No One Talks About Perimenopause—It’s Time to Change That

Between my devotion to the Judy Blume canon and studying Our Bodies, Ourselves on the floor of the local library, I felt pretty prepared for what was going to happen when I got my first period. It wasn’t until much later in life—about 37 years later—that I felt like I was living that terrifying locker room shower scene from Carrie. My relatively reliable three- or four-day period was on day 14 and the bleeding was heavier than I had ever experienced outside of a head wound. Being the super-rational person that I am, I called my doctor to inform her I was sure I was definitely dying.

“Are you bleeding through a pad or tampon every hour?” she asked, calmly. “Oh God! I would have admitted myself to the hospital already!” I said, trying to joke through my panic that she was about to utter the words ovarian cancer.

Turns out, I wasn’t dying. I was, at 48, experiencing the harrowing symptoms of something far more terrifying: perimenopause.

What Is Perimenopause?

In case you aren’t familiar (I wasn’t and it was happening to me!), perimenopause is the ambiguous period of time in a female body’s reproductive life that literally means “around menopause.” In a world where menstruation is still a taboo subject, the transition between your reproductive years and menopause is even more mysterious. “I sometimes say, ‘Why don’t women know this?’ Like, women’s bodies have been working this way forever,” Nina Coslov, cofounder of Women Living Better, which provides information and resources for those going through perimenopause, said during a recent Today show interview.

I thought I was pretty well-informed about women’s health, but even so I was under the delusion that at some point when I was in my mid-50s or so, I would get a bunch of hot flashes and then—BAM!—no more monthly period. Spoiler alert: That’s not how it works at all!

The reality is more like feeling as if my body thinks it is part of the grand finale of a fireworks show. Pop, pop, BAM! POW! Pop, fizzle, fizzle.

Imagine if you had to white-knuckle your way through the emotional roller coaster of puberty while also handling all the grown-up responsibilities you’ve accumulated since getting your braces off—work, maybe a partner, some kids, aging parents—while also trying to figure out how to find time for yourself and maybe even sleep, occasionally. Add super-fun symptoms like fatigue, hot flashes, sleep disruption, and low libido, and that’s the joy of perimenopause for you. As Mary Ruefle wrote in her essay “Pause”: “You are a depressed adolescent who sweats through their clothing and says terrible things to everyone, especially the people they love.”

In the U.S., the average female body hits menopause—officially defined as 12 consecutive months without a period, according to the Mayo Clinic—at 51. But the perimenopausal process can anywhere from two to 10 years (and sometimes even longer), before that; most enter this fog sometime in their 40s, but many women may start noticing changes even earlier.

“Perimenopause is one of my favorite subjects, because it’s complicated,” says JoAnn Pinkerton, M.D., a professor of obstetrics at the University of Virginia and the executive director of the North American Menopause Society. “It’s different for different women, and it runs a very large gamut.” For some, perimenopause means irregular or heavy periods. Others experience “episodic flooding,” she says, which is unfortunately exactly what it sounds like: Periods so heavy you regularly bleed through tampons and pads. Then there are some for whom perimenopause comes bearing migraine headaches (or making existing migraines worse). PMS, too, can get worse, even turning into PMDD—premenstrual dysphoric disorder—which is when PMS becomes so severe that it actually affects your work or family life.