Is This Perimenopause?

Gillian Goddard

3 min Read Gillian Goddard

Gillian Goddard

Is This Perimenopause?

Introducing Hot Flash

Gillian Goddard

3 min Read

I don’t know about you, but I entered my 40s with so much optimism. I had spent my 30s building my career and pregnant or caring for very tiny humans. At 40 I had an established career and all my kids were out of diapers (mostly). Sure, I had a little gray hair, but I felt healthy. And perhaps most importantly, I felt comfortable in my skin!  

Two or so years into my midlife nirvana, a few changes started to sneak in. It felt like I was always getting my period. I was sometimes waking up in the middle of the night for no reason. I was getting searing headaches every time the weather changed and on the second day of my period. I suspect my family would also tell you that, at times, I was quite a bit more … irritable.  

Despite a medical degree and several years of advanced training, I was mystified. Was this perimenopause already? At my annual visit my gynecologist told me I was not in perimenopause, “but, well, you are in your 40s now.”

I am in my 40s (46, if you’re curious), but I am also an endocrinologist. I spend my workdays talking to women about their hormones and helping them understand how those hormones are impacting how they feel. How could my own hormonal changes sneak up on me like that? 

Once I got over my surprise, I started talking to my patients in their 40s to prepare them for these changes that can catch us by surprise. Because, while it may be helpful to know we aren’t in perimenopause, I find that it is easier for me and my patients to navigate hormonal changes when we understand them and can anticipate what’s coming. With that as the goal, let’s discuss our hormones in our 40s — or the late-reproductive stage.  

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Hot Flash is a new weekly newsletter on navigating your health and hormones in the post-reproductive years, written by Dr. Gillian Goddard. Sign up now for free!

What (and when) is the late-reproductive stage?

There are times when we expect hormonal shifts. Our reproductive lives are bookended by puberty and menopause. We discuss those changes often because they are definitive and dramatic — a first period is something many of us remember clearly. But between ages 13 and 53, our hormones are changing in more subtle ways.   

Much of what we know about female hormonal changes comes from longitudinal studies, studies that enroll large numbers of participants and then follow them over many years with surveys, lab tests, and other measures to better understand typical biological changes over time. This type of data is helpful because we can see a wide range of women and see clearly the trends in hormones within a woman. Two such studies that help characterize the late-reproductive stage are the Study of Women’s Health Across the Nation (SWAN) and the Seattle Midlife Women’s Health Study

The Seattle Midlife Women’s Health Study enrolled 508 mostly white women and followed a number of health parameters in participants for up to 23 years. Data from 184 of those women who were not taking any hormones found that the earliest changes in cycle flow and length most often occur between ages 40 and 44 but that there is a lot of variability. 

The SWAN study, which is larger, actively recruited a more racially representative sample. Data from SWAN suggest that Black American women have their final menstrual period on average 8.5 months earlier. The start of the late-reproductive stage may also be different among women of color, although SWAN has not specifically looked for these differences.    

Based on data from these studies and others, the Stages of Reproductive Aging Workshop + 10 (STRAW + 10) Collaborative Group met in 2012 to develop universal definitions for the stages of a typical female reproductive life cycle. The late-reproductive stage is sandwiched between our peak reproductive years and early menopause. STRAW + 10 defines it as a time when menstrual cycle length and flow change but periods still occur regularly.  

More specifically: according to these definitions, the late-reproductive stage ends and early menopause begins when menstrual cycles become longer than 35 days and vary more than seven days from one cycle to the next. For example, your cycle might go from a regular 24-day cycle in the late-reproductive stage to a 35-day cycle and then a 27-day cycle and then a 40-day cycle in early menopause. These changes occur most frequently between the ages of 45 and 49 but can be as early as age 40 and as late as ages 50 to 54. 

Further confusing matters, the Seattle Midlife Women’s Health Study found that only 39% of participants progressed linearly from one stage to the next over a four- to seven-year period; 48% of study participants seesawed back and forth between the late-reproductive stage and early menopause. 

Bottom line: You can expect a lot of changes in your menstrual cycle in your 40s. The changes of the late-reproductive stage are characterized by regular but shorter cycles. The changes of early menopause are characterized by long and variable cycles.

Why does our menstrual cycle change in our 40s?

