Just as we are programmed to expect our first period with a combination of fear and panic, we also expect it to disappear. But the years leading up to menopause (which doesn’t officially start until you’ve been on your period for 12 consecutive months; the average age is 51) can, thanks to ongoing hormonal changes, present their own set of challenges.

These are challenges that many women, including this one, feel unprepared for. In a brutal twist, they often mirror what many of us went through as teenagers. “It’s like puberty, but at 40,” says Santa Monica ob/gyn Shamsa Amersi, MD. produced.”

And while we are becoming more and more familiar with the term perimenopause (defined as the transitional phase before menopause), there is still a lot of confusion about what happens to our bodies during this time, especially when it comes to our periods.

First, some basics: In a typical menstrual cycle, the ovaries produce a hormone called estrogen, which accumulates in the lining of the uterus, where a pregnancy can implant. In the middle of your cycle, you ovulate. When you ovulate, a mature follicle containing an egg is released, and if you don’t get pregnant, this triggers the production of the hormone progesterone, which aims to remove the uterine lining and also regulate your mood. (It is often referred to as the feel-good hormone.)

How does menstruation change in perimenopause?

As with adolescence, Dr. Amersi says, at 40, you may not ovulate every month. What does it mean? “You end up in a state of estrogen dominance,” Amersi explains, which thickens the lining of the uterus and can lead to what some of us unlovingly refer to as a crime scene period marked by copious discharge and intense pain. A drop in progesterone in your 40s can lead to a roller coaster mood as well as insomnia and sleep disturbance, all exacerbated by an overall concomitant drop in serotonin (the pleasure hormone).

What is a normal cycle?

To determine what constitutes a break in your cycle, it is important to understand what constitutes a so-called healthy period. “I always try to avoid the word ‘normal’ when talking to women who come to me worried about their periods because I don’t want anyone to feel abnormal,” says Cincinnati gynecologist and surgeon Somi Javid, MD. medical sciences. , from GerMD. when i’m a doctor Professionals describe menstrual cycles, Dr. Javid says, in terms of three factors: bleeding time, cycle length, and flow. “Typically women’s cycles are 7 days or less, cycle length can vary from 21 to 42 days, and discharge averages 4 to 5 pads or tampons per day,” she says. from measuring flow by consumption of a pad or tampon, and women simply state whether they find it abundant or not.

What many women begin to experience in their 40s is a change in the course, length, and length of their cycles. Some can be bloody while others are very light; some last longer and others not so long; some have a minor pain factor while others feel debilitating. That there will be some changes is inevitable, says Dr. Javid, although some changes should not be dismissed as typical.

“If your periods suddenly become very painful, last longer than 7 days, become severe, or occur less than once every 21 days, you should see your doctor for a physical examination and possibly lab tests and a pelvic ultrasound,” he adds. . Heavy bleeding can also be a sign of something more insidious, such as fibroids, polyps, cysts, adenomyosis, thyroid problems, bleeding disorders, or certain types of cancer, which is why many healthcare professionals advise women to use the app (Clue is great) to track your periods and monitor your symptoms.

Pregnancy, which more women are postponing into their 40s, can also disrupt your menstrual cycle because it essentially resets your endocrine (hormonal) and immune systems, says New York City-based holistic gynecologist Eden Fromberg, MD. post-pregnancy rhythms affect melatonin secretion, which is related to pacemaker control of the menstrual cycle,” explains Dr. Fromberg, adding that oxytocin and stress hormones are also affected by pregnancy and lactation, which can affect your cycle.

Recently, some people have reported changes in their menstrual cycle after receiving a COVID vaccine or becoming infected with COVID itself. Dr. Amersi notes that these hormonal changes typically last four to six weeks and do not affect fertility or the ability to conceive, although more research is needed on the effects of the vaccine on women.

Do hormonal contraceptives help or harm?

Women in their 40s who complain of heavy bleeding may be given birth control, which Dr. Amersi likens to putting a band-aid on their symptoms rather than addressing the root cause of the imbalance. “I always advise patients not to take birth control pills or synthetic hormones for an extended period of time due to risk factors for stroke, blood clots, and associated mood swings,” he adds. Dr. Fromberg agrees: “Long-term use of the pill can affect menstrual periods by recalibrating hormone receptors and hormone production in the endometrium, ovaries, pituitary, hypothalamus, and other tissues.

