Why It Feels Like Your Body Falls Apart In Your Late 30s
One day you’re fine, the next day you have low back pain. And a sun allergy. And insomnia. And hair loss. What gives?
For Liesl Verzal, it started at 39. One night, she said, “I woke up drenched in sweat for no reason.” Tricia Bowden was 38 when her periods mysteriously became short — down to two days, maximum, from her previous four to five days a month. They also became super painful.
Sharon Dunford, for her part, was 42 when a litany of strange health issues began, starting with trouble sleeping. “I put it down to, ‘Oh, I’m just having a shit period of sleep,’” she said. Later, she developed a sun allergy — a little weird, but she still wasn’t too concerned. But when she started having morning sickness a few years later, “it was the first clue that something might be wrong,” Dunford says.
These are not uncommon stories: Many women reach a particular age, usually in their late 30s or early 40s, and suddenly feel as if their body just… falls apart, and seemingly all at once. As a viral tweet recently put it: “Women really need to get over not being direct and honest about what happens to your body after 37 years old.” They start to forget simple things, or they struggle to stay asleep, or they blow up at their spouse more than usual — it’s all something to do with aging, sure, but why does it seem to happen overnight?
It’s all something to do with aging, sure, but why does it seem to happen overnight?
The answer, much of the time, turns out to be perimenopause, or the precursor to menopause, which typically occurs around age 52. Despite being a natural stage in every woman’s life, little attention is paid to this period — though that’s changing, slowly, with a recent increase in public conversation about perimenopause and menopause. Still, there’s a long way to go, and some doctors might not even recognize the symptoms for what they are. (Bowden says she got more helpful advice from her mother-in-law than her gynecologist.)
To make matters more confusing, perimenopause symptoms can come and go. “There’s not an on and off switch. It’s not if you’re pregnant or not,” she said. Also, there isn’t currently a reliable test to determine whether someone has entered perimenopause: Bloodwork to test FSH (follicle stimulating hormone) and estradiol levels can confirm menopause has occurred, but it can’t tell you if you’re on your way there. For these reasons, it may be more helpful to rely on symptoms rather than bloodwork, says Dr. Mary Jacobson, chief medical officer for Hello Alpha, a telemedicine service aimed at women.
But that introduces new problems, because of the wide variety of nagging health issues associated with perimenopause — everything from weak nails to fatigue to weight gain. It can be tricky to know when it’s perimenopause, since there’s a lot of overlap between that and other medical conditions, Jacobson says. And if these first signs are missed, it can make the symptoms that follow feel as if they’re happening overnight.
One of the most common early indicators, for example, is changes in mood. When Gemma Chapple, now 40, was 33, she recalls experiencing “crippling anxiety that came out of nowhere.” Her doctors told her it was depression, but she didn’t feel depressed. Instead, things felt “out of control,” she says, and she remembers “struggling with holding onto my temper, blowing up at the children over the smallest things.” One time, when she was stuck in traffic with her children, on the way to their swimming lessons, she was “struggling to breathe, my heart pounding out of my chest, because we were going to be late.” At the time, she remembers, “it felt like the end of the world.”
Anxiety is often one of the first signs of perimenopause.
Anxiety — along with poor concentration and a shortening of the menstrual cycle — is often one of the first signs of perimenopause. But how many women in their 40s aren’t experiencing some degree of anxiety? It’s an age when many women are caring for children and parents while simultaneously at the height of their career. “There’s a lot going on for a lot of my patients,” says Dr. Tara Iyer, lead physician at the Menopause and Midlife Clinic at Brigham and Women’s Hospital. And if that increase in anxiety is chalked up to general life stress, the physical signs of perimenopause that follow may be especially confusing. In reality, Iyer assures, it’s all happening gradually — but it might not seem like it.