Our menstrual cycle changes in the late-reproductive stage because of changing hormone levels. (Bear with me while we get a little technical — I am an endocrinologist, after all; I love hormones.) In a normal menstrual cycle, follicle-stimulating hormone (FSH) from the pituitary gland stimulates the ovary to produce estrogen to build the uterine lining and mature an egg. Mid-cycle, luteinizing hormone (LH) from the pituitary gland spikes, along with FSH and estrogen, triggering ovulation. After ovulation, progesterone rises. If the egg isn’t fertilized and implanted in the uterus, progesterone then drops. Dropping progesterone triggers a menstrual period.  

In the late-reproductive stage, fewer eggs remain, and they are typically of lower quality. More FSH is needed to mature eggs, which drives estrogen higher and leads to earlier ovulation. Old eggs simply need more juice to get ready for ovulation. Progesterone levels are also lower.

Why are these changes important to you and me? Because they can have big impacts on how we feel throughout our menstrual cycle. Higher estrogen levels before ovulation can build a thicker uterine lining, which will lead to heavier menstrual bleeding when it sloughs off. It can also cause more breast fullness and tenderness.  

Earlier ovulation and lower progesterone can lead to shorter menstrual cycles — sometimes just 21 days from the first day of one period to the first day of the next. Bigger drops in estrogen around ovulation and the start of a menstrual period can cause changes in mood, irritability, headaches, sleep disruption, and hot flushes and night sweats.  

Should I worry?

Given all this variability, how do you know when you should consult with your doctor? The following symptoms should prompt a visit to your gynecologist:  

  • Cycles that are less than 21 days from the first day of one period to the first day of the next  
  • Cycles that are longer than 35 days from the first day of one period to the first day of the next, or skipped periods if you are under age 45  
  • Any symptoms that are impacting your day-to-day functioning, including heavy menstrual flow, changes in mood, hot flushes, night sweats, sleep disturbance, or headaches 

Abnormally long or short cycles may not be related to your reproductive stage at all. Other hormonal changes, such as hypothyroidism, may be the culprit and may need to be treated.  

If symptoms are related to the hormonal changes of the late-reproductive stage, they can be treated individually — for example, I started taking a magnesium supplement at bedtime to help with sleep disturbance and to prevent headaches. And in many cases hormonal contraception, including birth control pills and progestin-eluting IUDs, can be safely used to alleviate a host of symptoms at once, from heavy bleeding to changes in mood to hot flushes.  

Hormonal changes and the progression toward menopause are inevitable for all women. Armed with information — and perhaps some strategies for symptom management — we can still enjoy all the great things about being this age. 

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In the future, before hopping onto the latest trend, check the data first. Unlike Cabbage Patch Kids, parenting trends can add a lot of unnecessary stress and challenges to your plate. What’s a recent trend that you’ve been wondering about?

#parentdata #emilyoster #parentingtips #parentingadvice #parentinghacks

Parenting trends are like Cabbage Patch Kids: they’re usually only popular because a bunch of people are using them! Most of the time, these trends are not based on new scientific research, and even if they are, that new research doesn’t reflect all of what we’ve studied before.

In the future, before hopping onto the latest trend, check the data first. Unlike Cabbage Patch Kids, parenting trends can add a lot of unnecessary stress and challenges to your plate. What’s a recent trend that you’ve been wondering about?

#parentdata #emilyoster #parentingtips #parentingadvice #parentinghacks
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I’m so grateful you’re all here as a part of this, and I want to thank you! If you’ve been waiting for the right moment to sign up for full access to ParentData, this is it. ⭐️ Comment “Link” for a DM with a discount code for 20% off of a new monthly or annual subscription to ParentData! 

Thank you again for being the best community of readers and internet-friends on the planet. I am so lucky to have you all here.

#parentdata #emilyoster #expectingbetter #cribsheet #familyfirm #parentingcommunity

As of this week, 1 million copies of my books have been sold. This feels humbling and, frankly, unbelievable. I’m so thankful to those of you who’ve read and passed along your recommendations of the books.

When I wrote Expecting Better, I had no plan for all of this — I wrote that book because I felt compelled to write it, because it was the book I wanted to read. As I’ve come out with more books, and now ParentData, I am closer to seeing what I hope we can all create. That is: a world where everyone has access to reliable data, based on causal evidence, to make informed, confident decisions that work for their families.

