Irregular Periods in Your 40s — Is It Perimenopause or Something Else?
If you’re in your mid- to late 40s and your periods are becoming irregular, you may be in the menopausal transition, or “perimenopause.” This is the natural stage your body goes through as you approach menopause.
This stage lasts about four years on average, although some women may experience only a few months or many more years of symptoms. It is characterized by fluctuations in hormones as your ovaries are nearly out of eggs. Your estrogen levels drop and you may have markedly irregular menstrual cycles. On top of irregular periods, hormonal changes can lead to weight gain, hot flashes, trouble sleeping, vaginal dryness, mood changes, and depression.
Perimenopause ends with menopause, at which point you have not had a period for 12 months.
When Can You Expect Perimenopause?
Chances are, if you’re between the ages of 45-50, your irregular periods are a sign of perimenopause. The average age a woman starts the menopausal transition is 47.
While we cannot predict when this will occur for you, the age your mother began to experience symptoms may be a good indicator. Smokers tend to reach menopause earlier than non smokers as well.
Should You Get Tested for Perimenopause?
The short answer: No.
The blood tests that measure your ovarian reserve are rarely accurate during perimenopause. FSH and estrogen change by the day and throughout the day so they are generally not helpful.
We do consider testing these hormones if you experience perimenopausal symptoms under the age of 45. We generally will also check other pituitary hormones, like TSH and prolactin, if you are experiencing these symptoms prematurely.
Keeping a menstrual diary is generally the best “test” you can do. This will give you and your OBGYN insight into what your body is doing and for how long.
Any time you experience abnormal uterine bleeding (i.e., changes in the amount of blood, frequency of bleeding, and length of bleeding), checking in with your doctor is a good idea to make sure it is normal and that no other work-up is needed.
Stages of Perimenopause
Women typically go through the menopausal transition in two phases: early and late.
Signs of Early Perimenopause
- More frequent menstrual cycles
- Unpredictable menstrual cycles
- Heavier or lighter bleeding
Signs of Late Perimenopause
- Hot flashes or mood changes
- Less frequent menstrual periods
- Heavier or lighter bleeding
What to Expect During Perimenopause
Just as every woman’s period is different, the way you experience perimenopause will be different. The intensity of symptoms varies from one woman to the next, but they follow a typical progression until you have reached menopause and do not have a period for 12 months.
This is the hallmark of perimenopause. The frustrating part is the unpredictability. Periods may change gradually from one cycle to the next, or you may notice more abrupt changes.
Hot Flashes & Night Sweats
Hot flashes and night sweats are common symptoms of perimenopause and menopause, with over 85% of women reporting hot flashes. Hormone changes affect your body’s “internal thermostat.” A hot flash feels like a wave or sensation of heat across your face, neck, and chest. It can last for several minutes. Hot flashes can happen a few times a day, a few times a week, or less often.
Hot flashes that happen at night are called night sweats, which can cause women to wake up drenched in sweat and disturb sleep. Women are more likely to report hot flashes at night.
When hot flashes wake you up, it can be hard to fall back to sleep. You may feel like you are in “fight or flight” mode. In addition, mood trouble can often make sleep tricky.
Irritability & Depression
Perimenopause increases the risk of depression by about 30%. The rise in depression may come from the changes and lack of control over what’s happening to your body, sleeplessness, and other life events that typically occur at this point as we age. There is good news! Studies have shown that the risk of depression decreases after menopause.
Treating Perimenopausal Symptoms
Perimenopause itself does not need to be treated. It is a natural, normal transition as you move to the next stage of your life.
Treating perimenopausal symptoms, however, is definitely possible. A discussion with your OBGYN will help you determine the best path for you.
- Birth control pills that contain low doses of estrogen can be used to help control the uncomfortable symptoms of perimenopause by regulating your body’s fluctuating hormones.
- Antidepressants can be prescribed to help with depression. They can also help treat hot flashes.
- Supplements, such as multi-vitamins, support your overall health. Herbal and hormonal therapies, however, are not recommended. Studies consistently show they are as equally effective as a placebo at managing symptoms and some are associated with risks.
- Mindfulness and meditation are tools that you can learn to use to manage irritability, depression, and anxiety.
- Counseling can help you learn how to cope with the changes your body and life are experiencing.
- Exercise (strength training, cardiovascular routines, yoga) is beneficial throughout perimenopause as it can help you maintain a healthy weight, improve your mood, strengthen your bones, and reduce your risk of cardiovascular and other diseases.
Frequently Asked Questions about Perimenopause
Q. Can I still get pregnant during perimenopause?
- The chance that you could become pregnant in your mid- to late-40s is very low. However, as long as you are menstruating, it is certainly possible that you could get pregnant. We recommend contraception into your 40s if you do not want to become pregnant.
Q. When should I stop taking my birth control?
- Birth control can mask the transition to menopause, which is why it is used for treating symptoms such as hot flashes and irregular bleeding. Birth control also makes lab tests for perimenopause unreliable. We recommend stopping birth control around age 50-51 and then monitoring your symptoms.
Q. What can I do about perimenopausal weight gain?
- As you age, your metabolism naturally slows down. You may also lose muscle mass and gain unwanted fat. It’s important to maintain a healthy diet and shoot for 30 minutes of exercise each day. Carrying excess weight increases your risks of heart disease, Type 2 diabetes, and even various types of cancers. Talk to your doctor about ways you can obtain (and maintain) a healthy body weight.
Q. When should I call a doctor about my perimenopausal symptoms?
- If you are experiencing hot flashes and night sweats under the age of 45, contact your OBGYN to see what else might be causing them. When you have abnormal uterine bleeding, it is important to alert us regardless of age as we may recommend an ultrasound or endometrial biopsy to rule out abnormal changes in the uterus.
If you have not had a period for 12 months and then experience vaginal bleeding, contact your doctor. It is not normal for bleeding to recur after this period of time. Read our article about when you should see your OBGYN.
Remember, perimenopause and menopause are natural and normal transitions, but they can be stressful. Many symptoms can be managed which can help you regain a sense of control, well-being, and confidence to thrive in your next stage of life.
We want you to feel supported, heard, and cared for as you go through this change.
Sometimes, the biggest help is simply confirmation that what you’re experiencing is normal!
Dr. Ashley Durward has been providing healthcare to women in Madison since 2015 and joined Madison Women’s Health in 2019, specializing in high and low risk obstetrics, contraception and preconception counseling, management of abnormal uterine bleeding, pelvic floor disorders, and minimally invasive gynecologic surgery.