It seems like only yesterday you were snickering in health class as
you learned about feminine hygiene and your impending first period.
Now here you are in the prime of life -- and it's already time to
think about your last.
By your 40s -- and sometimesearlier, for the 1 to 5 percent of women
headed for premature menopause -- important menstrual-cycle changes
are already on the way. Here's what to know.
A skipped or heavy period might be your first sign of menopause.
Your menstrual cycle until menopause isn't a now-you-see-it,
suddenly-you-won't kind of thing. "The ovary doesn't stop, boom!" says
Sandra Carson, a professor of ob-gyn at Brown Universityand medical
director of the Center for Reproduction and Infertility at Women's and
Infants Hospital of Rhode Island.
Most women experience gradual menstrual irregularity during the phase
known asperimenopause,the three to five years before
menopause.Estrogen levels start falling even earlier, as eggs
disappear from the ovaries, though we don't notice. Ongoing hormonal
shifts finallybecome obvious in the form ofchanging periods.
Usually this means lighter and less frequent, but "normal" reactions
are surprisingly variable. A woman's periods may turn longer than
usual, shorter than usual, space farther apart, or in some months be
skipped entirely. Some women begin to have bouts of heavy bleeding.
Others spot between periods.
Tracking their timing, length, and nature now can help you notice the changes.
Bleeding changes are normal, but you shouldn'tassumethey're normal.
Even though the majority of women develop some kind of menstrual
irregularity in their 40s as the body closes shop on reproduction,
heavy bleeding is one symptom you should always report to your doctor.
15 Medical Tests Every Woman Should Have
At minimum, heavy periods canlead to anemia or disrupt yourability to
conduct daily life. (Example: a teacher or a surgeon who must spend
hours on her feet without a break.) But heavy bleeding can also flag
other treatable conditions that can affect women of any age, including
fibroids, polyps, ovarian cysts, an overgrowth of the endometrium
(uterine lining), or, rarely, uterine cancer.
"Heavy" periods can feel different from woman to woman.
The medical definition of a heavy period (menorrhagia) ismore than 80
ccs (cubic centimeters) of blood, or about three ounces, accordingto
Carson. (Most women lose about six teaspoons of blood per cycle.) But
who measures her flow, let alone knows what80 ccs looks like? And if
you're someone who's always had intense periods, what should you look
for?
Trust what seems like a change foryou. "After you'vebeen menstruating
for 30 years, you know when there'sa change," Carson says.
Also look for: clotting, using more than one high-absorbency pad at a
time, combining a tampon plus a pad, needing to change pads hourly,
bleeding steadilyfor more than seven days. The American College of
Obstetrics and Gynecologists also recommends telling your doctor if
you're bleeding more often than every three weeksor you bleed after
having sex.
More things every woman should know about her periods before menopause
There's no link between menstrual difficulty in your reproductive
years and menstrual difficulty in perimenopause.
Good news for women plaguedby heavy bleeding, cramping, and bad PMS
(dysmenorrhea): Your odds of a rough passage through menopause seem to
be about the same asany woman's, says Carson. But there's some
evidence that stress worsens both PMSand perimenopausal symptoms.
You can still get pregnant even after you start missing periods.
The number-one mistake women with menstrual irregularity make (after
not checking with a doctor about big changes): assuming that being
down the road toward menopause means you can't conceive -- or that
your oddsare so low it's not worth bothering about.
"Your chances of pregnancy are low and your chances of miscarriage are
high once your periods become irregularin perimenopause, but you
canstill get pregnant," says Carson, an ob-gyn and endocrinologist.
And every year, thousands of perimenopausal women do.
Some doctors keep healthy women without risk factors (like smoking) on
hormonal contraceptives through their early 50s, since that has the
same protective effects against menopausal symptoms(such as minimizing
abnormal bleeding or hot flashes) as hormone replacement therapy
(HRT). Others prefer to transition patients to HRT or alternatives,
along with an alternate birth control method.Some advise women to wean
off hormonal contraceptives by their late 40s in order to measure
levels of FSH (follicle-stimulating hormone), which, when elevated,
indicatethat the ovaries are failing and heading toward menopause. To
get an accurate reading, a woman should not be taking
hormonalcontraceptives for as long as six weeks before testing.
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