The Change Is Coming
Think perimenopause starts at 50? Think again. A Monmouth doctor breaks down 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. If you’ve spent any time online, you’ve probably come across a wide range of opinions on this topic. Unfortunately, a lot of the information available can be inconsistent, making it difficult to know what’s accurate. It’s also a complex and highly individualized experience—one that often brings more confusion than clarity. That’s why MONMOUTH reached out to Susan Marie Pacana, M.D., a gynecologic surgeon and obstetrician-gynecologist at Hackensack Meridian Jersey Shore University Medical Center in Neptune City. A Menopause Society-certified practitioner, Dr. Pacana debunked common myths, many of which women encounter in everyday conversation and online.
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. Pacana says it can begin several years before a woman’s final menstrual period, when changes in the menstrual cycle occur. “Perimenopause is considered to continue until one year after a woman’s final menstrual period,” she adds.
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 also fluctuate significantly during this transition,” Dr. Pacana says. “As a result, hormone levels may appear normal even when a woman is experiencing symptoms of perimenopause. For this reason, there is no single reliable laboratory test that can definitively diagnose perimenopause.”
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. “It is important to work with a healthcare provider who is willing to listen carefully to your history, understand your concerns and help develop an individualized treatment plan to address your symptoms,” our expert says.
Over-the-counter hormone tests—often marketed directly to consumers—aren’t recommended. One’s experience and symptoms matter most.
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.
“Hormone therapy—including estrogen, progesterone and, in selected cases, testosterone—can be a safe and effective treatment option for many women experiencing menopausal symptoms,” Dr. Pacana says, cautioning that certain medical conditions and individual risk factors may make its use inadvisable.
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.
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.
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. “Strategies to help prevent or manage weight gain during perimenopause include regular aerobic exercise and resistance training, along with a Mediterranean-style or other plantrich dietary pattern” Dr. Pacana says.
STAYING AHEAD
Perhaps most important, medical professionals 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 non-hormonal 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.
“For women who are not candidates for hormone therapy or who prefer not to use hormones, there are several non-hormonal treatment options available,” Dr. Pacana says. “These medications and other therapeutic approaches can help manage symptoms such as hot flashes, night sweats, mood changes and sleep disturbances. A thorough discussion with a healthcare provider can help determine the safest and most effective treatment plan based on an individual’s symptoms, medical history, and personal preferences.”
