Perimenopause is a word that often sparks confusion and uncertainty, even among women who are otherwise well-versed in their health. Before joining Flow Space as a health writer, I thought I had a solid grasp on my body and overall well-being. After all, I’d spent the past eight years writing about women’s health and felt sure I was prepared for anything. But I couldn’t have been more mistaken—especially when it comes to perimenopause. The last time I felt this overwhelmed and uncertain was when I was 14, facing my first period.
Back then, teachers and family friends described menstruation as an “exciting transition into womanhood,” conveniently leaving out the part about the excruciating cramps, bloating and consistent craving for all things rich in carbohydrates. Just add it to the many lies I’ve been fed about my health.
Now, at 33, those feelings of confusion and anxiety are creeping back.
Fortunately, I spend my days writing primarily about the challenges of perimenopause and menopause, gradually piecing together what to expect when the time comes. This time around, when my body experiences another major shift, I’ll be prepared to handle it with grace and perhaps a little bit of humor.
When does perimenopause begin?
For those who are just as confused as I was, perimenopause refers to the natural transition period leading up to menopause, when the ovaries gradually begin to produce less estrogen. Even though this is going to leave my editor-in-chief fuming, I didn’t even realize there was a period in between. I simply thought one day you’re not menopausal and the next, you’re experiencing an array of symptoms that are enough to drive you insane.
But alas, there is an in-between and it lasts anywhere from a few months to over a decade, typically starting in a woman’s 40s but occasionally as early as her mid-30s. While menopause is often discussed as a key milestone, the journey to get there is rarely given the attention it deserves. Yet, understanding what to expect can ease the mental and physical challenges that come with this stage of life.
Seeing as I spend my days writing about the numerous realities of perimenopause, one would think I’m fully equipped to handle the slew of symptoms that come along with the perimenopause transition. Sadly, I don’t think that will be the case.
What are some of the symptoms?
If you thought your teenage hormones were dramatic, think again. Perimenopausal hormones take drama to a whole new level. The hallmark of perimenopause is fluctuating hormones, especially estrogen. While many women associate menopause with the cessation of menstruation, perimenopause is all about inconsistency. Hormonal shifts can lead to irregular periods, which might come closer together, last longer or skip months altogether.
Will they show up this month? Maybe. Maybe not. Maybe three times. They keep you guessing, like the world’s least fun game of Russian roulette.
“During perimenopause, women may still have bleeding; however, they may start to have symptoms that are signaling a decrease in estrogen, such as hot flashes, night sweats and changes in weight, among other symptoms,” says Dr. Jessica Shepherd, an OB-GYN and Flow Space Advisory Council member.
Then, there’s the mood swings. One day you’re feeling calm and collected, and the next, your estrogen levels have tanked, leaving you weeping because your cat meowed at you. And let’s not forget the hot flashes. Imagine you’re minding your own business, and suddenly you feel like you’ve been transported into the middle of the Sahara Desert. At noon. In July. Night sweats are their partner in crime, waking you up in the middle of the night drenched like you’ve just run a marathon (spoiler: you haven’t).
Of all the symptoms, I think the one I could do without is the unexpected weight gain. Perimenopause is a time when women start to move from a pear-shaped to an apple-shaped figure. Most women undergoing perimenopause gain about five to 10 pounds. This is because estrogen helps regulate metabolic health, so when it slows down, your metabolism does too.
Even though I’m just on the edge of perimenopause, I noticed changes in my body almost immediately after turning 31. As someone who’s always had a fast metabolism and struggled to gain weight, I was shocked to see the scale go up in just two years. My partner likes to joke that it’s from those early days of our relationship, when we spent every opportunity indulging in New York City’s food scene, complete with midnight pizza runs. But deep down, I know it’s more likely a sign of shifting hormones.
Brain fog is another fun surprise. Forgetting what you were just talking about mid-sentence? Welcome to the club. It’s like your brain decided to take a vacation, but didn’t tell you where it’s going or when it’ll be back. That, along with a low libido and vaginal dryness. With falling estrogen levels, there’s less blood flow to the vagina resulting in vaginal dryness and potentially painful sex. Apart from the pain, perimenopause can zap your sex drive. Reduced estrogen levels may lessen the desire to have sex and make it more difficult to get sexually aroused.
When to call in the pros
If perimenopause is turning your life into a hormonal roller coaster you didn’t sign up for, it’s OK to call in reinforcements. Talking to your doctor might be a good idea if your symptoms are making you feel like you’re trapped in a sitcom gone wrong. They can suggest things like hormone replacement therapy (HRT) or maybe even lifestyle tweaks you hadn’t thought of.
Just a word of caution: if you go to Dr. Google, you’ll find an endless rabbit hole of advice, ranging from herbal remedies to elaborate rituals involving moon phases (seriously, people suggest anything). Stick with the science and your doctor’s recommendations—less guesswork, fewer regrets.
Women should be proactive and start discussions with their healthcare providers in their mid-30s, even before symptoms begin. Doing so could make the perimenopause journey more manageable, Shepherd says.
“Noticing when the symptoms of perimenopause are beginning should be an important part of the conversation so that it provides solutions as well as comfort during this transition,” she says.
If you’re unsure whether or not your symptoms are related to perimenopause, it doesn’t hurt to get a second opinion from a medical professional. Just make sure it’s someone trained in menopausal care. About “80 percent of residency programs that are training OB-GYNs don’t have any education in menopause, and for the majority of the 20 percent of programs remaining, that education is only elective,” says Dr. Bruce Dorr, an OB-GYN and senior medical advisor to Biote.
Embracing the weirdness
Perimenopause might feel like a chaotic surprise party where you don’t know half the guests and someone set off the fire alarm, but here’s the thing: you’re not alone. Millions of women are right there with you, fanning themselves through hot flashes, laughing at their own mood swings and trying to zip up their favorite jeans after yet another round of bloating.
Honestly, the temper tantrum I threw over having to give away my favorite pair of Reformation jeans because they suddenly were too small was a sight no one needed to witness. But as Julia Roberts says in Eat, Love, Prey: “Just buy yourself bigger jeans.”
Embrace the weirdness, the unpredictability and the fact that your body is doing its best to adjust to this new phase. And while it may not be an “exciting step into womanhood” like menstruation was (ha!), it’s another chapter that’s helping you grow stronger and more resilient. Besides, think of all the hilarious stories you’ll have to share when you come out the other side.