Is it… perimenopause?

Dear Lucy: I assume I am in perimenopause. I just got my period after 10 months. Does that mean I am ovulating again? My energy level is very low, so I assume my iron is low. I take iron supplements plus a multivitamin, but this period has drained me. Is there anything I can take to feel energized? —Too Tired

Illustration of a woman dozing off as she sits at a desk

Dear T-Squared: There’s nothing worse than that feeling of being completely drained. Lucy is glad you wrote to her in search of answers rather than just assuming that this is your “new normal.” And Lucy knew just where to turn for those answers—Gynecologist Annie Liau, who has cared for many patients going through perimenopause and menopause during her more than 30 years at MIT Medical. 

According to Liau, perimenopause, the interval of transition into menopause, begins, on average, four years before a woman’s final menstrual period. Perimenopause is marked by irregular menstrual cycles and intense hormonal fluctuations, often accompanied by “vasomotor complaints”—in laymen’s terms, hot flashes, flushing, and night sweats.

Liau tells Lucy that 95 percent of women enter perimenopause between the ages of 40 and 51. During this time, menstrual cycles may become irregular, and women may or may not ovulate during any particular cycle. “Without ovulation, the interval between menstrual cycles increases,” Liau explains, “and bleeding can be excessive when the period resumes.” 

Though you don’t mention your age, you may well be correct in your assumption that you have entered perimenopause. But then again, maybe not. “In general,” Liau says, “we recommend clinical evaluation after a woman who has been menstruating regularly misses three periods.”

That’s because there are many other conditions that can cause “amenorrhea,” or the absence of menstrual periods. “For example,” Liau says, “underactive thyroid can cause fatigue and amenorrhea.” She recommends that you make an appointment with your primary care provider (PCP)—especially if you continue to have low energy despite getting enough sleep.

Your PCP will most likely take a history, do a physical exam, and order laboratory tests to check iron reserve and thyroid function, Liau tells Lucy. “It’s also important to tell your clinician about your pattern of bleeding,” she adds. “The pattern of bleeding in a normal period is bell-shaped, with steady flow that increases and then decreases before tapering off. If your period doesn’t follow this pattern, your provider may decide to check for abnormalities of the uterine lining, perform a hormonal evaluation, or do other clinical tests.”

Lucy concurs with Liau’s recommendation to make an appointment with your PCP to find out if health concerns other than perimenopause could be contributing to your irregular periods and fatigue. And even though perimenopause is a natural transition in a woman’s life, that doesn’t mean you shouldn’t involve a clinician in helping you make this transition in the easiest, healthiest way possible. —Lucy

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