Perimenopause's Signals Can Be Faint for Some

Patient Expert

One of the comments from my last sharepost was, "A woman knows her body by the time she is 40ish." That comment made me wonder - when do women realize that they are entering perimenopause? I, for one, sure didn't understand the changes that my body was undergoing for quite a bit.

The thought started to dawn on me when I began realizing that I was experiencing sudden irrational displays of anger (and at times, temper tantrums and crying jags) once a month. (Just a note: I believe most of my family members and friends would have called me even-tempered throughout my life with rare blow-ups, so these sudden eruptions would have been considered unusual.) Once I started seeing a pattern and tried to analyze what was behind these uncharacteristic mood swings, I realized that the outbursts tended to happen about a week before the onset of my period - and that my period was getting heavier and wasn't as consistent in appearing at a regular monthly time. That realization forced me to realize that something was going on physically. So for the past few years I've chronicled on a calendar when my period appears and make sure I take a deep breath if I begin to feel the urge to lash out at someone the week prior.

It turns out that I'm not alone. For some, there are no symptoms that they've entered a different phase. Kathy recounted, "I realized I was in perimenopause when my doctor told me after my annual check-up and blood test. My hormone levels were changing. I wasn't having any symptoms I was aware of."

Another friend said, "I've always had really heavy periods. You know, the two tampons plus a pad type. Plus, the first day was always hell and survived only with the help of 14 Tylenol and one bottle of red wine. I remember a few years ago when I was driving my daughter to a dance class. She was probably 15 or so at the time. I remember thinking, you poor soul, I only have a few more years of this, but you have 35 more years. Although I was always on a regular schedule, I never really kept up with it on a calendar. My mood swings and bloated body always gave me a clue as to when it was time to purchase the pain killers and wine. So, it was a surprise to me when I recently realized that I had gone several months without an excuse to get drunk. I really hadn't thought about it, but I had obviously stopped having a regular period. Sure, there had been a few occasional hot flashes, but were they really hot flashes or just the price we pay for living in the humid south? There had been mood swings, but what woman with two kids, a husband, full-time job, elderly parent and parents-in-law and crashing economy had not felt a little overwhelmed? The more I thought about it, the more obvious it became. I am in perimenopause. I'm not sure what the next stage will involve, but this one has not been near as bad as I would have expected. It's not a barrel of roses, but so far, it has just been a minor inconvenience. My biggest complaint? I no longer have an excuse for a bottle of red wine."

"The first signal for me was my periods started getting more and more irregular -- usually they are pretty regular (27 to 30 days apart)," my friend Christina remarked. "Here, I'll go thru my calendar for 2009. While I was still age 48 the days between periods were at 25 and 21. Then I turned age 49 and the days between periods were 26, 32, 38, 21, and 26 which was just in August. Then I get one yesterday, which is 3.5 months since my last one in August. Weird I also am crampier than usual."

Another friend reported, "I'm 49 going on 50 and haven't reached this point. My FSH level has been zero for the past 5 years - levels of about 25-150 mean you're in menopause. I have an IUD so my periods have almost stopped for 3 years so I have no clue if I am still 'having' them or not. Signs of perimenopause? I may have some. I've occasionally had bad sleep where I've been awake from 2-5 a.m. many nights. I found that occasional Ambien has helped that. And my fat around the belly? Maybe it's hormones, or maybe too much bread and not enough exercise."

So what can some of the symptoms be that indicate that our body is changing? HealthCentral provides a good list that will help you gauge what is happening:

  • Hot flashes and night sweats.
  • Heart pounding or racing
  • Difficulty sleeping.
  • Mood changes.
  • Forgetfulness.
  • Urine leakage.
  • Vaginal dryness.
  • Joint stiffness.

Dr. Christiane Northrup, an internationally known expert on women's health and wellness and of medicine and healing, also noted that other physical changes such as osteoporosis, which can begin when a woman is her 20s and 30s, can for some continue into the onset of menopause. In her book, "Women's Bodies, Women's Wisdom," Dr. Northrup warned, ""as much as 50 percent of a woman's bone loss over a life span is lost before the onset of menopause." She added, "Hip fracture rates for white women in the United States begin to rise abruptly between the ages of forty and forty-five, before the normal advent of menopause." Other signs suggested by the physician include changes in sexuality, thinning head hair and excessive facial growth. We'll discuss these issues in later shareposts.

Dr. Northrup also had some good advice for women who are beginning to experience signs of this change. "What you're likely to experience in menopause has a lot to do with your beliefs, your culture, and your expectations. Given the culture of medicine, it's no surprise that the vast majority of studies through the years have been on women who are experiencing health problems during menopause. The medical system (which is simply a reflection of the larger culture) has only very recently begun to study the menopausal experience of health women who exercise regularly, don't smoke, eat a good diet, and lead a healthy lifestyle." Therefore, how we go through perimenopause can be product of our own self-care. Therefore, I hope as we enter 2010, you'll make a pledge to yourself to take good care of your own health as one of your resolutions.