Last updated: Mar 02, 2016
At first I thought my friends and I were simply using perimenopause as an excuse for bitchy attitudes. But the more we experience unusual periods, sporadic cycles, and surprising symptoms, the more it appears that a genuine physiological phenomenon is at play.


After having our babies and heading into our early 40s, we notice that our bodies are changing and that we are going down the long, hot-flash-ridden path to the “change of life,” or menopause.

And its a long path. Perimenopause can begin as early as a womans mid-30s, and can last anywhere between two to eight years, as our bodies begin to wrap up the reproductive years.

News stories about late-in-life pregnancies, such as Kelly Prestons, had me thinking that my fertility would stick around for a while. So when I started experiencing hot flashes at night, I thought, “Nah. Not me.”

Now that Im looking for it, I see perimenopause everywhere (including Sex and the City 2).

We, the formerly fertile women, are now picking up ibuprofen and “super plus” boxes of tampons to deal with abnormal periods, signing up for yoga classes, and ingesting more soy than ever before—anything to alleviate the continued onset of perimenopausal symptoms.

Though perimenopause may seem like a less-than-comfortable transition, Ive learned several surprising facts, and some nice upsides to this time of life.

Eggs gone bad
Our ovaries start running out of eggs as we age. And as their number decreases, their quality can deteriorate. This deterioration can cause unpredictable cycles for a decade before we can be pronounced menopausal.

“As some of the ‘poorer quality eggs start to develop, they may not develop normally and may not be released in ovulation,” says Alicia Stanton, MD, hormone health expert, in Hartford. If this occurs, Dr. Stanton explains, it may upset the hormonal balance, which may result in a skipped cycle and perimenopausal symptoms.

As eggs arent released as often, progesterone levels drop, and this can cause estradiol levels to fluctuate, says Dr. Stanton. “This might lead to symptoms of estrogen dominance—heavier menses, bloating, irritability, PMS, breast tenderness, anxiety, hot flashes, heart palpitations and fibroids,” she says.

Because these symptoms can often be confused with other health issues, women may overlook perimenopause as a cause.

However, one poor quality egg isnt the end. A better quality egg may be released the next month, and the cycle may resume to normal. According to Dr. Stanton, many women “may have (perimenopausal) symptoms off and on for up to 10 years prior to having no menses for an entire year.”



Hormones play a role
In order to alleviate that overwhelming host of symptoms, Kent Holtorf, MD, an expert in natural bioidentical hormone replacement, advises testing your hormones. “Most doctors fail to detect the causative hormonal imbalance because standard blood tests generally miss the hormone imbalance causing the symptoms,” he says.

As mentioned above, low or improper ratios of hormones can cause perimenopausal symptoms, and low-dose birth control pills are sometimes prescribed to addresses this imbalance.

But lower egg quality and hormones arent the only factors that could trigger the onset of perimenopausal symptoms. According to Dr. Holtorf, genetic factors, weight gain, insulin resistance, and even environmental toxins, such as plastics and pesticides, can also affect the timing of perimenopause and menopause.

Is our mood really affected?
And what about our bitchy attitudes? Can we pin them on perimenopause? Yes, as it turns out.

“This bitchiness (as well as weight gain and depression) is typically due to a combination of progesterone and thyroid deficiency,” Dr. Holtorf says.

In fact, over 20% of menopausal women in the U.S. are diagnosed with thyroid dysfunction. And it might be worth having these imbalances treated. “When these [deficiencies] are addressed, the overwhelming majority of women will find significant improvement in symptoms,” says Dr. Holtorf.

Whats the good news?
After learning about all these symptoms that could be heading my way, I felt desperate for an “upside” to perimenopause. Dr. Stanton had some reassuring news for me: “It usually signifies a time when a woman can start thinking more about herself.”

She explains that a woman going through perimenopause has fewer responsibilities to others, the wisdom that comes from her 40 to 50 years on the planet, and children who can take care of themselves. “I find that this is the time when women re-evaluate their lives, jobs, and relationships and finally get the strength to do the best for themselves,” she says. And, she adds, because you dont have to worry about pregnancy once youre actually menopausal, you can really have fun with sex!

I knew those ladies in Sex and the City were onto something. Perimenopause may be nigh, but I feel prepared, and even intrigued, by this next chapter in our lives.