Dr. Kim Foster: Wicked Health


Perimenopause: Everything We Don’t Talk About

Let's Have A "2nd Talk"

Perimenopause is a time of enormous change in your body. It can be a phase of major upheaval as your hormones elect to take a ride on the Leviathan at Canada’s Wonderland.  Every woman goes through this transition but do you know what to expect? If you’re in your 40s, or even your 30s, do you have any idea what is headed your way?

I remember when my mom sat me down, many years ago, and gave me The Puberty Talk. I was nine and we were at our cottage in Haliburton. It was a beautiful summer day, golden and lazy. As we sipped our lemonade she spelled it all out. Of course, the predominant emotion I felt at the time was horror. In retrospect, though, I am so thankful for that talk. I appreciate that she prepped me early for all the big stuff that was about to go down.

But, when my mom went through the other side of things herself—as she approached menopause—who was there to take her by the hand and talk to her about the changes she would experience? It wasn’t me, that’s for sure. It wasn’t her own mom, who had passed away years prior.

Perimenopause is just as significant a change as puberty. Exiting your reproductive years can be as turbulent as entering them was. Many of us remember having that first talk with a trusted somebody who explained how our bodies were going to change. But when does the dialogue happen to give women a heads-up on menopause? Who answers our burning, personal questions? Who guides us through menopause?

*Crickets chirping*

Exactly. Nobody.

All too often, there is no talk. There is no preparation. And that leaves many women—more than half—experiencing significant anxiety about their health and wellness during perimenopause.

So why are we reluctant to talk about this? Is it embarrassment? Is it lack of knowledge? Or, is menopause a taboo subject because of a deeper societal issue: the fact that we live in a youth-obsessed culture. Discussing, commiserating, even celebrating the ultra-natural phase of menopause is not exactly encouraged in such an environment. Which, let’s face it, only adds to the trauma if you happen to be careening towards that stage yourself.

So. What is menopause all about? Let’s talk about it! Here’s everything you wanted to know but were too afraid to ask:

First, what is perimenopause, exactly?

Perimenopause is the term for the transitional phase into menopause. It typically begins several years before actual menopause (which is defined as a full twelve months without a period, and usually happens around age 50). You enter perimenopause when your ovaries gradually stop producing estrogen. Which sounds gentle and easy, right? Yes, well, while your ovaries are peacefully retiring...the rest of your body tends to be having a panic attack.

Perimenopause is normal and natural.

This is not considered a pathologic medical condition. It is a normal body process and nothing to be ashamed of. In itself, menopause does not require “treatment”. The symptoms of perimenopause, on the other hand, are a different story. More on this, below.

It’s different for everyone.

Some women sail through menopause with hardly a complaint. Others have plate-tectonic-scale turmoil. The majority of us are in the middle of that spectrum somewhere. Most women experience an average of five perimenopausal symptoms. But the degree of those symptoms, and the length of time you might experience them, is highly individual.

And those symptoms might be...

  Hot flashes. This is the most common symptom of perimenopause, and it can be incredibly uncomfortable and disruptive. Typically, a hot flash is an intense sensation of heat that lasts about 30-60 seconds and then gradually dissipates. It may happen several times a day, and also through the night, too.

  Insomnia. Even if you have been a champion sleeper up to now, when perimenopause hits, you may find yourself staring with glazed eyes at the LED display on your clock radio, desperate for rest. Nocturnal hot flashes, or night sweats, are a common factor underlying sleep disruption.

  Mood changes & irritability. It’s not funny that many women hit their perimenopausal years right at the time their kids are teenagers. I’ll be blowing out 50 birthday candles when my firstborn is 16. If there will ever be a time when I’ll need emotional stability (and my sense of humor), it’s when my sons are learning to drive. Not to mention staying out till the wee hours with friends, experimenting with alcohol and cigarettes and worse...in fact, I think I’m having a hot flash right now just thinking about it...

  Irregular bleeding. Your period can do crazy things before it ultimately ceases. It’s common to first have an upsurge in period heaviness and frequency (I tell patients it’s like one last hurrah), before things start to peter out and stop altogether. But this is extremely variable. Erica had a particularly nasty bout of this, several months ago.

  Vaginal dryness. The tissues of the vagina and vulva are very responsive to the presence—or absence—of estrogen, and uncomfortable dryness of these tissues can result. Which can also lead to painful intercourse. A whole other taboo topic, yes? Geez, we could go on all day...

  Decreased libido. Just when you thought the irregular periods and moodiness were bad enough for your sex life, this little glitch comes along to round out the perfect storm for your relationship.

  Urine leakage. This, especially when coughing or sneezing. Many of us are familiar with this charming phenomenon from the postpartum phase (and beyond, if you were unlucky). It’s a common symptom of menopause, too.

But at least I don’t need to worry about pregnancy, right? Right?

Um, wrong. In spite of the vaginal dryness, the mood swings, and the lack of libido...yes, ladies, you can still get pregnant during perimenopause. Ridiculous and unfair, I know, but true. Until you are fully through menopause (meaning a straight 12 months without a period), you may still be ovulating.

But it’s not all bad news. Fact is, there are options for treatment of all these symptoms and issues (the subject of a future post, I'm thinking.). Whatever you do, be sure to see your doctor and discuss it. No shame, it’s all normal and natural...but that doesn’t mean you should suffer.

I think it’s time we open this dialogue and start talking to each other about this. If we do, we can all approach menopause feeling confident, armed with knowledge and well-supported by friends, family, and society as a whole.

Start by talking to your girlfriends, your sisters, your mom, your nieces. Let’s get this out in the open. Let’s not just endure this life stage...let’s rock menopause.