast tissue cells is to blame [source: Smith].
To reduce your discomfort, you can try cutting your caffeine and fat intake, popping some pain relievers and applying a cold or hot compress. It may help to wear a sports bra during the day or while sleeping for extra support. Some women swear by evening primrose and vitamin E capsules, but make sure you talk to a health care provider before adding them to your daily routine -- supplements can have dangerous interactions with other medications you're on.
On the next page is a symptom that's often a secret.
This one is a common symptom of perimenopause you may not have heard much about: urinary incontinence. Some women may be too embarrassed to discuss their leaks, but it's not unusual to experience some bladder changes in perimenopause.
Just like it helps keep vaginal tissue in shape, estrogen is partly responsible for the health of the bladder. It also makes sure pelvic muscles are in good condition. So when estrogen is reduced, bladder control may weaken.
Whether it's a little pee escaping when you sneeze or the sudden urge to "go" when you're at the bank, talk to a doctor. Urinary incontinence is a problem for more people than you think, and there are exercises, medications and behavioral techniques that can retrain those weakened muscles. All of which are a better idea than staying home to avoid public embarrassment.
Next, a pain that's more physical than psychological.
We know that abnormal brain activity causes migraines, but beyond that, the causes of these headaches are a mystery. Certain foods can trigger a migraine attack, as can certain odors, missed meals, stress, exercise -- the list goes on.
The factor these triggers have in common is change. A change in the usual, like less caffeine or too much noise, sets off a neurological alarm that results in a debilitating headache [source: Goweke].
And what's more changeable than a woman's hormones during perimenopause?
It has long been believed that hormones have a great deal to do with migraines, since the majority of their victims are women. The withdrawal of estrogen during a certain phase of a woman's menstrual cycle often precipitates a migraine in women who are prone to them. This same estrogen withdrawal may be what prompts migraines during perimenopause in women who have never had them. Others find that the frequency of their migraines has diminished. No two women are alike, so just cross your fingers that you're a proud member of the migraine-free club.
Looking for more articles on women's health? We've got links on the next page to more reading material you might like.
This menopause journal tracks the stories of one woman's journey into menopause. Get information and tips with HowStuffWorks's menopause journal.
- Booth, Rebecca. "Menopause is the Ultimate Sleep Challenge." Huffington Post. Feb. 2, 2010. (March 26, 2012) http://www.huffingtonpost.com/rebecca-booth/menopause-sleep-menopause_b_443902.html
- BreastCancer.org. "All About Hot Flashes." Aug. 17, 2011. (March 26, 2012) http://www.breastcancer.org/tips/menopausal/facing/hot_flashes.jsp
- Camillo, Patricia A. "What are the risks of central adiposity in women?" Medscape. Feb. 3, 2006. (March 28, 2012) http://www.medscape.com/viewarticle/520724
- Carroll, Dana G. "Nonhormonal Therapies for Hot Flashes in Menopause." American Family Physician. February 2006. (March 27, 2012) http://www.aafp.org/afp/2006/0201/p457.html
- Fries, Wendy C. "Menopause and Dry Skin: The Hormone Connection." WebMD. Last reviewed Aug. 23, 2010. (March 27, 2012) http://www.webmd.com/healthy-beauty/features/menopause-dry-skin-hormone-connection
- Geweke, Lynne O. "Menopause and Migraine." Menopause Management. September/October 2007. (March 27, 2012) http://www.menopausemgmt.com/issues/16-05/MM0910_feature.pdf
- Harvard Women's Health Watch. "Perimenopause: Rocky road to menopause." August 2005. (March 26, 2012) http://www.health.harvard.edu/newsweek/Perimenopause_Rocky_road_to_menopause.htm
- Khine, Khursheed et al. "The Perimenopause and Mood Disorders." Primary Psychiatry. December 2003. (March 27, 2012) http://www.afwh.org/pdf/primarypsy.Khine_2003.pdf
- Mayo Clinic. "Breast pain: an interview with a Mayo Clinic specialist." July 6, 2004. (March 28, 2012) http://health.msn.com/health-topics/menopause/articlepage.aspx?cp-documentid=100096408
- Mayo Clinic. "Menopause weight gain: Stop the middle age spread." Sept. 11, 2010 (March 27, 2012) http://www.mayoclinic.com/health/menopause-weight-gain/HQ01076
- Sternfeld, Barbara et al. "Physical Activity and Changes in Weight and Waist Circumference in Midlife Women: Findings from the Study of Women's Health Across the Nation." American Journal of Epidemiology. May 26, 2004. (March 28, 2012) http://aje.oxfordjournals.org/content/160/9/912.full.pdf
- Stoll, BA. "Perimenopausal weight gain and progression of breast cancer precursors." Cancer Detection and Prevention. 1999. (March 28, 2012) http://www.ncbi.nlm.nih.gov/pubmed/9892988