Knowing whether or not you are entering perimenopause isn’t as easy as you’d expect.
We show you the signs to look out for.
Jessie Morgan, a photographer from Augusta, Maine, usually put her irregular periods down to stress. “Whether I was traveling, working to tight deadlines or suffering from a viral infection, the first thing to go would be my menstrual cycle,” she says. “I don’t think it’s ever been regular.” So when Morgan’s periods stopped in her late 40s, she didn’t think much about it. “It wasn’t until I started getting hot flashes that I realized I was entering menopause.”
Perimenopause—the stage before a woman’s periods stop—can last from a few months to several years. While some women go straight from experiencing regular periods to having no periods at all, for others, menstrual irregularity of all varieties can occur. So, knowing whether you’re entering perimenopause or not isn’t always straightforward.
Home TestsIf you’d like to know your menopause status, home testing kits aim to give you some indication. These tests measure urine levels of follicle-stimulating hormone (FSH), a hormone made by the pituitary gland in the brain, which increases as estrogen levels drop. They won’t work for everyone, though: they’re invalid if you’re using hormone therapy, including oral contraceptives.
Self tests work by measuring urine FSH levels, usually at least twice over a period of time. A urine sample is checked against a test panel, and menopause is supposedly indicated when all results indicate high FSH.
But the tests, which cost about $20, can be inconclusive. Unlike a pregnancy test, which provides a simple “yes” or “no” answer, the question of perimenopause isn’t quite so simple. Felicia Cosman, MD, a New York City gynecologist, says. “During perimenopause, any FSH test can only give you a snapshot of your hormone level on that particular day, information that may not be very useful.” This is because hormone levels can fluctuate wildly during perimenopause. Self tests try to compensate for this by requiring two or three tests at various intervals. You also may ask your healthcare provider about getting an FSH blood test, but it, too, may be unreliable.
Tracking Your PeriodsTraditionally, you are considered to have reached menopause after 12 months without any periods. However, for some women, this method is not sufficient. Oral contraceptives often extend periods beyond menopause. And, if you had your uterus removed, you’ll no longer have periods, even when your ovaries continue their monthly hormonal ups and downs.
Your Best Bet? Pay attention to your body and your symptoms. Use a home test kit if you want, but if you’re in your 40’s and having night sweats and hot flashes, skipping periods or having them more often, or find that your flow is lighter or heavier, you’re probably in perimenopause. The important thing is not to try to guess. Discuss your symptoms with a knowledgeable healthcare provider to assess your personal situation.
Could It Be Early Menopause?The average age of menopause is 51. If you reach it at or before age 40, whether naturally or because it’s been medically induced, you’re considered to have had a premature menopause. Premature menopause can be the result of genetics, autoimmune processes, or medical interventions such as cancer treatments.
Before a diagnosis of premature menopause, women often undergo numerous tests and second opinions about their symptoms. Sometimes years may pass before a doctor finally confirms what these women already suspect: They have experienced menopause early.
If you think you have premature menopause but have tested normal on blood tests, seek a second opinion. See The North American Menopause Society (NAMS) Web site for a referral list www.menopause.org/consfef.aspx.
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