Your forties mark the beginning of perimenopausal hormonal fluctuations, which are precursors to menopause. During this time, generally the eight to 10 years before menopause (1) (which typically happens in your early 50s), your body preps for the the menstruation finish line. Normal hormone changes cause ovulation to be more irregular, and estrogen level variations mean you could start experiencing missed periods, a heavier flow, spotting between periods, and longer stretches of PMS (2).
Speaking for myself, when I hear the word “menopause,” I immediately think “I’m too young for this.” In an exclusive interview with Redbook Magazine, Alyssa Dweck, M.D., Assistant Clinical Professor of Obstetrics and Gynecology at Mount Sinai School of Medicine, says “Perimenopause-type changes can start up to 10 years before menopause, so you could start noticing changes in your 30s.” That's because when you're younger, the levels of estrogen and progesterone wax and wane over the course of your menstrual cycle. According to the American College of Obstetricians and Gynecologists (3), as you approach menopause though, these hormones stop following their normal patterns and trigger changes in your cycle. If it isn't resulting in any painful symptoms, this isn't a cause for concern.
Your period evolves during every stage of womanhood. As we get older, our cycle continues to adjust based in part to normal age-related hormonal changes. Dr. Dweck confirms “There's an unspoken rule among doctors (4) that a woman's period tends to change through the decades." Dweck adds that "your cycle is often an indicator of what's going on in your health and in your life, and there are many transitions between your 20s, 30s, and 40s."
Let’s learn more about what’s common about menstruation, what might be cause for concern and why it matters particularly during your forties and beyond.
Menstruation In Your 40s & Beyond
Perimenopause, or the menopausal transition, is the time in a woman’s reproductive life leading up to her last period. Perimenopause literally translates to “around menopause” (the prefix “peri-” means “about” or “around”). While this stage can start earlier, perimenopause usually begins during your mid-to-late 40s (5). As your body gradually prepares for menopause, your hormone levels may change randomly, causing menopause symptoms unexpectedly. During this transition, your ovaries will begin to produce different amounts of the hormones estrogen and progesterone (6).
Although “the change” is typically associated with hot flashes, perimenopause can cause everything from headaches and breast tenderness to changes in your menstrual period. Irregular periods happen during this time because you may not ovulate every month. You might skip a few months or notice your menstrual cycles may be longer or shorter than usual, too. Your period may be heavier or lighter than before.
Just don't forget, even if ovulation is erratic, you may still get pregnant. Perimenopause can potentially last between two and eight years total before your periods completely stops (6). On average though, perimenopausal women experience these symptoms for about four years before their period stops permanently and are not longer able to get pregnant (5). Your body will transition from perimenopause to menopause after 12 months without any bleeding or spotting (6).
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Something to be mindful of especially in your 40s: It can be hard for you and your doctor to determine whether you are in perimenopause. Here are a few recommendations from the U.S. Department of Health and Human Services’ Office On Women’s Health to help you navigate this time of transition:
Track your cycle. Irregular periods may be your first sign of perimenopause.
Speak up. Tell your doctor or nurse about any menopause symptoms you’re experiencing, such as hot flashes or trouble sleeping.
Take a test. Your doctor may test the amount of hormones in your blood if your periods stopped at an early age (before 40). Disclaimer: Doctors don’t typically recommend this test unless there is a medical reason to do so. For many women, since hormone levels go up and down in an unpredictable way during the transition to menopause, it is difficult to tell for sure whether you have gone through menopause or are getting close to it based on this blood test.
Menopause is a normal, natural event in a woman’s life. Often (lovingly) referred to as “the change of life," menopause is the point in time when menstrual cycles permanently cease due to the natural depletion of ovarian oocytes (egg cells in an ovary) from aging (7). Menopause does not happen all at once. On average, American women begin menopause at 52 years old, however the age range for women is usually between 45 and 58 (6). According to the Office On Women’s Health, one way to figure out when you might start menopause is the age your mother went through it. Menopause may happen earlier if you:
Never had children. Pregnancy, especially more than one, may possibly delay menopause (8)
Each woman’s menopause experience varies. As your body transitions to menopause over several years, you may notice menopausal symptoms that begin suddenly. Symptoms may have a tendency to be very mild at first, occurring for most women once they begin, or happening only once in a while. Some symptoms may be familiar (i.e., PMS-like conditions) while others may be completely new. The Office On Women’s Health and Cleveland Clinic highlight some changes in several different areas to expect; for instance:
Your menstrual periods may not come as regularly. They also might last longer or be shorter. You might skip some months. Periods might stop for a few months and then start up again.
Your periods might be heavier or lighter than before.
You might have hot flashes (a sudden feeling of warmth that spreads over the body) and problems sleeping.
You might experience emotional changes like mood swings or increased irritability.
You might experience vaginal dryness, pain or discomfort during sex.
You may experience urinary urgency (a pressing need to urinate more frequently)
You may have less interest in sex. It may take longer for you to get aroused.
What Might Be Cause for Concern
Serious Health Condition or Illness
When you reach your 40s, changes in your period can potentially signal something more serious. Dr. Dweck says "Uterine cancer is something that can come up. Keep in mind that this is an extreme rarity, however it's possible to find a precancerous cell that could be causing a problem with your periods around this time in your life" (4). If your period patterns are getting really unrecognizable (either extremely abnormal or super heavy), it's time to have a conversation with your doctor.
Medically speaking though, remember menopause doesn't occur until your period has stopped for an entire year. This means you have not had any bleeding, including spotting, for 12 months in a row (6). If you experience bleeding after that point, that's major cause for concern (3) and you should contact your doctor immediately.
Other possible changes that should concern you are not as noticeable. For example, you might begin to lose bone density because you’re producing less estrogen. This can potentially lead to osteoporosis (11) , a condition that causes bones to become weak and break easily. Changing estrogen levels can also raise cholesterol levels and increase your risk for heart disease and stroke (12).
Many women do not need or want treatment for their menopause symptoms. Some may even find that their symptoms go away by themselves. However, if your menopause symptoms are making you uncomfortable, speak with your doctor about available treatment (13) options.
Why It Matters
Whatever your age, remember that your period offers a lot of insight into overall health. If you are experiencing any unusual symptoms, definitely check in with your doctor. Highly irregular periods or drastic changes to your flow may be a sign of thyroid issues, polycystic ovarian syndrome, or a number of other (treatable) health concerns (14).
Are you experiencing any of these issues in your forties and beyond? What change(s) in your cycle or period symptoms have you noticed over the years? Was our #MenstruationMatters series helpful?
We’re happy to answer any #MenstruationMatters questions you have to help you navigate whatever decade of womanhood you’re in. Reach out to us directly at firstname.lastname@example.org and keep up with Kindara on Facebook, Twitter and Instagram for additional information and resources.