The Change Is Coming

Think perimenopause starts at 50? Think again. Three Bergen doctors breakdown the myths—and what’s really happening to your body.

It often starts subtly. You walk into a room and forget why. You wake up at 3 a.m.—again. Your mood feels unpredictable, your clothes fit a little differently and suddenly you’re Googling symptoms that don’t quite add up. For many women, these quiet, creeping changes are the first signs of perimenopause—though few recognize it right away.

Perimenopause is the transitional period before menopause, typically lasting four to eight years as the body moves toward the end of its reproductive phase. Clinically, according to the Mayo Clinic, it’s marked by fluctuating levels of estrogen and progesterone. Menstrual periods may become longer or shorter, and symptoms such as hot flashes and insomnia often emerge. It’s also a complex and highly individualized experience—one that often brings more confusion than clarity. That’s why attendees were eager for answers at the BERGEN Women’s Health Experience in April at The Terrace at Biagio’s in Paramus, where Valley Health System’s Kathlyn Kim, M.D., and Michelle Beloff, D.O., as well as Bergen New Bridge Medical Center’s Charlsie Celestine, M.D., spoke on the topic. The physicians focused on debunking common myths, many of which women encounter in everyday conversation and online.

“I’m sure if you’re on the internet or on your phones, you’ve seen many conflicting opinions,” says Dr. Kim, an obstetrician gynecologist. “The truth is, the internet gives you opinions. Online information can be contradictory and confusing.”

One of the biggest misconceptions is that perimenopause begins only at age 50. While the average age of menopause in the U.S. is about 51, perimenopause can start much earlier. Dr. Celestine, a gynecologist, says she sees patients of all ages at her practice, including perimenopausal patients between the ages of 30 and 40. This phase can last months or years, marked by hormonal fluctuations that affect everything from sleep to mood.

THE HORMONE ROLLER COASTER

When symptoms become disruptive, many women assume that hormone testing is the first step. While doctors can test hormone levels, that’s not the most reliable diagnostic tool. “Hormone levels can vary wildly from day to day—even hour to hour—so perimenopause cannot be diagnosed with hormone testing alone,” says Dr. Beloff, an obstetrician gynecologist.

Instead, physicians rely on symptoms and medical history. A woman in her late 40s experiencing irregular periods, brain fog, insomnia and night sweats, for example, is likely in perimenopause. “I don’t necessarily need a lab test to tell me that,” Dr. Kim adds. “It’s a clinical diagnosis.”

Over-the-counter hormone tests—often marketed directly to consumers—aren’t recommended. “It really has to do with what patients are experiencing—what you’re feeling,” Dr. Kim says.

Hormone therapy, once viewed with trepidation, has also been widely misunderstood. Much of the concern stems from a 2002 Women’s Health Initiative study that linked hormone therapy to increased cancer risk. However, subsequent analysis found that such danger was more significant in older women, while younger patients generally face much lower risk.

“The truth is that menopausal hormone therapy is a very safe and effective treatment for most patients,” Dr. Kim says. “You always have to look at the risk-benefit analysis. That’s an individualized discussion we have every day.”

To minimize risks, experts such as those at the Mayo Clinic recommend low-dose estrogen— delivered via pill, patch, gel or spray—along with progesterone when appropriate to manage symptoms such as hot flashes and insomnia.

“Diagnosis requires clinical expertise, and treatment should be personalized—not generic,” Dr. Kim says. “It’s not one size fits all.”

REGULAR OR NOT

Even women with regular periods aren’t necessarily in the clear. Hormonal changes often begin before cycles become irregular, meaning that classic perimenopause symptoms can appear earlier than expected. “All those things can happen,” Dr. Kim says, “and that’s a result of fluctuating hormones.”

Often, despite those changes, pregnancy is still possible. Ovulation can be unpredictable during perimenopause, so contraception is recommended until a full year has passed without a period.

Weight gain is another phenomenon frequently blamed on perimenopause. While hormonal shifts can influence body composition, adding a few extra pounds isn’t inevitable. Lifestyle plays a critical role. Strength training, balanced nutrition, quality sleep and stress management can all contribute to maintaining a healthy metabolism.

“Sleep changes everything,” says Dr. Beloff, arguing that poor-quality rest can negatively influence diet, energy and exercise habits.

Dr. Celestine also urges that women experiencing abnormal weight and mood changes should see a physician. “There are normal reasons why these things happen, but they’re also not things that should be ignored,” she says. “They should be evaluated before we say that it’s normal.”

STAYING AHEAD

Perhaps most important, the doctors emphasize that women don’t have to simply “wait it out.” A wide range of treatments is available, from hormone therapy in various forms to nonhormonal medications that target symptoms through different pathways in the brain. Complementary approaches—such as pelvic floor therapy, acupuncture and mindfulness—can also play a valuable role.

“Whatever modalities help women, we like to offer all of those,” Dr. Kim says. “Perimenopause is real and very treatable. With the proper treatments, brain fog lifts, moods stabilize, sleep improves— life improves.”