Perimenopause Marks the Official ‘Decline’ of Fertility—but Experts Say It Can Be a New Beginning, Too
While menopause is often talked about, perimenopause—the time before menopause when ovarian function starts to decline, causing gradually lower levels of estrogen—is an often-overlooked part of the reproductive health conversation. Yet it can have a huge impact on the lives of those going through it. According to Maribelle Verdiales, MD, an OB/GYN and naturopathic doctor at CNY Fertility in Atlanta, Georgia, perimenopause symptoms can include heavier (or lighter) periods, more intense PMS, weight gain, lack of sex drive, and vaginal dryness. Those symptoms are all the more difficult to address when you have no idea to expect them in the first place.
"Someone at 38 may feel young, wild, and free. Then, two years later, they’re seeing these signs of accelerated aging, which also indicates a decrease in their fertility," Dr. Verdiales says. "It can be a very difficult transition for a lot of women."
"I just felt like, Wow, I'm officially old"
Registered dietitian Jennifer Scheinman, RD, struggled with low energy levels, stubborn weight gain, and hormonal imbalances shortly after she turned 40—and had no idea what was going on. When her doctor clued her in that her symptoms were actually signs of perimenopause, Scheinman says it was difficult to process. "Whether you want kids or not, it represents the end of an era, for lack of better words," she says. "I just felt like, 'wow, I'm officially old because I'm starting to go through this.'"
Holistic psychiatrist Ellen Vora, MD, says that one of the reasons why it's so normal for women to feel this way is because in our culture, fertility represents a lot more than just being able to have kids. Dr. Vora says fertility is part of how many people define themselves as women. Indeed, having one's period is often considered to be a crucial passage into womanhood; once that starts to go away, some people might struggle with what it means to them to be feminine. Similarly, many people go into perimenopause at the same time that their children are getting older and moving out, Dr. Vora says, which is its own kind of adjustment. "The combination leads many to think about what their purpose is in life, which often then shifts as their children don't need them as much," Dr. Vora says.
She adds Western culture doesn't celebrate aging, which can further complicate a person's relationship with perimenopause. "Fertility is also linked to sex and libido... Our culture has this weird way that celebrates young, nubile female sexuality, and isn't empowering to women of all life stages," she says. It doesn't necessarily help that the decline in hormone levels during this time can lead to a decreased libido and can even make sex unpleasant thanks to vaginal dryness and other symptoms. "This is [all] going on at the same time a woman's hormones are wrecking havoc, which can lead to feeling more anxious or depressed or amplified PMS symptoms [for some people]. It's really the perfect storm," she says.
Here's what happened when our video editor decided to try fertility testing:
Another difficulty is the culture of silence around the health needs of older women. While the period positivity movement has helped somewhat erase the stigma around periods (although there is certainly still ground that needs to be gained), perimenopause is not as much a part of the cultural conversation—making it tough for some people to navigate when it's happening to them. (Where's the perimenopause version of The Care and Keeping of You?) "Especially in the workplace, I felt it was something you just had to deal with on your own and not talk about, similar to how many places are about mental health issues," says Mael. She recalls a time when her period was so heavy that it soaked through her clothes onto her office chair. When she went to her office admin and explained what happened, they acted embarrassed and didn't offer a solution, which made Mael's experience even worse. "Nobody seems to want to talk about it," she says. "In 18 months, I gained 25 pounds and no one asked me how I was feeling or if I felt healthy."
Starting a new chapter
While some people view perimenopause as an ending (or the beginning of one), others that I spoke to say they used the transition as an opportunity to recalibrate their lives. Carol Gee and her husband, for example, always were open to having children. Gee experienced a miscarriage in her first year of marriage, and in the decades that followed, she never conceived again despite not being on birth control. Fertility experts ran tests on both Gee and her husband, and didn't find any reasons why she couldn't get pregnant. "I always thought it would happen," she says. "I married the man of my dreams and thought we would have children." That is, until she started going through perimenopause.
"Once I learned what was happening to my body, I thought 'I guess the mystery is over now and having kids really isn't something that will happen for me,'" Gee recalls. (While pregnancy is still possible during perimenopause, it becomes less likely as estrogen levels decline.) It was certainly a heavy realization to grapple with, Gee says that in time, transitioning to this new phase in her life felt like a sense of freedom. She thought of everything she had been able to do, such as travel the world with her husband, and her career as a college educator, where she mentors young people every day. "I have a very full life and after perimenopause, I was able to fully settle into it and embrace it all because it was no longer this guessing game of whether I was going to have kids," she says.
Like Gee, Scheinman doesn't have children, and once she entered perimenopause, it made her think more about the life path she was on. "It definitely was a process and took time, but what helped me was looking at all the opportunities that were available to me instead of focusing on the doors that were being closed," she says. "It did become liberating to be able to think, 'Yep, I am not having kids and I'm okay with it.'"
"Puberty and perimenopause are very similar," says Dr. Verdiales, who has five daughters. "At both times, the menstrual cycle isn't always predictable, and it can be a lot to handle. But with teens, we don't make them feel embarrassed about asking for help getting through puberty, asking their doctor for advice on making their periods more regular or dealing with acne. So why do we make it difficult for women experiencing perimenopause to ask for help? There's nothing shameful about it. Just like puberty, it's a transition—and it should be celebrated."
Of course, getting to that point emotionally isn't as easy as flipping a switch. Dr. Verdiales, whose career has been centered on helping women navigate the physical and emotional rollercoaster of perimenopause, says the key to getting through it is finding purpose in your life while mitigating the difficult physical symptoms. "There are so many solutions for things like mood swings, low sex drive, vaginal dryness, and the other symptoms perimenopause brings," Dr. Verdiales says. Tackling those often-debilitating symptoms can help take the unpleasantness out of the transition and help people focus on their futures—and how they want it to look.
"I tell women to defy stereotypes," Dr. Verdiales says. "I'm 45. I'm going through this right along with my patients... Age is just a number. Look for medical alternatives to help make what you're going through physically easier and celebrate where you're at."
BTW, these essential oils can help with some of the physical symptoms. And if you're in your 40s, check out this wellness guide just for you.
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