In the fabulous Amazon show The Other F Word — does the “F” stand for 40s, 50s, female, friendship? Yes? — one character in her late 40s with a much younger boyfriend makes an appointment with her doctor seeking birth control. Instead, her doctor gives her a menopause kit. Another character in her late 40s is experiencing fatigue and fainting spells and, positive she’s going through menopause, makes an appointment with her doctor seeking hormone replacement therapy (HRT). Instead, her doctor tells her she’s pregnant.
Welcome to midlife, when a few skipped periods might mean there’s an off chance we’re pregnant, but more likely than not means that we’re perimenopausal.
Menopause is defined by a woman’s not having had a period for a year. Perimenopause is the time before that, caused by a gradual decrease in estrogen.
So while both of these characters were taken by surprise with their respective diagnoses, you don’t need to be. If you answer “yes” to any or many of the following questions (and have ruled out pregnancy—duh!) you’re probably perimenopausal.
1. You have irregular periods.
Your periods might get heavier before they get lighter. They might get closer before they get farther apart. Then you might miss three in a row. Valerie skipped 11 periods and asked her doctor if she could stop using birth control. “You really should wait one year,” her doctor said. Good advice; Valerie got her period. Then had to start counting all over again. When she missed her period for 12 consecutive months in a row, she was considered menopausal. And could throw away the condoms for good.
2. You gain a meno-pot.
Some women gain weight. Some just gain a meno-pot. If you don’t know what a “meno-pot” is, you might not be perimenopausal. It’s a bulge between your belly button and your groin that no number of crunches can get rid of. You can fight it, or you can make peace with it; I’ve named mine Mickey.
3. You’re beat.
I have read in various articles that “fatigue” is a symptom of perimenopause. But honestly, have you ever met a woman over 40 who isn’t tired? My advice? Just go with this one and blame your exhaustion on a medical condition! Tell your partner, “I’m sorry, I can’t possibly cook dinner/pick up the kids/clean the house. I have perimenopause.” Emphasize the word; make it sound like a disease. (And if your partner is a 40-to-50 something woman herself? I’m sorry, I’ve got nothing…)
4. You’re burning up with hot flashes and night sweats.
If you are taking off your sweater and putting it back on a half-dozen to a thousand times a day, feeling as if you’ve just wandered into a Japanese bath house with all of your clothes on, relax! It’s just a hot flash. If you wake in the middle of the night drenched in sweat and dreaming you died and went to hell, relax! You still have time to repent — it’s just a night sweat. Now go back to sleep. Oh, wait, you can’t, because...
5. You have insomnia.
If you’ve awakened due to say, a night sweat, and you can’t go back to sleep, maybe it’s because your spouse or pug is snoring (no? just me?), or maybe it’s because of those darned hormones being out of whack. (By the way, Black Cohosh has been known to help with insomnia — as long as you do have some estrogen, so it’s best for perimenopausal women or for those on HRT.) Oh, well, your insomnia isn’t the end of the world; it’s not like you have to get the kids to school or go to work in the morning. Surely no one will notice if your presentation doesn’t go well. Or if you look tired. Because it’s not as if your skin isn’t glowing, right? Oh, sorry, I didn’t mean to imply…
6. You have thin skin.
Some women get perimenopausal acne. Some women get rosacea. Some lucky women get both. (Raises hand. Ooh, me! Pick me!) But all women with decreased estrogen have skin that becomes less elastic and thinner. And speaking of thinning skin…
7. You have various problems “down there.”
Your vaginal walls are thinner and your vaginal skin is dryer, which can make sex more painful. (Have you tried lubricants?) Another problem? Incontinence or leakage. But before you rush out to buy “Depends,” don’t live with a problem for 30 or more years — fix it! Pilates instructors can help you build your pelvic floor, and doctors can refer you to physical therapists who can instruct you on how to do Kegel exercises correctly and monitor your progress to fix the problem. (If you’re in your 40s or 50s, you’re simply too young to pee in your pants, wear an adult diaper instead of sexy underwear, and call it a day.)
8. You’re moody.
One minute you’re happy; the next you’re weepy. Now you’re angry; now you’re fine. No, this isn’t a crazy improv game in Whose Line is It Anyway? — it’s just an average 15 minutes in a perimenopausal woman’s life. Estrogen is the nurturing hormone; its absence means that post-perimenopausal women have what one friend calls no “ducks” left to give. But between the time when women have plenty of estrogen and not very much of it at all, when estrogen is peaking and falling in our bodies like an out-of-whack roller coaster in a low-budget county fair, women are bound to find these hormonal changes confusing. And so will everyone who loves them.
Women who experience severe mood swings — as well as many of these other symptoms — may find that low-dosage birth control pills, HRT, or herbal supplements may help and should speak to their doctor about options. Other women find yoga and meditation to be helpful.
A woman named Kristi experienced depression, anxiety, hot flashes, night sweats, and a meno-pot. She was 50 and having irregular periods; her doctor prescribed for her low-dosage birth control pills, and all of these symptoms went away, except for the meno-pot.
“I’m still waiting for a pill to get rid of that,” she says wistfully.
I give Mickey a pat. Aren’t we all?
This essay was written by Kelly Dwyer, a published novelist, playwright, and freelance writer. Visit her at www.KellyDwyerAuthor.com.