I’m so grateful you’re all here as a part of this, and I want to thank you! If you’ve been waiting for the right moment to sign up for full access to ParentData, this is it. ⭐️ Comment “Link” for a DM with a discount code for 20% off of a new monthly or annual subscription to ParentData!

Thank you again for being the best community of readers and internet-friends on the planet. I am so lucky to have you all here.

#parentdata #emilyoster #expectingbetter #cribsheet #familyfirm #parentingcommunity
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Just eat your Cheerios and move on.

Just eat your Cheerios and move on. ...

The AAP’s guidelines recommend sleeping in the same room as your baby “ideally for the first six months.” However, the risk of SIDS is dramatically lower after four months, and the evidence in favor of the protective effect of room sharing is quite weak (both overall and even more so after four months). There is also growing evidence that infants who sleep in their own room by four months sleep better at four months, better at nine months, and even better at 30 months.

With this in mind, it’s worth asking why this recommendation continues at all — or at least why the AAP doesn’t push it back to four months. They say decreased arousals from sleep are linked to SIDS, which could mean that babies sleeping in their own room is risky. But this link is extremely indirect, and they do not show direct evidence to support it.

According to the data we have, parents should sleep in the same room as a baby for as long as it works for them! Sharing a room with a child may have negative impacts on both child and adult sleep. We should give families more help in navigating these trade-offs and making the decisions that work best for them.

#emilyoster #parentdata #roomsharing #sids #parentingguide

The AAP’s guidelines recommend sleeping in the same room as your baby “ideally for the first six months.” However, the risk of SIDS is dramatically lower after four months, and the evidence in favor of the protective effect of room sharing is quite weak (both overall and even more so after four months). There is also growing evidence that infants who sleep in their own room by four months sleep better at four months, better at nine months, and even better at 30 months.

With this in mind, it’s worth asking why this recommendation continues at all — or at least why the AAP doesn’t push it back to four months. They say decreased arousals from sleep are linked to SIDS, which could mean that babies sleeping in their own room is risky. But this link is extremely indirect, and they do not show direct evidence to support it.

According to the data we have, parents should sleep in the same room as a baby for as long as it works for them! Sharing a room with a child may have negative impacts on both child and adult sleep. We should give families more help in navigating these trade-offs and making the decisions that work best for them.

#emilyoster #parentdata #roomsharing #sids #parentingguide
...

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Watch the full segment at the link in my bio 🔗

#tamronhall #tamronhallshow #emilyoster #parentingsupport #workingparents

It was an absolute pleasure to be featured on the @tamronhallshow! We talked about all things data-driven parenting and, in this clip, what I call the plague of secret parenting. To balance having a career and having a family, we can’t hide the fact that we’re parents. If mothers and fathers at the top can speak more openly about child-care obligations, it will help us all set a new precedent.

Watch the full segment at the link in my bio 🔗

#tamronhall #tamronhallshow #emilyoster #parentingsupport #workingparents
...

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Listen and subscribe to ParentData with Emily Oster in your favorite podcast app 🎧

#emilyoster #parentdata #parentdatapodcast #parentingpodcast #householdtips #fairplay #invisiblelabor

Invisible labor. It’s the work — in our households especially — that has to happen but that no one sees. It’s making the doctor’s appointment, ensuring birthday cards are purchased, remembering the milk.

My guest on this episode, @everodsky, has come up with a solution here, or at least a way for us to recognize the problem and make our own solutions. I’ve wanted to speak with Eve for ages, since I read her book Fair Play. We had a great conversation about the division of household labor, one I think you’ll get a lot out of!

Listen and subscribe to ParentData with Emily Oster in your favorite podcast app 🎧

#emilyoster #parentdata #parentdatapodcast #parentingpodcast #householdtips #fairplay #invisiblelabor
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Prenatal vitamins 💊 If there is any product that seems designed to prey on our fears, it’s this one. You’re newly pregnant and you want to do it right. Everyone agrees you need prenatal vitamins, so you get them. But do you want to be that person who just… buys the generic prenatal vitamins?

