The Other PMS: The Lesser Known but Arguably Worse – Perimenopausal Syndrome
March 13, 2017
Like every female I know, my menstrual cycle has commanded more than its fair share of my attention over the years. This high maintenance relationship between my reproductive system and the rest of me began with a series of vaguely embarrassing and terrifying conversations with my mother, who thought she was bleeding to death when she got her first period and wanted to spare me that horror. As a result, I learned in graphic detail about the changes my body would undergo in preparation to procreate before I had mastered tying my own shoelaces.
Years later, six to be exact, when I started menstruating for real, I was sure I was adequately prepared for the mechanics of it all. What no one had articulated – not the pamphlets, the books, the sex-ed filmstrip, not even Are You There God? It’s Me, Margaret – was that the happenings in and around my uterus were going to dominate my life for a long, long time. I was also not informed that I was not to speak publicly of them. For decades, symptoms so disruptive they’re classified as a syndrome hit me like cyclical, lunar tides. Bloating, mood swings, headaches, cramps, etc., you know the drill, and then the period itself. Over and over, nature’s design on my body affirmed that I could bear life (!!!), but to me, the sluffing of dead cells was hardly something to celebrate, and I longed for the day when this whole fertility thing was over. That was before I found out what this whole fertility thing being over meant. If you think our society is repressed when it comes to talking about menstrual cycles (which we so are), wait till you hit the tail end of your fertile phase and enter a stage of life medically referred to as perimenopause. Perimenopause is what I like to think of as period purgatory, where your uterine lining isn’t quite passé, but it’s not the hot spot it used to be. You don’t meet the clinical qualifications for menopause, but you’re on your way. Your ovaries have become sluggish and lazy, and the production of delicately-balanced hormones, specifically estrogen and progesterone, which have kept you PMS-ing on a monthly basis, fluctuates and gradually decreases. This fluctuation is the last hoorah of your reproductive system before official old lady-hood, and it’s a doozy. Not to paint too bleak a picture of what is inevitably in store for the entire childbearing population, but perimenopause is everything unpleasant about menses combined with everything unpleasant about menopause. It’s essentially the body’s transition from producing and depending upon estrogen and progesterone, to existing and maintaining bodily functions with minimal amounts of either one. Perimenopause is like withdrawal but with the added bonus of irregular and unpredictably gory menstrual periods. As a curse, it’s got it all.The first time I heard anything about this lovely facet of womanhood was in my early forties when I went several months without having a period and asked my doctor about it. He said I was nearing the perimeters of menses cessation, i.e. I was perimenopausal. I asked him how long I had (as in, to live, because isn’t menopause the same as death?), and he said with sufficient opacity, I had “a while.” We commiserated about getting older – even though all he had to do was succumb to aging gracefully, whereas I had to clear the hurdle of this new affliction in addition to facing regular menopause – and then I went home to Google myself into a depressed, perimenopausal stupor. This is an overview of what I learned:
There are three stages to menopause
Beginning with pre-menopause, when women are still fully fertile; perimenopause, when reproductive function gradually declines; and menopause, which marks the end of menstruation. Most of the symptoms occur in the middle stage, as the ovaries are preparing to permanently shut things down, like some condemned amusement park. There is no set age for the onset of perimenopause, though it seems to be influenced by heredity, environmental factors, and lifestyle. It typically lasts ten years or longer. (You heard me.) Like everything else pertaining to the reproductive system, the timeline is unpredictable and varies greatly. What makes perimenopause so formidable is the gamut of symptoms women can and will experience, many of which disrupt daily life and are unlike anything else she’s previously encountered. Including: hot flashes, breast tenderness, worsened premenstrual syndrome, decreased libido, fatigue, irregular periods, vaginal dryness, discomfort during sex, urine leakage when coughing or sneezing, urinary urgency, mood swings, insomnia, difficulty falling or staying asleep. Doesn’t that sound like fun? As I move toward this stage in my own life, I have to confess that I am afraid. I’m vain, I like things the way they are, and I like my body the way it is. I don’t want to get old, and I don’t want to be less than a woman, if that makes sense. I know I’m not alone. My mission is to bring this whole perimenopausal thing into the open and talk about it until it becomes normal and, in time, less scary. We’re in this together, we got this.