Expecting the Unexpected: Perimenopause

Originally published in Family Foundations.

Gini was 35 when she began experiencing cycle irregularity and spent the next several years hunting for clarity. Finally, at age 39, a blood test came back with the answer. Menopause. “Suddenly a lot of my other symptoms made sense!” she says. Perimenopause simply hadn’t been on her radar, in part because the only symptom she associated with the waning of fertility was hot flashes. “Once I was diagnosed with premature ovarian failure, I started doing research and I realized I had been experiencing symptoms for years…night sweats, anxiety, mood swings, PMS for the first time in my life, terrible insomnia and fatigue, loss of libido — I just didn’t feel like myself anymore!” she said.

Understanding the Lingo…


Menopause is the end of female fertility. Once a woman’s body is menopausal, she will remain infertile until the end of her life. It occurs when a woman’s ovaries have run out of eggs.


Premenopause is the time of waning female fertility that precedes menopause. Perimenopause is used in a few different ways. Especially in the medical field, it refers only to the last few years in the premenopausal transition (also called late premenopause) when symptoms related to decreased hormone levels are present.


Hot flashes are sudden sensations of heat that flush over the body, usually around the face, neck and chest. Sometimes they’re accompanied by redness and sweating. While they’re a quintessential symptom of perimenopause, not everyone experiences them.


Night sweats are episodes of extreme heat during slumber that cannot be contributed to any environmental factor. Different from simply sweating at night, night sweats can result in soaked sleepwear or bedsheets.

The New Normal

Such reports are familiar to Dede Chism, nurse practitioner in Denver. “I don’t feel like myself ” is a common report among many premenopausal women. “A lot of women feel like, ‘I must be crazy,’” Dede explains, “but you’re not crazy. Perimenopause is such a rollercoaster of hormones. You can have one month in which you feel amazing and everything is normal, and the next month feel like everything is horribly not normal.” It can be hard to qualify exactly what is and isn’t normal during perimenopause. Like puberty, the seemingly unpredictable hormone fluctuations affect different women in different ways.

Take for example the age at which different women hit menopause. Statistically, the average is 51, but doctors admit that it’s common to reach menopause anywhere between ages 40 and 58. Outliers stretch that range even further. That doesn’t take into account the transitional time of perimenopause, of course, which itself can last between 4–8 years. There’s a lot of variability. However, just because symptoms may be normal, that doesn’t make them healthy. “That women have to suck it up and ride through the chaos is a misconception,” Dede says. “It’s not necessary and it’s not necessarily healthy.”

So how can women approaching or experiencing perimenopause know when symptoms are worth bringing to a doctor? First, says Dede, do what you can to promote overall wellness. Proper diet, exercise and rest can help ease many physical and mental concerns. Consider how multivitamins, omega 3 fatty acids and probiotics can supplement your nutrition and balance your gut. Work a light 30-minute walk into your schedule a few times a week. She acknowledges that it can be difficult to change habits, but the seasoned nurse practitioner points out the value of making commitments to even small lifestyle changes in this season of aging. However, if your overall wellness is good and you’re managing what you can yet perimenopause symptoms are still preventing you from enjoying your day-to-day life, it’s time to see a doctor. Consulting a physician isn’t just for convenience. For example, bleeding that lasts for two weeks is uncomfortable and irritating, sure, but such blood loss could lower one’s red blood cell count and contribute to anemia. Similarly, frequent mood swings can damage relationships.

Dede emphasizes something that’s easy to lose sight of in medicine: as humans, we aren’t just a body. We’re combined body, mind and soul. If any of those interconnected parts is suffering, intervention is warranted, and it’s best to have a doctor who respects your values. She also points out that when it comes to getting back to feeling like yourself, it’s important to go to a doctor who knows what that is. That means finding someone who’s familiar with hormonal changes, cycle problems and fertility symptoms.

Don’t Face Perimenopause Alone

The beauty of an NFP community is knowing nobody has to make this counter-cultural journey alone. These men and women have weathered the storm and come out alive and thriving on the other side of childbearing. Fertility Science Institute offers Coaching during Perimenopause in both English and Spanish. Check out fertilityscienceinstitute.org/coaching for more details.

Originally published in Family Foundations Magazine in 2020.