More things every woman should know about her periods before menopause
There's no link between menstrual difficulty in your reproductive years and menstrual difficulty in perimenopause.
Good news for women plagued by heavy bleeding, cramping, and bad PMS (dysmenorrhea): Your odds of a rough passage through menopause seem to be about the same as any woman's, says Carson. But there's some evidence that stress worsens both PMS and perimenopausal symptoms.
You can still get pregnant even after you start missing periods.
The number-one mistake women with menstrual irregularity make (after not checking with a doctor about big changes): assuming that being down the road toward menopause means you can't conceive -- or that your odds are so low it's not worth bothering about.
"Your chances of pregnancy are low and your chances of miscarriage are high once your periods become irregular in perimenopause, but you can still get pregnant," says Carson, an ob-gyn and endocrinologist. And every year, thousands of perimenopausal women do.
Some doctors keep healthy women without risk factors (like smoking) on hormonal contraceptives through their early 50s, since that has the same protective effects against menopausal symptoms (such as minimizing abnormal bleeding or hot flashes) as hormone replacement therapy (HRT). Others prefer to transition patients to HRT or alternatives, along with an alternate birth control method. Some advise women to wean off hormonal contraceptives by their late 40s in order to measure levels of FSH (follicle-stimulating hormone), which, when elevated, indicate that the ovaries are failing and heading toward menopause. To get an accurate reading, a woman should not be taking hormonal contraceptives for as long as six weeks before testing.
Women in their 40s who have quit birth control pills may be advised to wait 18 months without a period before considering another form of contraception unnecessary. Another reason to consider contraceptives in perimenopause and beyond: You'll still need protection against sexually-transmitted diseases if you're sexually active and not in a long-term monogamous relationship.
You won't know your last period when you see it.
For such a big deal, the official end of tampons, pads, and birth control always slips by without notice. "There's no test to say you'll go into natural menopause next month or next year," Carson says. "Some tests [such as blood tests to measure FSH] will suggest it will probably occur in the next three to five years, but that's the best we can do."
The average age of menopause is 51, most often occurring between 45 and 55. The extreme -- and rare -- ends of "normal" are the early 40s and as late as 60.
"Menopause itself is defined as the last menstrual period, but you won't know when that was until one year afterward," says Carson. That's because technically, menopause isn't the whole passage commonly referred to, from menstrual irregularity through hot flashes. It's the day menstruation ends -- as noted only by looking back on 12 full months without menstruation. Period.