10 MYTHS ABOUT PERIMENOPAUSE

Michal Schonbrun, MPH

March, 2025

Myth 1

“Peri” is one stage before menopause (reaching one year without a period)

Truth:  The Perimenopause can actually be divided into four stages of change:

• Very early perimenopause transition (2-5 years)- when menstrual cycles are still “regular,” but they may be shorter, with possibly heavier bleeding, pain, migraines and sleep issues.  There is less progesterone (P) and higher estrogen (E)
• Early per-menopause transition (2-3 years) – when cycles become irregular (more than than 7 days’ variance), still low P and fluctuating E.  When E goes low, it can trigger hot flashes, night sweats, breast pain, weight gain.
• Late perimenopause transition (4 years)- when cycles skip or are irregular, and symptoms intensify – heavier bleeds (even flooding), night sweats, hot flashes.
• Late perimenopause ( last 12 months before period stops) – when you think it is over and hormones are still fluctuating, A surprise period and random ovulation are possible. A year of late perimenopause and no periods leads to the menopause.  

Myth 2

Perimenopause can last a few years at most, and typically begins in late 40’s

Truth: Perimenopause, or “adult puberty,” typically begins during the early forties and lasts an average of four to eight years. Up to 10% of women experience premature ovarian insufficiency (POI) or early menopause, before reaching age forty.

Myth 3

Most women will have fairly regular menstrual cycles and normal fertility until they reach their late 40’s.

Truth:  Perimenopausal hormonal changes affect our fertility, metabolism, brain and gut health, typically beginning during our mid-to-late thirties. Just because a cycle seems “regular” doesn’t mean that ovulation occurs regularly.  Likewise, approximately 2500 Israeli women over forty apply yearly for pregnancy terminations..

Myth 4

Fertility charts are an excellent way to gauge hormonal health.

Truth:  Hormonal changes and decreased fertility can occur during the mid-thirties, when basal body temperature and secretion changes appear to be balanced. The chart does not necessarily tell the whole story.

Myth 5

Women can test their hormones to measure if they are approaching menopause.

Truth:  Because our cycle hormones fluctuate for years, there is no one blood test that can definitively diagnose hormonal status at a given point in time. Someone could literally be in the middle of their very last menstrual cycle and have totally ‘normal’ hormone levels.  Someone else may think they are already in menopause (because no periods for six months), and they could experience spontaneous ovulation. 

Myth 6

A 40-year old woman with regular cycles can have a baby (naturally) just like a younger woman with regular cycles.

Truth: While women in their forties can still get pregnant, their chances of carrying a healthy pregnancy to term gradually decrease after the age of 35.  Egg quality diminishes and the ovaries become less responsive to the hormones (FSH, LH, E and P) needed for ovulation and pregnancy. For women over forty trying to conceive, the success rates will be higher with frozen embryos rather than eggs.

Myth 7

When you experience irregular or missed cycles in your forties you can assume your fertility has declined, so birth control is not so essential.

Truth: You can skip three periods, have a spontaneous ovulation and get pregnant.

Myth 8

Menopausal symptoms typically kick in during the year before a final menstrual period.

Truth: Beginning in the mid-to-late thirties, women can experience a number of symptoms related to peri and menopause: irregular cycles; anxiety, mood swings, irritability; sleep disturbances; hot flashes; lower libido and changes in sexual response; weight-gain and breast changes. Typically,  neither a woman or her primary doctor will connect the dots and recognize these as signs of perimenopause.

Myth 9

Your gynecologist is the “go-to” address for perimenopausal changes.

Truth: Not necessarily.  Medical education places more emphasis on reproductive health, pregnancy, and general gynecological issues than it does on peri and menopause.  Most gynecologists have more clinical experience treating younger-aged women. Because of the range and variability of peri symptoms, practitioners may feel less confident in providing guidance and care, particularly around sexual issues. Listening to your body and trusting your instincts is key during this time of transition. A famous Hollywood actor’s personal perimenopausal story went viral last year when she was misdiagnosed with an STD when in fact she was only suffering from vaginal dryness. 

Myth 10

Perimenopause and menopause are signs of aging and the loss of womanhood.

Truth:  Peri and menopause are natural and normal life transitions. Losing our fertility is not a disease to be dreaded but a new stage of life, which we can embrace and utilize for resetting priorities and improving our health and quality of life.  It is the time to engage in radical “self-care.”  Dr. Christiane Northrup once wrote that “the menopause transition is like birth, but instead of giving birth to another person a woman gives birth to herself.” According to surveys, women in postmenopause report they are happier than during any other life phase!

References:

Perimenopause is Second Puberty and is Temporary, Lara Briden

Hormone Repair Manual: Every woman’s guide to healthy hormones after 40, Lara Briden, 2021

Applications to Israel Abortion Committees, 2022 Report