Imagine how unsettling it would be if girls started their periods without any warning or idea of what was happening. That's why most of us watched a film and received a booklet in elementary school preparing us for that life change.
Unfortunately, there's no similar collective warning about perimenopause. No one gave me a "talk" when I turned 40 to prepare me for what lay ahead.
First of all, unlike the start of menstruation, the tail end of the reproductive cycle is a vague and extremely variable process. Menopause itself is clearly defined: A woman is officially in menopause when 12 months have passed since having a period. Perimenopause, however, is a period of time leading up to menopause. Things could start to get weird anywhere from four to seven years beforehand.
That's a wide time span. And the list of possible changes is also lengthy: unpredictable menstrual cycles, heavy bleeding, painful cramping, hot flashes, night sweats, decreased sex drive, weight gain, sleep disturbances, irritability, short-term memory issues and vaginal dryness. These symptoms can start anywhere from the early to late 40s and continue for a couple of years after hitting menopause, which is often around age 51.
Women who stay on hormonal birth control or use an IUD often fare better because their cycles are still hormonally regulated.
You might experience some or all of these things. Symptoms might come and go. Some people have such severe hot flashes it gives them social anxiety, and others never experience a single one.
You can't predict any of it.
"This is what is so frustrating for ladies and providers, because everyone is so individual," said Stacy Selbert, a women's health nurse practitioner at Washington University School of Medicine with a certification in menopause. The body doesn't decrease the amount of estrogen it makes in a slow and steady way, like closing a faucet, she said. It sputters and spits across the finish line.
If men spent years experiencing symptoms like this, you can bet there would be a national PSA campaign and a presidential commission to research affordable treatments.
Women resort to asking friends for advice and getting sticker shock about the cost of medicines that might help.
Generations ago, when life spans were considerably shorter, menopause was seen as a transition to the end of life. Now, women may spend a third or half of our lives postmenopausal. We have to normalize talking about it and demand better, more affordable treatments to improve quality of life.
When my cycle turned considerably more painful in recent years, I did the math. With our family complete, how much longer would I be dealing with this monthly inconvenience and pain? I learned that age of menopause can be affected by factors such as genetics, weight, ethnicity, lifestyle factors, body size and composition and hormone levels.
By my best guess, I'm staring at five years of perimenopause.
I financed my last car for five years! I've got 60 easy payments left on a uterus I'm done with.
Selbert assured me that there are ways women can feel better through this process. In addition to routine exercise, some supplements and phytoestrogens, like black cohosh, can be helpful. Antidepressants can reduce hot flashes. Replacement hormone therapy is beneficial for some women.
In the 1980s and '90s, women would regularly take synthetic hormones to ease peri- and postmenopausal symptoms. The Women's Health Initiative study in 2002 changed that overnight when researchers found significant increased risk for blood clots and breast cancer.
"But then women were miserable, as well as the people they live with," Selbert said. Years of further research found inconsistencies in that original study. Now, bioidentical hormone therapy can be safely prescribed to many women who need it.
"It comes down to how you feel and what's your out-of-pocket cost," Selbert says. She's had patients report costs as high as $300 a month for various treatments, although $50 to $100 is more typical. Even birth control, which can help regulate your cycle, can cost $50 a month -- with insurance. (Medicines for erectile dysfunction are far cheaper, go figure.)
I was recently at an event with a friend who may have experienced her first hot flash. Her face turned red and she started sweating profusely. She quickly left. Later, she said it might have been a panic attack.
At any rate, it gave us a chance to talk about perimenopause.
The more women have this conversation, the better we can advocate for the health care coverage we deserve.