Physical Changes
Your body will tell you when you are entering perimenopause. You may not listen to it at first, or you may try to dismiss physical symptoms as “getting a bug” or some other familiar event. But once it gets your attention, you can tune in to your body and manage some of the physical changes before they get the best of you. Here are some common changes to watch for.
Hot Flashes (Including Night Sweats)
Along with irregularities in menses, hot flashes have to earn the dubious honor of being one of the symptoms most commonly reported by women during perimenopause. Nearly 75 percent of women who report perimenopausal symptoms list hot flashes among them. Hot flashes can come at any time of the day or night, but when they occur during sleep, they're usually referred to as night sweats.
Hot flashes can be mild or severe, but in general, they involve a fast-spreading sensation of warmth in your neck, shoulders, and face that may last a few seconds or as long as thirty minutes or more. This sensation may begin at the top of your scalp, behind your ears, on your chest, or even across your nose. Hot flashes don't have to limit themselves to your head and shoulders; many women have also reported flashes occurring across the breasts, below the breasts, or all over the body. Hot flashes are so common and bothersome that Chapter 5 is devoted entirely to managing them.
Irregular and/or Heavy Periods
Changes in your period are usually the very first sign that the peri-menopause has arrived. Even if your periods have always been as regular as clockwork, you can expect some irregularities to occur in the years preceding menopause. The levels of estrogen and progesterone produced in your body can flag and surge, contributing to unusually light or skipped periods, or periods that flow for weeks at a time. Some women experience spotting — or even phases of heavy bleeding — for a few days between periods. In other words, you may find that irregularity becomes the norm in your perimenopausal cycles.
Alert
If periods come less than twenty-one days apart, last more than a week, are unusually heavy, and maintain these irregularities for more than two cycles, make an appointment with your doctor or health care professional for a gynecological checkup.
Having said that heavy periods and ongoing irregular bleeding are not uncommon during perimenopause, it's also important to have them checked out by your health care provider. Heavy bleeding or bleeding that continues for a long time can be more than an inconvenience. Nonstop heavy bleeding can leave you tired, weak, and anemic — a prime candidate for getting a cold, flu, or infections. Even more importantly, heavy bleeding may have nothing to do with simple hormonal ebbs and flows. Heavy bleeding could be a sign of abnormal tissue in the uterus, precancerous conditions, or even endometrial cancer. Don't take chances that your period irregularities are just part of the change. If your irregularities are dramatic, see your health care professional. (For complications of the uterus and their treatment, see Chapter 6.)
Fact
According to some studies, your menstrual cycles may shorten before age forty, then lengthen slightly as you approach menopause. So while your period may occur every twenty-six days when you're forty years old, as you reach forty-five, thirty-five-day cycles may be normal for you.
Heart Palpitations
Heart palpitations are the sudden uncomfortable awareness that your heart is pounding, often at a more rapid rate than normal. Heart palpitations can be frightening, but remember that they aren't uncommon in perimenopausal and menopausal women. Certainly, these women aren't the only ones to experience palpitations — many men and women have them after exercising, when frightened, or while taking some medications. But at menopause, the incidence of heart palpitations seems to rise in women.
Women describe heart palpitations differently, but in general a heart palpitation feels like your heart is beating rapidly, out of sequence, too strenuously, or in some other abnormal fashion. A heart palpitation can feel like no more than a brief fluttering in your chest that passes within a matter of a few seconds. Other, stronger palpitations can feel like a distinct pounding in your chest that lasts a few minutes and can leave you feeling light-headed or short of breath.
Essential
Caffeine, cigarettes, and excess sugar can overstimulate your system and be a contributing factor in heart palpitations. Perimenopause is a great time to cut back on your intake of these.
Involuntary Urine Release
If you've ever experienced urinary tract infections (UTI), you might feel as though they're back with a vengeance during your transition into menopause. And if you've never had urinary tract problems, you might develop them during perimenopause. According to some estimates, nearly 20 percent of all women over the age of forty-five develop some urinary tract problems. Those problems can include UTIs, stress urinary incontinence (caused by a stressor such as sneezing, coughing, or laughing), and urge incontinence (caused by a bladder spasm that forces urine out, even when the bladder is not completely full).
Weight Gain
The results are in: weight gain is commonly seen as people of both sexes age. The term “middle age spread” was coined decades ago to describe the tendency of the post-forty body to take on excess weight. Of course, not everyone gains weight during perimenopause and after menopause, and not everyone who does gain weight gains debilitating amounts. But the fact is that the majority of women report weight gain at this time. Even women who don't gain weight may experience a change in their body shape. Many women in middle age gain softer, rounder abdomens, larger hips, thicker waistlines, and even extra weight on their shoulders, arms, and thighs.
