The Perimenopause Puzzle

by WV Marshall

My mom and her friends experienced “the change” and took what were resignedly called “pumpkin seeds,” because the blaze-orange HRT pills were the size of a pumpkin seed and, to put it delicately, altered the color of urine to a more orange-y hue. But we now live in a more enlightened age, where “the change” is now menopause and its precursor is perimenopause, and we are mistresses of our fate when determining courses of action to address symptoms and conditions typically associated with we stop menstruating.

But really, what is perimenopause? More importantly, when can we expect symptoms to typically manifest or do they just sort of sneak up on us?

The answers, according to a January 2018 Main Line Health blog, aren’t what doctors or their patients were expecting. Many women in their 40s and the years leading up to menopause – AKA perimenopause – discovered that symptoms typically associated with menopause can show up much sooner, creating a triple whammy of physical, mental and emotional mayhem on women’s lives.

Unfortunately, many women having perimenopausal symptoms – sleepless nights, lack of interest in sexor that feeling of “losing it” – didn’t know what was going on with their suddenly out-of-control bodies, Main Line Health said.

The likely reason? We’ve traditionally been told that after the childbearing years comes menopause, generally defined as 12 months since a woman’s last period.

Yet, for maybe five to 10 years before a woman actually stop menstruating, the ovaries start producing less of the sex hormones estrogen, progesterone and testosterone, wreaking all kinds of havoc including hot flashes, vaginal dryness, irregular or heavy bleeding, brain fog and lost sex drive.

These symptoms are familiar to most women, yet one in four women experiences no perimenopausal symptoms at all. And just as there is a range of symptoms, the presence of symptoms runs the gamut as well – for some only a few months, and for others, more than five to 10 years.

“I’ve been practicing for 30 years and there are women who never seem to perceive anything, never have moodiness in pregnancy, never a hint of depression or baby blues, and they go through menopause without a single hot flash,” said Dr. Jocelyn Craparo, an OB/GYN at Bryn Mawr Hospital, part of Main Line Health. “I’m not kidding—nothing!”

Craparo says the doctor in her wants to make her patients better, “but people don’t always want it to be fixed.”

Educating her patients about this phase of their lives is vital. She said she finds many patients benefit from validation and education – because they understand what’s going on, they know they aren’t crazy, and they recognize there are legitimate reasons why they don’t feeling so hot.