You can’t sleep, your sex drive is in retrograde, and your periods are all over the place. You know these are telltale signs of menopause, but you’re only in your mid-40s so write them off as something else. But don’t be so quick to dismiss them: Perimenopause, which is when you’ll experience a lot of the side effects, can begin up to 10 years before you actually hit menopause (which is defined as the moment you’ve gone a full year without a period and happens at the average age of 51).
Not only are people often not expecting perimenopause, but the symptoms aren’t the same for everyone and can often be blamed on something else. (That lackluster libido? It’s because life is so stressful!) As a result, many women have no clue whether or not perimenopause has started and don’t bring up the symptoms to their doctors, says Dr. Margaret Nachtigall, M.D., associate professor of obstetrics and gynecology at NYU School of Medicine.
So how do you know if you’re in perimenopause or not? These common questions and expert answers will help clue you in to the signs and how you can feel your best during this transition.
How can I tell if I’m in perimenopause?
n perimenopause, estrogen and progesterone levels start to drop, but they do it in an erratic fashion with dips and spikes. These rapidly fluctuating hormones are what trigger the symptoms. “Often, perimenopause manifests as irregular periods, occasional hot flashes, difficulty sleeping, memory problems, moodiness, or a decrease in libido,” says Nachtigall.
But not all women have the same symptoms at the same severity. “We all have different amounts of hormones and have experienced different environmental situations — things like smoking or taking birth control pills — which lead to a variation in menstrual cycles,” Nachtigall says. Research has found that genetics also play a role in the perimenopause symptoms you experience.
Due to the variety of symptoms, and the fact that they can often mimic health conditions such as depression or thyroid disease, it’s a good idea to see your doctor when you experience any of them, says Nachtigall. A good approach: Ask yourself if things have changed from your body’s usual status quo. “If you start experiencing symptoms that are new for you — for example, your periods are happening every 24 days instead of every 28 or you’re more irritable than usual — these are all signs,” says Dr. Mache Seibel, M.D., a former professor of medicine at Harvard Medical School and author of The Estrogen Fix.
Why are my periods so heavy?
If you’ve all of a sudden gone from having a pretty light flow to one that’s decidedly not light, you aren’t alone. Heavy periods occur in nine out of 10 women as they go through perimenopause. This could be due to something like endometrial polyps or could be caused by those changing hormones.
Throughout a normal, 28-day cycle, estrogen is released during the first 14 days, which helps build the lining of the uterus. During the second 14 days of your cycle, progesterone is released, which compacts the uterine lining, making it receptive to a fertilized egg.
During perimenopause, some estrogen is still being produced (a by-product of your remaining eggs trying to make their way from your ovaries), though at a reduced rate or lowered amount. Progesterone isn’t being created as consistently (due to those older, less responsive eggs not actually leaving the ovaries), “which means you’ve got this shaggy, extra lining that hasn’t been compacted,” says Seibel. “So with more lining to shed, you may have a heavier period.”
Why am I irritable one minute and a total sap the next?
The same unsynchronized hormones that are changing your cycle can also affect your mood, says Nachtigall. During perimenopause, estrogen and other hormones can reach new highs during some parts of your cycle, then even out again or dip to new lows during other stages of your cycle.
“These peaks and valleys in hormone levels cause peaks and valleys in your mood,” says Dr. Nieca Goldberg, M.D., clinical associate professor of medicine at NYU Grossman School of Medicine. “It’s why moodiness can actually be worse during perimenopause than after menopause. That’s when your hormones even out again — just at a new low.”
What happened to my sex drive — and is there anything I can do about it?
Those same hormonal ups and downs can also prompt you to feel surges and dips in your sex drive, says Goldberg. As perimenopause progresses and your hormones start to reach that new, steady low, decreased estrogen and testosterone can make it more difficult for you to get aroused.
When you do have sex, it can be more painful during perimenopause. This is because lower estrogen levels lead to a decrease in blood supply to the vagina, which in turn may cause a decrease in lubrication and even a thinning of the vaginal wall. And feeling discomfort during sex can make you even less likely to desire it.
While you might be tempted to deal with these symptoms in private, it’s important to talk to your doctor and work together on pinpointing the cause of your decreased libido, says Goldberg. “If it’s a physical cause, hormone therapy can really help,” she says. Hormone therapy increases levels of the hormones your body is no longer making, which can boost your libido. If your issue is localized (say, you’re dealing solely with vaginal dryness), your doctor may prescribe a topical vaginal estrogen.
What can I do to ease perimenopause symptoms?
First things first: Talk with your doctor about how you feel. “This period of transition is treatable in so many ways, and it’s critical for people to realize that they can get help,” says Nachtigall.
It can also help to have a healthy lifestyle. “Get enough sleep, eat a healthy diet, exercise, find an outlet for your stress—all the things that keep you optimally healthy will also help you have an easier time with perimenopause symptoms,” says Nachtigall.
Another often-overlooked tactic is to reframe your attitude about this time in your life. “Rather than taking the ostrich approach and pretending you’re too young for perimenopause, try to see it as an opportunity to take stock of where you’re at — and make changes that’ll help you retain your vitality and health and prevent the onset of chronic illness,” Seibel says. “If you take advantage of this time, you can really optimize the rest of your life.”
The bottom line
While menopause doesn’t usually occur until your early 50s, perimenopause can begin years earlier. Symptoms can include irregular periods, hot flashes, mood swings, low libido, trouble sleeping, weight and body composition changes, hair loss, and vaginal dryness. If you notice any of those symptoms, talk about them with your doctor (even if you think you’re too young for perimenopause). They will be able to recommend different lifestyle changes or treatments that can help you feel better.