It’s a common scene in any ob-gyn practice: A patient comes in, concerned that her periods have changed. “What’s going on?” she asks. “Is this menopause?”
If you’re a woman in your 40s, a change in your menstrual periods is the hallmark of perimenopause – that’s what we call the years leading up to your last menstrual period. Here’s a look at how we diagnose perimenopause and menopause, and what else to expect as you enter this phase of life.
A New Normal
A “change” can mean a lot of things when it comes to your menstrual period. It could be a change in the length of your cycle. It could mean your period is coming more often or less often. The flow could be heavier or lighter than you’re used to. You also could have some bleeding or spotting between periods. No matter the symptoms, women can usually recognize what’s normal for them – and when that stops being the norm. Your ob-gyn is there to help you figure out what’s going on.
Perimenopause is what we call a diagnosis of exclusion. This means we first need to rule out other conditions that could be causing your abnormal bleeding. Other causes can include:
Hormonal problems, such as a thyroid disorder or hyperprolactinemia (high levels of the hormone prolactin). Problems with the uterus, such as polyps, fibroids, or adenomyosis (a problem with the lining of the uterus).
We use a combination of pelvic exams, blood tests, and ultrasounds to guide this framework. If nothing is wrong, then perimenopause is the likely explanation of irregular periods, especially for a woman in her 40s.
The Course of Perimenopause
A change in your periods is often the first sign of perimenopause, but there are other signs to look out for. The most common are hot flashes, sleep problems, vaginal dryness, mood changes, and a decrease in sex drive. Not every woman will experience all of these symptoms. For those who have symptoms, they may come in any order. Once these symptoms arrive, most women can expect menopause itself to be a few years away. (Menopause is officially confirmed after you go 12 months without a menstrual period. But the average age for the last period is 51.)
There are many treatments to help with bothersome symptoms like hot flashes and sleeplessness. Even a few years of hormone therapy can help you get through the worst of it.
If you are prone to anxiety or depression, know that perimenopause can bring those conditions back to the surface. Finding a support network can make a big difference. Antidepressants also may be an option.
Part of the Reproductive Journey
We usually diagnose menopause in hindsight, after that full year of absent periods. I’ve found that most women know they’ve reached menopause when they get there. Even if your irregular periods turn out to be something else, you’ll face menopause eventually. Talk with your ob-gyn about what you’re experiencing. Together we can work through this part of your health journey.