Aria was 40 when she woke in the middle of the night so hot she felt as if she were in a sauna and sweating so profusely that her t-shirt was drenched. When it happened again a few weeks later, she was sure she was sick. Not sick as in the flu, but sick as in serious. She thought maybe she had dengue fever. But when she Googled her symptoms, something entirely different came up: Perimenopause. Perimenopause? She had never even heard the word before.
Menopause is defined as when a woman has gone one year without having had her period. Perimenopause is the time before that, when estrogen declines, periods can become irregular, and symptoms such as mood swings, hot flashes, night sweats, fatigue, and weight gain (especially around the midsection) can set in. While the average length of perimenopause is four years, it can last up to 10. Unfortunately, Aria is not alone in never having heard of the concept before.
Lindsey was 44, living in a freezing London flat, when she went a few months without her period and began to have hot flashes and fainting spells. It was her husband, who is even younger than she, who said, “Do you think maybe you have menopause?” Lindsay thought he was insane. “Well, he is insane,” she says. “Because he’s English. But he was not wrong! I couldn’t even believe it! I thought menopause happened in our 60s!” It’s four years later, and her period has never come back.
When a woman goes through perimenopause in her early 40s and doesn’t discuss her symptoms with her doctor (and her doctor doesn’t discuss the subject with her), perhaps it isn’t surprising that she’s taken by surprise. But Jen did discuss her symptoms with her doctor — who didn’t make the connection. Suddenly, without any warning, Jen began to have severe night sweats for weeks, soaking the bed each night. Jen went to see her general practitioner, who was 41, the same age as she was. And Jen thinks that perhaps it’s because her doctor was her age, and perhaps in denial, that she didn’t catch what was going on. She even tested Jen for tuberculosis! Eventually, Jen accepted the situation before her doctor did, and began to treat her perimenopaue symptoms herself, using herbal supplements such as black cohosh and primrose oil.
If women are shocked to be going through perimenopause and even menopause in their early 40s (and such stories seem to be ubiquitous; for example, Carla was 40, experiencing the end of a lesbian relationship, and still going back and forth deciding whether or not to have children with her partner, when she was diagnosed with perimenopause; LaShawna took pregnancy test after pregnancy test at 42, only to learn she was early menopausal), then you would think that by 50, women would be prepared for this change in our lives.
You would be wrong.
What does perimenopause feel like?
While doctors, mothers, and teachers prepare girls for puberty and their first menses, very few doctors prepare women for menopause. Most women I spoke to became passionate when they talked about how they wished their doctors would have discussed perimenopause with them, so that they could have been prepared. I thought I was going crazy. I didn’t know what was happening. I knew my periods would one day cease, but why were they so heavy? And so close together? And then so far apart? And why was I angry all the time? So weepy? AND WHY DID I FEEL LIKE THIS FOR TEN MILLION YEARS?!
Of course, not everyone has severe symptoms; some fortunate women have few to no symptoms at all. Lynn is 55 and is still waiting to be sure she is menopausal. Her periods have been irregular for many years, but she still hasn’t gone a full year without one. She’s had some weight gain and lowered libido, but she’s never had a hot flash or a night sweat. Marie, who began perimenopause at 43, says that after a few years, she’s totally used to it, “and so grateful I never walk down the tampon aisle, ever! Miserable cramps and chocolate cravings are gone. Buh bye!”
Allison had no symptoms, so that when she missed a few periods at 50, she thought she was pregnant, not perimenopausal. Kara had trouble with her periods when she was younger, but menopause at 48 was “like turning off a faucet.” She had a normal period one month and then never another one again — that was it.
Women dealing with cancer can be forced into menopause due to chemotherapy. For some women, this means their periods never return. For women like Karoline, this means they may go through menopause twice. After being diagnosed with stage 2 breast cancer at the age of 39 and having chemotherapy and radiation treatments, Karoline’s periods ceased, and she began to have hot flashes and night sweats. Over a year later, her periods returned — while she was on vacation at Disney World with her family. Now 55, Karoline has not had a period in over a year. The good news (besides the fact that she has been cancer-free all this time!) is that for this “second” menopause, Karoline has had no hot flashes, no night sweats, no mood swings — absolutely no symptoms at all.
The age at which one experiences menopause is often hereditary, but not always, which is another reason women can feel unprepared. Marie was 43 when she began to have “massive sweating episodes” at work, though her mother didn’t go through menopause until she was 51. Ana’s mother, who went through menopause early, and whose symptoms ranged from hot flashes that “called the fire department” to “murderous rages,” kept warning Ana that menopause was going to be “the worst time of your life.” But Ana didn’t even begin to miss periods until she was 50, and her symptoms were quite mild.
“I feel like I spent years worrying and dreading menopause for no good reason,” she says. “Was the fire department going to come? Was I going to be charged with murder? The most dramatic thing that ever happened to me was once I had such a bad night sweat, I had to change the sheets. That was about it.”
Not everyone knows her family history. My own mother died when I was in college, and she’d had a hysterectomy previous to her death, so she never experienced a natural menopause, and it never occurred to me to ask my grandmother about hers, since she died when I was 31. I’ve been going through perimenopause more or less blindly — which has turned out to be okay, since my symptoms have been trying but manageable. When I’ve tried to talk to my 15-year-old daughter about what I’m going through so that she’ll be prepared someday, she looks at me as if I’m explaining exactly how to live on Mars after the oxygen on Earth is all used up: The information is for such a distant future, it could only be coming from an insane person.
Still, whether women experience perimenopause in their late 30s or early 50s, whether we have severe symptoms or none at all, it seems that one thing we can agree on is that it would help us if our doctors (if not our mothers) broached the subject with us early on. After all, if we are fortunate to live long enough, all women will experience menopause at some point. It would be nice for us to be prepared, so that we don’t worry we’re going crazy — or that we’ve come down with dengue fever.
This essay was written by Kelly Dwyer, a published novelist, playwright, and freelance writer.