What does this mean for my skin?

Birth control or not, our skin can be a mirror image of our hormonal upheaval at 40. “The major hormonal changes that affect your discharge can also affect your skin,” says Dr. Javid. He explains that estrogen attracts water, so when levels drop, skin becomes drier. Collagen production is also reduced when estrogen does this, and acne is a common occurrence with hormonal cascades. When acupuncturist Sandra Chiu sees a new patient with any skin condition, she always asks and evaluates her menstrual cycle. “It gives us clues as to what might be wrong on the inside that could affect healthy skin function,” she says, adding that rosacea and melasma are problems she often sees in women in their 40s with disabilities. menstrual cycle.

Is there a way to make switching smoother?

There are ways to ease the hormonal transition at 40. And if you can start relaxing it sooner, that’s even better. “Developing healthy lifestyle habits in your 30s is important because each decade prepares you for the next,” says Dr. Amersi.

Chiu uses Traditional Chinese Medicine to treat patients in need of reproductive health and fertility support. “I think the more people who know that TCM can help with problems like painful periods, heavy bleeding, or cycle interruption without the use of birth control or pharmaceutical intervention, the more interest there will be in this option,” she says.

When it comes to diet, it’s especially important to consume sugar, alcohol, and gluten in moderation, as insulin resistance can develop in perimenopause, causing fatigue, insomnia, and hot flashes. Also make sure you’re getting enough protein (60 to 100 grams per day). “I’ve found that most of my female patients don’t get enough protein, and that can be a problem for hormonal health and even strong, healthy hair,” says Chiu. Good sleep hygiene and adequate hydration (from both water and food) are also key during this transition, Chiu says. While exercising, movement is vital, but consider replacing high-intensity cardio with strength training. “This approach is often more effective for reintegration and wellness than rapid exercise, which can overstimulate an already stressed adrenal and nervous system and compromise joint and structural integrity during a critical life transition,” says Dr. Fromberg.

What about additives?

There are a number of supplements that will help you maintain your hormone levels after 40. Dr. Fromberg recommends cimicifuga (a non-estrogenic herb), maca (root from the Andes), and vitex (also known as vitex) for symptom relief. “The fruit of Vitex agnus-castus, also known as vitex, especially increases luteinizing hormone levels, which can increase the luteal phase of the cycle as it declines during the menopausal transition,” says Dr. Fromberg. If you’re struggling with weight gain and fatigue, Dr. Amersi recommends adrenal support supplements such as ashwagandha, an Auruvedic adaptogenic herb. Michel Jacobs, co-founder of menopausal wellness brand Womaness, points to the effectiveness of Pycnogenol (French sea bark) both during and in the years leading up to menopause. “It can reduce pain associated with menstrual cramps, hot flashes, night sweats, and also help increase libido,” he says.

Any other support items worth knowing about?

Once empty, the market for vintage stamps continues to grow. Knix, Thinx, The Period Company, and Proof make great underwear for periods and leaks. “We created Proof as a solution for women of all ages, including women in their 40s who are experiencing unpredictable periods, postpartum urinary incontinence problems, and excessive sweating during exercise,” explains Proof co-founder Jody Kaden. Nyssa, a brand specifically designed for the postpartum period, has become a favorite for those who suffer from menstrual cramps: they make a pair of underwear with a bag that contains ice or a warm compress instead. Cora also makes a thin thermal patch that sticks easily to underwear. Another way to relieve cramps at home is Acera’s Lanshin massager, which uses infrared heat to relieve cramps while massaging the abdomen to stimulate blood flow. Preparing for something that can be wildly unpredictable can seem like a daunting task. “Perimenopause is clinically more challenging for patients in terms of symptoms than menopause,” says Dr. Amersi. It doesn’t help that there is no set time frame for change. “Women can be in perimenopause for varying lengths of time and it’s barely noticeable, or it can be eight years of slow change,” adds Jacobs. Accept the fact that change is coming, talk about it, and most importantly, ask for help.


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