What to Expect When You’re Not Expecting Perimenopause

Maybe you clock a sudden onslaught of sweatiness. Maybe it’s your sleep that becomes weird, or your period’s new… vigour, or an unexpected set of quivering pimples that threaten to burst over half of your face. Maybe your sex drive has taken a nose dive. Whatever the first distress signal sent up by your body, you’ll soon be besieged by a rebooted puberty that makes the first go-round seem like a picnic. Hold on tight: This is perimenopause.

And what exactly is perimenopause? “Perimenopause is chaos,” says Dr. Jerilynn Prior, a professor of endocrinology at the University of British Columbia and scientific director at the Centre for Menstrual Cycle and Ovulation Research (CemCOR). More specifically, she explains, it’s the unruly, hormonally unpredictable stage of life between reproductive adulthood (when periods generally hum along nicely) and menopause (when they tap out for 12 straight months—and then for good).

The bad news: Women can enter perimenopause as early as in their mid-30s, and they can stay there for over a decade. The worse news: Half of the women Balm surveyed don’t even know what perimenopause is, which is unsurprising, since 77 percent of them say they haven’t been taught a single thing about it. But Prior is emphatic that “it isn’t a disaster for everyone,” and a bit of information can go a long way. Consider this, then, your perimenopause primer.

First: a word about cycles

For most of our reproductive years, our menstrual cycles tend to follow an established path, propelled by the precise dance between estrogen and progesterone that results, every 28(ish) days, in an urgent need for tampons and ibuprofen. Perimenopause occurs as the body prepares to get rid of its remaining eggs and stop menstruating — which, Prior says, “makes a heck of a lot of sense, because you don’t want a rogue period when you’re in a nursing home.” But that means, as more eggs are stimulated each cycle, that estrogen levels can spike dramatically while progesterone begins to drop, throwing the whole system out of whack. “Night sweats, sleep problems, increased premenstrual symptoms—they begin when our hormones change,” Prior says. While the severity of these problems will vary from person to person, here’s a general forecast.

Given that up to 85% of perimenopausal women experience hot flashes, it might come as a surprise that science still isn’t quite sure what causes them. It could be that the hypothalamus — that’s the part of our brain that regulates body temperature — goes on the fritz during perimenopause, and our internal thermometer seems to drop, triggering a flush that expels heat from the body to cool us down.

Whatever the precise cause of hot flashes, length, intensity and frequency will vary among women: They could be over in 30 seconds or go on for five minutes; they could leave you a little dewy or utterly soaked; they may occur every few months or 20 times a day. Hot flashes will definitely happen when you’re trying to sleep (those are night sweats and tend to be most intense right before your period). And — this is the really important part, because it’s for sure not going to feel that way — they will end. On average, women contend with hot flashes and night sweats for about five years.

High-pressure systems

Women already have far more difficulty falling and staying asleep than men, and during perimenopause, getting a decent night’s shut-eye is almost impossible. “Even people who slept well before may become disturbed by small things,” Prior says. According to a 2017 10-year analysis of data  from the Study of Women’s Health Across the Nation, 31% to 42% of women in the early stages of perimenopause reported insomnia symptoms. Blame the night sweats, as well as higher rates of sleep apnea, which tend to coincide with dwindling hormone levels.

When you can’t sleep, it can be harder to manage the shifting moods that accompany perimenopause. About 14% of women with a history of low anxiety reported high levels of it during this time (says a 2013 meta-analysis from the University of Pittsburgh), while women with no previous episodes of depression became at least four times more likely to experience a depressive episode (according to an eight-year study from the University of Pennsylvania). And everyone seems to be straight-up angry: A 2008 paper from the universities of Toronto and McMaster found that a full 70% of perimenopausal women complained they were irritable.

“There are lots of reasons for women to be angry, but most of the time we just suck it up. In perimenopause, our capacity to suck it up is diminished.”

There’s some evidence that this irritability is linked to diminished serotonin, the mood regulator, which drops in tandem with estrogen. Prior suspects something a little more … IDGAF. “I think there are lots of reasons for women to be angry, but most of the time we just suck it up,” she says. “In perimenopause, our capacity to suck it up is diminished.”

Heavy floods

Remember those unpredictable periods of early puberty? They’re back! And for a third of perimenopausal women, they’re far more intense—leading to a superperiod that causes more than 80 mL in lost blood, rather than the typical 30 mL. If you want a visual: On average, women will soak six tampons over one period. Those having a superperiod (medically known as menorrhagia) will go through 16 tampons instead. Although it’s not entirely clear what causes this flooding, one potential culprit is a spike in estrogen, which builds up your uterine lining so it can shed, combined with too little progesterone, which causes that lining to thin. These unbalanced hormones are also to blame for the triumphant return of pimples, since they can cause a rise in androgen levels, which leads to excess oil production.

Droughts

You know what a sweaty, sleep-deprived, irritable, oily woman might not be so keen on? Sex. So it’s little wonder the Massachusetts Women’s Health Study found that perimenopausal women felt significantly less desire than those who hadn’t yet entered this stage. And as women inch closer to menopause and their estrogen levels drop further, vaginal dryness can make sex difficult — the Study of Women’s Health Across the Nation reported that perimenopausal women were 40% more likely to experience frequent pain during sex than those in premenopause. “It’s important for women to communicate to their partners if they need space and don’t feel like being touched,” Prior says. “And it’s just as important for women to know that this phase is temporary and will get better.”

Foggy patches

You might as well staple your keys, wallet and lastborn to your body now: In one 2016 study, 72% of perimenopausal women reported problems with name recall (sorry, Susan), while roughly half the women surveyed also struggled to remember where they had put things, what they’d just been told or what they were, at that very moment, supposed to do.

Understandably, these symptoms can ring alarm bells for dementia, which affects women twice as often as men. A UCLA study, however, found that perimenopausal memory lapses aren’t permanent; once women safely cross into menopause, cognitive function returns to earlier levels. In other words, the brain bounces back. And here’s the sunny part of the forecast: Your body, your sleep and your general sense of well-being will, too.