The Perimenopause Info You Need — And Likely Haven’t Heard

It came on one evening as I spoke animatedly at my husband. A family member had just done something massively irritating, and I was railing about it. So, at first, I thought I was suddenly broiling from the inside out because I was amped up with emotion, flushed because I was flustered. For a few seconds, it felt like when you're just out of a shower and can't regulate your temperature, so you stand in front of the fridge — or like when you're out with friends and a little drunk and overheated. But then the burn in my chest, neck, and face kept rising, up up up, until I felt like I was, as my former mother-in-law used to say mid-hot flash, "spread eagle in the Gobi Desert." I went out onto the porch, pulse racing, to cool off, and later watched myself in the doorbell cam: panting, panicked, and deeply confused.

I'm about six weeks away from my 40th birthday. I figured I had a solid decade before dealing with any of this — despite knowing that perimenopause can begin as early as your mid-thirties. I just thought that meant I might have an irregular period now and then, or that hormonal shifts might thin my hair or something. I didn't expect to spontaneously combust on my front steps.

As it turns out, I'm not alone in my ignorance about the change before the Big Change. According to a 2021 study, nearly half of women worldwide are either under-informed about or completely unaware of perimenopause: 44% of those surveyed said they didn't know what it was until they started experiencing it; 46% said they were not expecting it when it began; 34% were unaware of the two phases of menopause, despite being in one or the other; and 46% said they did not feel adequately prepared for menopause. Honestly, why should they? Think about how much you knew about your first period compared to how much you know about your final one: That's one skewed ratio.

And it doesn't take much to figure out that cultural taboos around female bodies — especially aging ones — are what keep so many of us in the dark. (It's important to point out here that because estrogen fluctuations cause menopausal symptoms, perimenopause can also affect trans men and non-binary people.)

Symptoms of Perimenopause

I decided to ask around to see what others were experiencing and was surprised to hear a wide variety of responses about symptoms — and also to register that it had never occurred to these folks, some of whom I am very close to, to talk about this stuff. One good friend, several years older, has been having hot flashes for years, while another friend who is also several years older has had zero symptoms whatsoever. A friend who's a week older than me laughed when I asked if she'd noticed anything different. It seemed ludicrous to her that we should be thinking about this stuff yet.

But we should think about it, because a friend of a friend who's my age suffers from vicious night sweats, while another is plagued with late-onset chronic migraines. One hasn't had a decent night's sleep in months. One said she has "a wiry hair that grows under my chin. I tend to stroke and play with it, so I have to pluck it to keep myself from doing that constantly." I LOLed at this, of course, but then had an epiphany: I've been plucking suddenly aggressive throat hairs for a year or so, too. And suffering a rash of chronic headaches. I also recall asking my doctor last summer why suddenly no deodorant seemed to work anymore. It seems perimenopause has been lurking around my life for a while now; I just didn't connect the dots. (By the way, CertainDri is a lifesaver.)

I decided to look into more objective sources, but this was an exercise in frustration. Why did I run into so many bland, unhelpful understatements? Take the Cleveland Clinic's page on the subject, which states that "the term perimenopause simply describes the time when your cycles are no longer predictable." Really? It's simply, only that? Because some people report debilitating symptoms that go well beyond a flushed chest, dry vagina, or bit of spotting. Some people develop severe depression or anxiety. Others experience unpredictable feelings of rage. A woman quoted in a New York Times article from 2021 lives with brain fog so severe she initially feared she had early-onset Alzheimer's.

To say nothing of the wide array of more minor (but still seriously unpleasant) symptoms that perimenopausal people face — none of which I'd ever heard of, despite being in the target demo and never skipping a well-woman exam. These include:

• Chronic heartburn
• Vaginal bleeding during or after sex
• Anal bleeding
• Persistent dry eye
• Incontinence
• Nausea
• Chills
• Dry skin
• Hair loss
• Burning Mouth Syndrome, a condition in which one's tongue, lips, or palate feel as though they've been scalded, accompanied by a metallic taste and a chronic sensation of dryness in the mouth

But menopause symptoms aren't restricted to the ones listed above. When your body is going through the highs and lows of the change, you can go experience some pretty unusual transitions. Here are a few more symptoms you should know.

• Body odor
• Tinnitus
• Fatigue
• Breast tenderness
• Burning tongue
• Dry mouth
• Dental issues/gum disease

Perimenopause Treatment

The message is clear: We need to be talking about this stuff a lot more than we are. Being in the dark about what may happen to your body — and about ways to treat it, which 73% of women decline to do, according to another 2021 study — isn't cutting it. But to whom should we do the talking?

Doctors would seem to be the logical choice, except many also seem to be at a loss. According to a survey of medical residents specializing in internal medicine, family medicine, and gynecology, only 7% said they felt qualified to help a menopausal person with their symptoms; 20% said they had received no education about menopause at all. There are, of course, doctors out there who can render real assistance once the hot flashes start and the periods taper — but clearly, they may be few and far between. The North American Menopause Society's practitioner portal is a good place to start.

Once you find a doctor you feel you can trust, it can be helpful to ask whether what you're experiencing (or will experience in the years to come) is perimenopause or something else. After all, reduced libido can stem from lots of things (like being exhausted, for example), not just the big change. Same with mood swings, depression, and insomnia. Ask what sort of treatment might be available to you, like hormone therapy, vaginal estrogen, or even the off-label use of gabapentin, a medication typically used to treat seizures that has also been shown to help with hot flashes. You may ask about antidepressants, since they could help with the mood shifts that sometimes accompany hormonal changes.

Perimenopause Support

The ultimate answer is that we all need to be talking to each other more. There are support groups available to those who long to connect. Remember Peanut, that app designed to help moms make friends? Last fall, they launched a menopause group, too. There are also helpful subreddits on the subject, like r/Menopause or r/AskWomenOver30. (In the latter, a recent discussion about perimenopause revealed dozens of people who began suffering in their thirties.)

But the need to vocalize these matters applies to daily life, too. Rather than suffering in private because our symptoms are "taboo," menopause being rooted in the supposedly icky realm of menstruation, it's time to come out with it. Tell your coworkers why you're sweating buckets in the board meeting. Tell your friends you've found a great lube and wholeheartedly recommend X brand. Buck the trend of silence between parent and child (a paltry 9% of women talk about menopause symptoms with their mothers) and clue your daughter in on what lies ahead.

The more we speak up, the less surprised we'll be by our inaugural trips to the Gobi Desert — and the better prepared we'll be to weather the changes ahead.