Professor Jerilynn Prior says perimenopause can start as early as 35 and includes many symptoms

Vancouverite Naomi Singer was in a meeting with colleagues a few years ago when a wave of emotion overtook her and she couldn't stop crying — hard.

"It was so disproportionate to the situation," said Singer, the founding artistic director of the Winter Solstice Lantern Festival.

"It was like, what the hell is going on?"

Singer, now 63, was in her mid-forties at the time. It took a few years, and a few conversations with female friends around the same age, for her to realize she was experiencing perimenopause — the change in hormonal balance that leads to menopause.


Naomi Singer is the founding artistic director of the Winter Solstice Lantern Festival. (David Horemans/CBC)
Perimenopause took Singer completely by surprise. She thought she was too young to go through it.

In fact, University of British Columbia endocrinology professor Dr. Jerilynn Prior says perimenopause usually starts around 45, but can begin in women as young as 35, even when they're still having regular menstrual cycles.

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'Miserable for some women'
Stories like Singer's are part of what propel Prior to research, educate and advocate for women as they transition through their hormonal phases in life — phases she says are too often misunderstood, not just culturally but even within the medical community.

"Perimenopause is miserable for some women," Prior said. "For some women, menopause is far less symptomatic."

Prior, who is also a medical doctor, will be discussing perimenopause at an upcoming talk as part of UBC's women's health seminar entitled: Women's misunderstood, confusing and long midlife transition.

Part of her talk will address what she considers to be the most common misconceptions of perimenopause, beginning with the definition of the word.


Experts say insomnia is one of the most common symptoms of perimenopause. (Maridav/Shutterstock Images)
Most physicians and gynecologists say perimenopause doesn't officially start until a woman's menstrual cycle begins to change. But Prior says perimenopause and its symptoms can begin years before that.

"Basically, if you talk to any doctor, if your periods aren't changed then 'It's all in your head, dear,'" she said. "The medical students are not being taught what is scientifically very obvious."

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Instead, Prior defines perimenopause as "the period of time before and for a year after the final menstrual period during which ovarian hormonal patterns, experiences and sociocultural roles change."

The most common symptoms include sleep disturbances, hot flashes and mood swings. They can also include sore breasts, migraines and weight gain with no accompanying change in diet or exercise.

'Understand it's normal'
Prior says another common misconception, culturally and in the medical community, is that perimenopause is only caused by decreasing estrogen levels.

But Prior says scientific research doesn't back that up. She says estrogen levels can actually be quite high during perimenopause, and low progesterone levels are also to blame. That's why progesterone therapy can help alleviate some symptoms.

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Prior has several suggestions for how women can cope with this phase in their life.

"The first and most important is understand it's normal, understand that others are having similar experiences," she said.


Prior's book of short stories, Estrogen's Storm Season, shares the fictional experiences of women going through perimenopause. (Martin Dee/UBC)
Prior wishes she had received similar advice years ago when she was in her mid-forties and she shot up in bed one night in an unprovoked fit of rage, followed by a wave of heat that flowed through her body.

"I'm an expert in hormones and women's reproduction, and it hit me with a ton of bricks," she said, adding that her symptoms went on for nearly a decade.

"I had to start from scratch to try to figure out what was going on because the literature didn't help me at all."

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Since then, Prior has focused her work on helping women understand their bodies. She wrote a novel, Estrogen's Storm Season, to share stories about women's experiences. Her website for the Centre for Menstrual Cycle and Ovulation Research answers frequently asked questions.

But also, Prior wants to get women talking about their experiences and sharing them with others.

"Have somebody that you can share close things," she said. "So that you don't feel like you're totally alone."

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