Good news: fancier vitamins are not better.  Folic acid is the most important prenatal ingredient. Iron (with vitamin C) and DHA are also nice to have. Other included ingredients have only weak or no evidence to support their use. (If you do not consume animal products, add B12, plus a few others depending on your diet.)

Vitamins are just vitamins. Any prenatal vitamin that contains these is enough. 

Comment “Link” for a DM to an article with everything you need to know about prenatal vitamins.

#emilyoster #parentdata #prenatalvitamins #pregnancydiet #pregnancytips

Prenatal vitamins 💊 If there is any product that seems designed to prey on our fears, it’s this one. You’re newly pregnant and you want to do it right. Everyone agrees you need prenatal vitamins, so you get them. But do you want to be that person who just… buys the generic prenatal vitamins?

Good news: fancier vitamins are not better. Folic acid is the most important prenatal ingredient. Iron (with vitamin C) and DHA are also nice to have. Other included ingredients have only weak or no evidence to support their use. (If you do not consume animal products, add B12, plus a few others depending on your diet.)

Vitamins are just vitamins. Any prenatal vitamin that contains these is enough.

Comment “Link” for a DM to an article with everything you need to know about prenatal vitamins.

#emilyoster #parentdata #prenatalvitamins #pregnancydiet #pregnancytips
...

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#parentdata #emilyoster #newborncare #parentingadvice #parentingtips

When it comes to introducing your newborn to the world, timing matters. It’s a good idea to minimize germ exposure in the first 6-8 weeks; after that, it’s inevitable and, very likely, a good idea! This doesn’t mean you need to be trapped inside. The most significant exposure risks are from seeing other people at home — family, etc. These interactions are not infinitely risky, but they do pose more risk than a walk or a trip to the grocery store, since they involve closer interaction. Think simple and make sure everyone is washing their hands before holding the baby. 💛

#parentdata #emilyoster #newborncare #parentingadvice #parentingtips
...

The first edition of Hot Flash is out now! Comment “Link” for a DM to learn more about the late-reproductive stage.

There are times when we expect hormonal shifts. Our reproductive lives are bookended by puberty and menopause. We discuss those changes often because they are definitive and dramatic — a first period is something many of us remember clearly. But between ages 13 and 53, our hormones are changing in more subtle ways. During the late-reproductive stage (in your 40s), you can expect a lot of changes in your menstrual cycle, including the length and symptoms you experience throughout. It’s an important time in our lives that is often overlooked!

🔥 Hot Flash from ParentData is a weekly newsletter on navigating your health and hormones in the post-reproductive years. Written by Dr. Gillian Goddard, Hot Flash provides all of the information you need to have a productive, evidence-based conversation about hormonal health with your doctor.

#emilyoster #parentdata #hotflash #perimenopause #womenshealth

The first edition of Hot Flash is out now! Comment “Link” for a DM to learn more about the late-reproductive stage.

There are times when we expect hormonal shifts. Our reproductive lives are bookended by puberty and menopause. We discuss those changes often because they are definitive and dramatic — a first period is something many of us remember clearly. But between ages 13 and 53, our hormones are changing in more subtle ways. During the late-reproductive stage (in your 40s), you can expect a lot of changes in your menstrual cycle, including the length and symptoms you experience throughout. It’s an important time in our lives that is often overlooked!

🔥 Hot Flash from ParentData is a weekly newsletter on navigating your health and hormones in the post-reproductive years. Written by Dr. Gillian Goddard, Hot Flash provides all of the information you need to have a productive, evidence-based conversation about hormonal health with your doctor.

#emilyoster #parentdata #hotflash #perimenopause #womenshealth
...

There are plenty of reels telling you how to parent. Plenty of panic headlines saying that “studies show” what’s best for your kid. Even good data, from a trusted source, can send us into a spiral of comparison. But I want you to remember that no one knows your kid better than you. It’s important to absorb the research, but only you will know the approach that works best for you and your child. 💙

Now tell me in the comments: what’s a parenting move you’ve made recently that feels right to you?

#parentingcommunity #parentingsupport #parentingquotes #emilyoster #parentdata

There are plenty of reels telling you how to parent. Plenty of panic headlines saying that “studies show” what’s best for your kid. Even good data, from a trusted source, can send us into a spiral of comparison. But I want you to remember that no one knows your kid better than you. It’s important to absorb the research, but only you will know the approach that works best for you and your child. 💙

Now tell me in the comments: what’s a parenting move you’ve made recently that feels right to you?

