Remember puberty? You probably wish you didn’t. Experiencing uncomfortable hormonal changes the first time around probably felt like enough, but women are quietly undergoing something akin to a second puberty. It is called perimenopause and refers to the transition into menopause that typically begins in a woman’s mid- to late 30s, according to Healthline. The process can involve changes to hormones, skin, hair, weight, and more.
Perimenopause has recently gained attention. Filmmaker Miranda July’s latest book, “All Fours,” was hailed as the “first great perimenopause novel” by The New York Times, and actress Naomi Watts has suggested perimenopause should be considered “the new puberty” to garner more empathy and attention. Watts expressed frustration with the lack of information and community support when she entered perimenopause, as reported by The Wall Street Journal. Many women, famous or not, share this feeling of being uninformed about this often-overlooked stage of life.
Understanding Perimenopause
To clarify, perimenopause is not literally a second puberty — there is only one of those, and it happens during adolescence. However, “second puberty” is sometimes colloquially used to describe the point in a woman’s life when irregular estrogen levels cause the physical changes associated with perimenopause, according to Healthline. Perimenopause typically occurs about three to five years before menopause (which typically begins in a woman’s 40s) and is a natural process triggered by the gradual decline in ovarian function, as described by Johns Hopkins Medicine.
Menopause is widely recognized as marking the end of a woman’s reproductive years, defined as occurring 12 months after her last period, according to the National Institute on Aging. However, many people are less aware of perimenopause preceding it, which can bring symptoms such as declining bone and muscle mass, wrinkles, sagging skin, graying hair, irregular periods, decreased fertility, vaginal dryness, and hot flashes — symptoms that overlap with those experienced by 90% of women during menopause.
A recent study published in the Journal of Affective Disorders highlighted a significant link between perimenopause and an increased likelihood of depression. CNN reported that women in this stage are about 40% more likely to experience depression than their premenopausal counterparts. Mayo Clinic explains that this is partly due to the uneven fluctuations in estrogen levels during perimenopause, which impact neurotransmitter metabolism and emotional states, as noted by the study authors to CNN.
Why Perimenopause is Overlooked
Many women do not anticipate experiencing menopausal symptoms as early as their 30s, often failing to connect these symptoms to perimenopause. JoAnn Pinkerton, an OB/GYN at the University of Virginia and executive director emeritus of the North American Menopause Society, expressed concern to The Washington Post about the dismissal of perimenopause symptoms by clinicians who may not recognize them. Leana Wen, in her column for the Post, added that women are often told these symptoms are just a part of life with no solution.
Despite approximately 2 million women reaching menopause annually, CNN reports that fewer than 1 in 10 physicians feel adequately prepared to treat them, citing a study from Mayo Clinic Proceedings. Healthcare providers frequently fail to inform their female patients about available medications and lifestyle changes that can alleviate perimenopause and menopause symptoms. Pinkerton advocates for lifestyle changes such as healthier eating, alcohol avoidance, regular exercise, and stress reduction to manage symptoms.
The issue extends beyond clinical practice. Harvard Medical School notes that 99% of preclinical aging studies exclude menopause, resulting in significant gaps in women’s healthcare. Normalizing and promoting awareness of this challenging life stage is crucial to improving women’s health outcomes.
“It’s common for parents to discuss a girl’s first period,” Wen remarked. “Nearly everyone has some expectation of puberty. Similar conversations should occur to normalize and increase awareness of perimenopause and menopause.”
By acknowledging and addressing perimenopause as a significant transitional phase, society can better support women navigating these health challenges.
