No One Talks About Perimenopause—It’s Time to Change That

Between my devotion to the Judy Blume canon and studying Our Bodies, Ourselves on the floor of the local library, I felt pretty prepared for what was going to happen when I got my first period. It wasn’t until much later in life—about 37 years later—that I felt like I was living that terrifying locker room shower scene from Carrie. My relatively reliable three- or four-day period was on day 14 and the bleeding was heavier than I had ever experienced outside of a head wound. Being the super-rational person that I am, I called my doctor to inform her I was sure I was definitely dying.

“Are you bleeding through a pad or tampon every hour?” she asked, calmly. “Oh God! I would have admitted myself to the hospital already!” I said, trying to joke through my panic that she was about to utter the words ovarian cancer.

Turns out, I wasn’t dying. I was, at 48, experiencing the harrowing symptoms of something far more terrifying: perimenopause.

What Is Perimenopause?

In case you aren’t familiar (I wasn’t and it was happening to me!), perimenopause is the ambiguous period of time in a female body's reproductive life that literally means “around menopause.” In a world where menstruation is still a taboo subject, the transition between your reproductive years and menopause is even more mysterious. “I sometimes say, ‘Why don't women know this?’ Like, women's bodies have been working this way forever,” Nina Coslov, cofounder of Women Living Better, which provides information and resources for those going through perimenopause, said during a recent Today show interview.

I thought I was pretty well-informed about women’s health, but even so I was under the delusion that at some point when I was in my mid-50s or so, I would get a bunch of hot flashes and then—BAM!—no more monthly period. Spoiler alert: That's not how it works at all!

The reality is more like feeling as if my body thinks it is part of the grand finale of a fireworks show. Pop, pop, BAM! POW! Pop, fizzle, fizzle.

Imagine if you had to white-knuckle your way through the emotional roller coaster of puberty while also handling all the grown-up responsibilities you’ve accumulated since getting your braces off—work, maybe a partner, some kids, aging parents—while also trying to figure out how to find time for yourself and maybe even sleep, occasionally. Add super-fun symptoms like fatigue, hot flashes, sleep disruption, and low libido, and that’s the joy of perimenopause for you. As Mary Ruefle wrote in her essay "Pause": “You are a depressed adolescent who sweats through their clothing and says terrible things to everyone, especially the people they love.”

In the U.S., the average female body hits menopause—officially defined as 12 consecutive months without a period, according to the Mayo Clinic—at 51. But the perimenopausal process can anywhere from two to 10 years (and sometimes even longer), before that; most enter this fog sometime in their 40s, but many women may start noticing changes even earlier.

“Perimenopause is one of my favorite subjects, because it's complicated,” says JoAnn Pinkerton, M.D., a professor of obstetrics at the University of Virginia and the executive director of the North American Menopause Society. “It's different for different women, and it runs a very large gamut.” For some, perimenopause means irregular or heavy periods. Others experience “episodic flooding,” she says, which is unfortunately exactly what it sounds like: Periods so heavy you regularly bleed through tampons and pads. Then there are some for whom perimenopause comes bearing migraine headaches (or making existing migraines worse). PMS, too, can get worse, even turning into PMDD—premenstrual dysphoric disorder—which is when PMS becomes so severe that it actually affects your work or family life.

But wait! There’s more!

“It could cause depression or worsening depression. It could cause pain with intercourse or vaginal dryness. It could cause issues with stress urinary incontinence. It could cause fatigue. If you have fibromyalgia, perimenopause could cause worsening joint aches,” Pinkerton says. Oh, and then there’s the potential for irritability and sleep disruption. And, of course, there is metabolism slow-down and weight gain often associated with aging. Sounds fun, right?

Power to Perimenopause

In case it's not glaringly obvious, these changes wreak havoc on you mentally and physically. You're exhausted. You worry you're becoming invisible. You're anxious that you're drying up. Because no one really talks about perimenopause, those going through it don't really know what to expect. It can be a lonely and scary time. Take it from me.

So it was incredibly refreshing for me to see Pamela Adlon’s rare and honest depiction of perimenopause on her show Better Things. Adlon’s character, Sam, wrestles with the clothes in her closet that no longer fit due to unexpected perimenopause-related weight gain. Her sleeping patterns are a mess; she has hot flashes and she’s anxious. She endures an embarrassing TSA pat-down where she has to admit she is wearing “special underwear” designed to withstand her heavy perimenopausal flow.

A gynecologist tells her: “This is normal. You’re degenerating.”

In a recent interview on Fresh Air, Adlon talked about why she incorporated the indignities and challenges of this process into the sitcom. “Your metabolism does funky things,” Adlon said, laughing, “I decided that it would be a very generous thing for me to kind of illustrate it in my show, so everybody doesn't feel so alone.”

How to Survive Perimenopause

If you’re experiencing perimenopause, welcome to the party. If you're not yet, consider this a love note from the future. Either way, you might want to grab a cocktail and settle in. Then get down to business and find an expert.

Not all doctors fit that bill, since there’s not a lot of focus placed on the wonderful world of menopause in med school, says Pinkerton. “It's not until you're in practice that you realize how challenging it is and how variable perimenopause is.” Organizations like the North American Menopause Society and Women Living Better can help you find a doctor who has more experience with perimenopause and menopause. “Providers need to not blow it off when women come in and say, ‘I'm having irregular cycles, some of them are really heavy. I'm having worsening headaches. I can't sleep,’” Pinkerton says.

In the meantime, “we need to start talking about perimenopause,” says Pinkerton. “Women need to be able to talk with other women, because that's how you get support.” I can’t promise it will save you from a mortifying period moment in the locker room shower, but it may just save you the horror of feeling like you are alone.

Lisa Tozzi is the former global news director of BuzzFeed and a writer living in New York City. Follow her at @lisatozzi.

Originally Appeared on Glamour