#parentingcommunity #parentingsupport #parentingquotes #emilyoster #parentdata
...

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Listen and subscribe to ParentData with Emily Oster in your favorite podcast app 🎧

#parentdata #parentdatapodcast #emilyoster #emilynagoski #comeasyouare #cometogether #longtermrelationship #intimacy #relationships

Let’s talk about sex (after) baby! Today on the podcast, I was lucky enough to speak with @enagoski about her new book on sexual connection in long-term relationships. Especially after having kids, this is something many people struggle with. Emily tells us to stop worrying about what’s “normal” and focus on pleasure in its many forms.

Listen and subscribe to ParentData with Emily Oster in your favorite podcast app 🎧

#parentdata #parentdatapodcast #emilyoster #emilynagoski #comeasyouare #cometogether #longtermrelationship #intimacy #relationships
...

Ever wondered if you can safely use leftover baby formula? 🍼 The CDC says to throw out unused formula immediately because of the risk of bacterial growth. However, research suggests that bacterial concentrations do not appreciably increase after 3, 12, or even 24 hours at refrigerator temperatures. Good news! This means there’s not a strong data-based reason to throw out formula right away if you store it in the fridge.

Comment “Link” for a DM to an article on another common formula question: should you throw away old formula powder?

#emilyoster #parentdata #babyformula #babyfeeding #parentingstruggles

Ever wondered if you can safely use leftover baby formula? 🍼 The CDC says to throw out unused formula immediately because of the risk of bacterial growth. However, research suggests that bacterial concentrations do not appreciably increase after 3, 12, or even 24 hours at refrigerator temperatures. Good news! This means there’s not a strong data-based reason to throw out formula right away if you store it in the fridge.

Comment “Link” for a DM to an article on another common formula question: should you throw away old formula powder?

#emilyoster #parentdata #babyformula #babyfeeding #parentingstruggles
...

What’s the most important piece of advice for new parents? Here’s one answer, but I want to hear from you! Share your suggestions in the comments ⬇️

#emilyoster #parentdata #parentingtips #parentingadvice #newparents #parentingcommunity

What’s the most important piece of advice for new parents? Here’s one answer, but I want to hear from you! Share your suggestions in the comments ⬇️

#emilyoster #parentdata #parentingtips #parentingadvice #newparents #parentingcommunity
...

What's in the bag of a Vagina Economist? 👀 Someone please tell me this looks familiar to you.

What`s in the bag of a Vagina Economist? 👀 Someone please tell me this looks familiar to you. ...

Comment ”link” for a DM to learn more about tongue ties 🔗

Breastfeeding is often difficult, especially at the start. For babies with tongue ties, many infants (and their moms) struggle to get the hang of a good latch. This can lead to painful nipples and to inefficient feeding, and then low weight gain.

So what does the data say about the increasingly common practice of cutting tongue-ties in infants to improve breastfeeding success? Several weeks ago, @nytimes published a long and quite scary article on this topic.

After diving into the data, here is what I found. There is limited evidence that frenotomy procedures improve breastfeeding efficacy and the harms of the procedure are minimal. Many women do report that it alleviates pain and helps them with breastfeeding. However, it should not be a first-line treatment for breastfeeding problems.

#parentdata #emilyoster #tonguetie #tonguetiebabies #breastfeedingsupport

Comment ”link” for a DM to learn more about tongue ties 🔗

Breastfeeding is often difficult, especially at the start. For babies with tongue ties, many infants (and their moms) struggle to get the hang of a good latch. This can lead to painful nipples and to inefficient feeding, and then low weight gain.

So what does the data say about the increasingly common practice of cutting tongue-ties in infants to improve breastfeeding success? Several weeks ago, @nytimes published a long and quite scary article on this topic.

After diving into the data, here is what I found. There is limited evidence that frenotomy procedures improve breastfeeding efficacy and the harms of the procedure are minimal. Many women do report that it alleviates pain and helps them with breastfeeding. However, it should not be a first-line treatment for breastfeeding problems.

#parentdata #emilyoster #tonguetie #tonguetiebabies #breastfeedingsupport
...