You’re happy. You’re sad. Your brain feels like cotton candy. Your periods are irregular and heavier — or lighter — than normal. And let’s not even mention your waistline that’s disappearing along with your sleep.
In other words, you may feel like you’re on a wild roller-coaster ride. What’s happening? It’s likely perimenopause.
“Perimenopause — otherwise known as the ‘menopausal transition’ — is the phase of reproductive life that is positioned between a woman’s peak reproductive years and menopause,” explains ob-gyn Dr. Sharon Malone, chief medical adviser to Alloy Women’s Health and New York Times bestselling author of Grown Woman Talk. During perimenopause, your levels of estrogen rise and fall unevenly and unpredictably, she tells Yahoo Life.
Dr. Lauren Streicher, a clinical professor at Northwestern University and host of Dr. Streicher’s Inside Information Podcast, says that many women are blindsided by the changes in their bodies and don’t think this happens until they’re in their 50s.
But they’re wrong: Perimenopause usually hits in your mid-40s but can occur earlier than you think — as early as in your mid-30s. Malone says that women under extreme stress, in poor physical health or who smoke cigarettes generally start sooner. All of these ages are within normal range, although the changes — which can range from mild to disabling — might not feel normal at all.
I’ve been writing about menopause for over 10 years and also produce my own Substack newsletter, thePause Newsletter With Sheryl Kraft. I’m passionate about covering a subject that has been neglected for too long and mired in mystery, especially perimenopause, which too often catches women by surprise. Here’s what you need to know about perimenopause.
Perimenopause can last a short time — or a long time
This transition period is different for everyone — your experience as individual as your thumbprint.
On average, it could last from three to four years. Or it could be as long as a decade. “The large range can be due to genetic differences or the health and lived experience of the individual,” says Malone. One 2017 study published in the journal Menopause found that the earlier women began the transition, the longer that transition lasted.
The end of perimenopause occurs when you go for 12 consecutive months without a period. At this point you are postmenopausal, “which you are for the rest of your life,” Streicher tells Yahoo Life.
Your genetics play a role
Like mother, like daughter? If you’re wondering about your perimenopause journey, it might be useful to ask your mother or sister. Many times, you’ll find a connection between their experience and yours. Genes can influence how old you’ll be and what your experience will be like (especially when it comes to hot flashes and night sweats), according to a study published in the journal Menopause.
While there could be multiple genes and variants at play, genetics don’t always rule: A study by the University of Michigan found that genetic factors may vary by race and ethnicity.
For instance, Black women, in addition to starting perimenopause earlier, have more severe symptoms, notes Malone. “These changes are more than likely due to environmental and lived experiences rather than genetic factors,” she says. “Black women also experience an almost 50% increase in depressive symptoms and are more likely to experience disturbed sleep — decreased hours of sleep and poorer-quality sleep.”
There are some surprising symptoms, from frozen shoulder to itchy ears
Here’s some eye-opening news: Perimenopause is not limited to the usual suspects of symptoms such as hot flashes and night sweats. There are some unknown or surprising ones you might not know about, says Streicher. “You might ignore these, thinking they’re not related, but they can be!” she says. They include:
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Itchy skin
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Painful sex
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Heart palpitations
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Panic attacks
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Anxiety
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Forgetfulness
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Leaky bladder
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Dry mouth
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Breast tenderness
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Itchy ears
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Frozen shoulder
There’s a new drug to treat hot flashes
Hormone therapy is a Food and Drug Administration-approved effective treatment designed to alleviate many menopausal symptoms. Research also shows that it promotes healthy aging. But for women who can’t or choose not to take hormone therapy, there’s a new medication in town.
Elinzanetant, a nonhormonal drug to treat hot flashes and night sweats, is not yet approved by the FDA but looks promising in clinical trials. It may also help improve sleep.
It is in a class of drugs known as NK3 receptor antagonists, which work by inhibiting the neurokinin 3 receptor, which is influenced by estrogen and plays a part in the brain’s regulation of body temperature, Streicher explains.
So far, there is one FDA-approved drug, called fezolinetant (Veozah), which works on similar mechanisms. Important to know: These drugs have only been tested in menopausal women, Dr. Mary Jane Minkin, gynecologist, clinical professor at Yale School of Medicine and host of the podcast Madame Ovary, tells Yahoo Life. It’s a good idea to discuss all your options with your doctor to see if they might be helpful for you too.
Perimenopause will pass
The next time you want to stick your head in the freezer or are silently cursing while changing your sheets at 3 a.m., remember this: Perimenopause is a natural life event that all women experience if they are lucky to live long enough. Although your body is changing, most women will experience relief from these pesky symptoms once they reach postmenopause.
In the meantime, the old tried-and-true advice for healthy living applies here: Eat healthy foods, watch your alcohol intake (which can make perimenopausal symptoms worse), get regular physical activity and manage your stress levels.
Even more importantly, Streicher urges women to find a doctor with menopause expertise with whom you can discuss your perimenopause struggles. The Menopause Society has an excellent clinician finder, or you can find a virtual care clinic, such as Midi Health, which connects patients to experts in menopause and perimenopause and is covered by most insurance plans.
And one last point worth mentioning: You can still become pregnant during perimenopause. So until you go that magic year without a period, do not forgo birth control. “My personal best was delivering babies for three different 47-year-olds who thought they didn’t need contraception,” says Minkin.
Sheryl Kraft is a writer, integrative wellness coach and producer of the Substack newsletter thePause.
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