Menopause, the permanent pause in your periods (menses),
is one of those things that you aren't sure has happened until long after it’s
over. Like the first time you met your best friend: You probably had no idea
that you’d become so close. You only realized how special that occasion really
was when you were able to look back on it. Okay, maybe menopause isn't a
warmed- fuzzy-greeting-card occasion, but it is a passage worth noting.
Are you or aren't you menopausal? You can
answer that question only after the fact — after you've gone a year without
your period. Many of the annoying symptoms assigned to menopause actually are
much worse prior to menopause in the phase known as perimenopause. During
perimenopause, you get both the annoying symptoms (hot flashes, irritability,
mood swings, and so on) and your period.
Previewing perimenopause
For many women, perimenopause is a big case
of déjà vu. Remember puberty (vaguely)? Remember the crying jags, the mood
swings, and the “what’s wrong with my skin!” traumas? Well, guess what? They’re
back. Once again your hormones are ready to wreak havoc on your body, your
emotions, and your mental faculties. This time around, however, you’re a bit
wiser, you have experience dealing with change, and you realize that this too
shall pass.
Some gynaecologists advise women who are still
experiencing periods not to worry about “menopausal” symptoms. But you know that the symptoms folks often attribute to
menopause are usually felt as intensely or more intensely during perimenopause.
And perimenopause can last for ten years before a woman stops menstruating
altogether and becomes truly menopausal.
Experiencing periodic periods
During perimenopause, things change. If you
welcomed your period on the same day as the full moon for 20 years, you may
wake up to find the planets suddenly out of alignment.
The hormonal shift is due to changes
happening in your ovaries. Your ovaries hold little oocytes (seeds), and
each month, some of these seeds develop into follicles (little sacs that
hold an egg). One or two lucky follicles mature and release an egg. That’s when
you ovulate. The oocytes in your ovaries are held together by a substance
called stroma. The stroma produces testosterone, and the follicles produce oestrogen. When you’re very young, you have hundreds of thousands of these
little seeds. As you age, you have fewer seeds and more stroma. As the mix of
seeds and stroma in your ovaries changes, so does hormone production. Your
ovaries decrease their production of oestrogen but continue to produce
testosterone.
Sometimes you ovulate during your cycle;
sometimes you don’t. Sometimes the FSH just doesn’t get the follicles producing oestrogen right off the bat. Oestrogen levels are low at the beginning of your
cycle when they should be high. Your brain responds to this lack of
get-up-and-go by sending another surge of FSH. Finally getting the message,
your ovaries become a little frantic and go into double-time production of oestrogen. Right at the time when you should be ovulating and producing
progesterone, your ovaries are just kicking into gear developing a follicle.
That means you won’t ovulate when you usually do and your period will be late.
Your menstrual cycle is all messed up. Your oestrogen shoots up, and then it drops down. You get hot flashes and maybe even
heart palpitations (a racing heart) when oestrogen plunges. But just when you’re convinced that something is seriously wrong and you need to schedule a gynaecologist’s appointment, you get your period and everything returns to normal. You wonder
why you were so worried and cancel the appointment (if you made one) until the
next weird thing happens.
This is all perfectly fine (maybe not with
you, but with Mother Nature) — it’s all part of perimenopause.
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