Understanding Perimenopause: The Overlooked Second Puberty

Remember puberty? You probably wish you didn't. Experiencing uncomfortable hormonal changes the first time around likely felt like enough, but women are quietly undergoing something akin to a second puberty. It's called perimenopause, the transition into menopause that typically begins in a woman's mid- to late-30s. This process can involve changes to hormones, skin, hair, weight, and more.

What is Perimenopause?

Perimenopause is not literally a second puberty—there is only one of those, and it happens during adolescence. But while "second puberty" is not an official medical term, the slang is sometimes used to describe the point in a woman's life when "irregular estrogen levels cause the physical changes of perimenopause." Perimenopause typically occurs about three to five years before menopause (which usually begins during a woman's 40s) and is a natural process prompted when the ovaries gradually stop working.

Symptoms and Impacts

Menopause is widely known to be a marker of the end of a woman's reproductive life, designated 12 months after her last period. However, many people are less aware that perimenopause precedes it, causing symptoms like declining bone and muscle mass, wrinkles, sagging skin, graying hair, irregular periods, decreased fertility, vaginal dryness, and hot flashes. Many of these symptoms echo those that crop up for 90% of women during menopause.

Mental Health Concerns

A recent study published in the Journal of Affective Disorders links perimenopause to a significant increase in the likelihood of depression. Women in this stage are about 40% more likely to experience depression than premenopausal women. This is partly because estrogen levels rise and fall unevenly during perimenopause, affecting the metabolism of neurotransmitters such as dopamine, norepinephrine, β-endorphin, and serotonin, all of which play a role in emotional states.

Why Does Perimenopause Fly Under the Radar?

Many women do not expect to experience menopausal symptoms as early as their 30s and thus do not link these symptoms to menopause. JoAnn Pinkerton, an OB/GYN at the University of Virginia, noted that "clinicians might not recognize the symptoms, and even if they do, women are often told it's just life and that there is nothing to be done."

Despite approximately 2 million women reaching menopause every year, fewer than 1 in 10 physicians feel prepared to treat these individuals. Healthcare providers often fail to make female patients aware of medications that could help alleviate perimenopause and menopause symptoms. Even lifestyle changes can help, like healthier eating, avoiding alcohol, regular exercise, and stress reduction.

The Need for Awareness and Research

Ninety-nine percent of preclinical aging studies ignore menopause, which translates to gaps in women's health care. Normalizing and promoting awareness of this tricky stage of life seems to be an important first step in helping women better navigate their health struggles.

Lets talk about the snails and the trees….

It's normal for parents to talk to girls about their first period. Virtually everyone has some idea of what to expect during puberty (talking about the birds and the bees). We should have similar conversations to normalize and increase awareness of perimenopause and menopause.