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The cruel coincidence when perimenopause and puberty collide

Posted by Andraya J. Huldeen, MD, Western OB/GYN, A Division of Ridgeview Clinics on Jul 2, 2019 2:00:00 PM

IMG_2278Andraya Huldeen, MD, Western OB/GYN, A Division of Ridgeview Clinics, has done the math. She realizes that she and her young daughter Gwen—now age 7—will likely approach perimenopause and puberty at the same time. Perimenopause begins mid- to late-40s and puberty in girls starts between ages 10 and 14. Both involve cascading hormone fluctuations and being an expert on women’s health, Dr. Huldeen is acutely aware of relationship challenges ahead, with a sense of humor about the irony of it all.

A woman’s menstrual cycle, the simple explanation

The reason women have regular, predictable periods is because we regularly and predictably ovulate or release an egg. There are two main female hormones: estrogen and progesterone. We always make estrogen. And when we ovulate, part of the ovary releases progesterone for approximately 14 days. 

If we don't get pregnant that month, the ovary quits making progesterone. It’s this progesterone drop that leads to bleeding—or your period. The body resets and the process repeats. It’s this typical hormone cascade that causes women to experience certain symptoms before their periods such as poor sleep, food cravings, mood changes, breast tenderness, irritability and depression.

Menopause: when the body stops ovulating

Menopause, by definition, is when the body stops ovulating—generally around age 51. It doesn’t happen because there are no eggs left; there are always eggs left. As we age, the eggs that remain become less responsive to hormones, and are not able to finish developing and release. Now, there are women out there who get regular, predictable periods and then they just stop. They are the lucky ones. Most women have changes in their cycles for an unpredictable length of time before actual menopause. This is perimenopause—which typically begins in mid- to late-40s and for some women, it can last several years.

Signs of perimenopause

  • Hot flashes
  • Breast tenderness
  • Worse premenstrual syndrome
  • Fatigue
  • Irregular periods
  • Vaginal dryness including discomfort during sex

It’s not uncommon for a woman in her 40s to come in to see me or my colleagues and discuss changes to her period and an increase in hormonal symptoms. Women who previously set their watches by their period now have no clue what’s going on. Their periods are a little early or late, longer or shorter, or their heavy day has shifted. Sometimes they skip a month or more, likely because they did not ovulate that month. 

The eggs that remain need larger and larger hormone swings to get them to ovulate. It is these bigger hormone swings that lead to the cycle changes and hormonal symptoms. 

This is when many women say they feel like a teenager again, and, in a way, they do. Teenage girls require big hormone swings to get the first eggs to release and become regular. Perimenopause is that in reverse. It's a cruel coincidence that many of us will experience perimenopause at the same time our daughters go through puberty. Both are hormonal rollercoasters and likely will impact the mother-daughter relationship.

How long will this last … and what can help?

Women ask me how long perimenopause will last, and my answer is almost always "no clue." Unfortunately, there is no test that can provide an answer. I can only make an educated guess based on the patient's age. If perimenopause began at age 50, she probably won’t have to do this for long. If it started at age 42, a woman may experience this “period of life” for many years. 

Additionally, there is no treatment to make the move to menopause go faster. If symptoms are particularly troublesome, we use birth control to reduce symptoms. When a woman uses birth control, hormone swings won’t be as large and bleeding will be on a controlled schedule. If the symptoms are primarily mood-based, antidepressants/anti-anxiety medications can help. As always, healthy diet and exercise is helpful. 

Most women feel better once this process is explained and they are reassured that they are experiencing typical symptoms. But as far as the mother/daughter relationship is concerns, I can only prescribe an extra dose of patience and understanding.

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Medical and health information presented here is intended to be general in nature, and should not be viewed as a substitute for professional advice. Please consult with a health care professional for all matters relating to personal medical and health care issues. In case of an emergency, please call 911. 

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