JUANA SUMMERS, HOST:
Perimenopause is a hot topic among Gen X'ers and millennials, and these generations are ready to shake off the stigma associated with this stage of life. But perimenopause has a long list of symptoms. It can be hard to know when you're actually in it. NPR's Katia Riddle reports on that question - is it perimenopause, or is it something else?
KATIA RIDDLE, BYLINE: It's often clear enough when someone is in menopause - they stop having a period. But perimenopause - the years leading up to it, when hormones start to fluctuate - can be a lot more sneaky. Perimenopause can be a few years or closer to 10. It can show up in the early 40s or the late 40s. It can have a few symptoms. It can have a lot of symptoms. One thing that perimenopausal women interviewed for this story said consistently, you just don't feel like yourself, like Rachel Bellinsky.
RACHEL BELLINSKY: For example, my dogs started to get on my nerves so badly, which they're, like, my whole world. So I knew something was very off.
RIDDLE: At the time she started perimenopause, she was 51. She was having hot flashes. Emotional changes and mood swings can be part of the equation for many women. Bellinsky felt rage, irritability and depression.
BELLINSKY: So that's where it's complicated 'cause I've always been on the depressive side.
RIDDLE: Midlife can already be an emotionally difficult time, with caretaking responsibilities, family relationships and just aging. Monica Christmas is the associate medical director of the Menopause Society. She says one important step in grappling with this chapter of life - accepting the uncertainty of it all.
MONICA CHRISTMAS: The menopause transition, otherwise called perimenopause, is the most tumultuous time frame for many people.
RIDDLE: Often, says Christmas, it's not that women aren't making estrogen during perimenopause. It's that they're making it inconsistently, that it can make people feel inconsistent.
CHRISTMAS: It's a pretty vulnerable time frame in a woman's life.
RIDDLE: Not only is it hard for women to figure out if they're in perimenopause, it can be hard for doctors to diagnose it. Some experts recommend testing for other conditions as a first clinical step. Nanette Santoro is a gynecologist in Colorado who treats menopause.
NANETTE SANTORO: The 40s are a time in life when a lot of different autoimmune diseases can begin to show up.
RIDDLE: Santoro says many conditions can have similar symptoms to perimenopause, and some are easier to diagnose.
SANTORO: Quite often, I will do a miniature workup for making sure there's no signs of early diabetes, which happens in this age group, there's no signs of thyroid problems, which is fairly common in women, and that deserves to be checked every now and then.
RIDDLE: Using a process of elimination to identify perimenopause, she says, is often more reliable than checking hormone levels.
SANTORO: If it's not well-timed to the menstrual cycle, you may get misleading tests, and even then you still may get misleading tests because they vary from month to month.
RIDDLE: Hormone therapy is one treatment that does help people. Both of these experts cautioned that despite what some influencers would suggest, hormone therapy is not a necessity for everyone. It carries some risks and side effects. The research on it is still evolving. Santoro says women also undergo metabolic changes at this age and lose muscle mass. The basics - healthy eating, sleeping enough, weight-bearing exercise - is more important than ever and may have more impact than medication.
SANTORO: So pretty much what your mother told you. Yeah, just do more of it.
RIDDLE: One thing both doctors and patients agree on - women need to advocate for themselves and not accept suffering. That may mean seeing a specialist or seeking out a different provider. After a long odyssey of different treatments, Rachel Bellinsky has just started hormone therapy. She's hoping it will get her back to the things she used to enjoy.
BELLINSKY: I just want to care about my dogs and the people around me. I want to have a little bit of that part of me come back to life.
RIDDLE: A life that will look different in the second half, she says, but can still be great.
Katia Riddle, NPR News.
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