It’s no surprise that the average woman might not recognize perimenopause when it hits; for most of us, this isn’t exactly something anyone warned us about. From her patients, Iyer says, “I commonly hear: ‘No one ever spoke about this, my mom never spoke to me about it. My aunt never spoke to me about it. I had no idea that it would occur this early.’”
Chapple, like many others I spoke to, hadn’t heard of perimenopause while she was in the thick of it — but she did expect more from her doctors. “You put your faith in these people who think they know what they’re talking about,” says Chapple, who was disappointed by the medical help she received. But medical professionals, too, are under-educated in this area.
“When I was doing my medical education and then in residency, there really was not a significant amount of time dedicated to treating and evaluating perimenopause or menopause,” Iyer says. Indeed, one small 2013 study by Johns Hopkins University found that just one in five medical students receives any formal training about menopause at all. Iyer argues that it’s particularly important for those studying family medicine and internal medicine to get more training with regard to female reproductive hormones, yet “it’s not prioritized.”
“These symptoms affect all parts of our lives, our careers, our relationships,” Jacobson says. “Premenstrual dysphoric disorder, premenstrual syndrome — these are all real conditions that, unfortunately, are dismissed by colleagues of mine.”
The best thing you can do, then, is to arm yourself with information about yourself. The more you know about your symptoms, the better you can relay this information to your doctors. Chapple recommends keeping a journal to record symptoms — everything from how long your cycles are to what other symptoms you’re experiencing. “If you don’t have the evidence, they don’t tend to listen to you,” she says.
“You think it’s something that happens to old women, your grandma, or whatever. You just feel old.”
Ignoring perimenopause can have some serious ramifications. Failing to adjust hormones can worsen cardio metabolic health, for instance, or contribute to muscle and bone loss. On top of all this, there are severe mental health consequences. One of the most difficult parts of perimenopause is the shift in identity.
“It’s almost like a body dysmorphic thing where you look in the mirror and that’s not you,” Dunford says. “You think it’s something that happens to old women, your grandma, or whatever. You just feel old.”
In the spring of 2023, Peanut (a support app connecting people in perimenopause) surveyed 200 women in the United Kingdom, United States, and Australia. Mental health problems like anxiety and depression were experienced by 91% of respondents. Seventy-nine percent felt isolated.
It doesn’t have to be this way. It can feel like an awkward topic, true, but lately, more celebrity women than ever are open about their experiences with perimenopause and menopause, which provides an easy way into talking about this with your friends and family. (Take Naomi Watts, for example, who’s spoken about experiencing menopause in her late 30s.) As an added bonus — until and unless you find a competent doctor, this can be the best way to get and trade advice for dealing with the symptoms of perimenopause.
For hot flashes and night sweats — arguably the two most talked-about symptoms — there are some common, evidence-based treatments. Hormone therapy can help: Systemic estrogen therapy can be prescribed in pill, patch, spray, gel, or cream form, and it’s been shown to alleviate hot flashes and night sweats associated with perimenopause. The treatment has had a bad reputation for decades, due to a misinterpretation of a 2002 study on the dangers of hormone replacement therapy. The bottom line: If you’re under 60, relatively healthy, or within 10 years of your last period, the benefits of hormone therapy far outweigh the risks. For Dunford, after a frustrating several years (and several doctors), she was put on hormone therapy, which has helped her find relief from her symptoms.
There’s also some potential good news on the horizon: In May, the FDA approved a new drug to treat hot flashes and night sweats, which may appeal to women who have shied away from hormone therapy, or to those who have health backgrounds that make hormone therapy less safe.
The point is that you’re not imagining things — women’s bodies do some really weird stuff in our late 30s and early 40s. But you don’t just have to put up with it. “We live in a sexist and ageist society,” Jacobson says. “Older women get the brunt of that.”
Iyer says that if women are taught anything about perimenopause, it’s that “this is just what happens to a woman’s body, and this is what we deal with as women,” even if their quality of life has plummeted. Many of her patients report that they’ve been living in physical and mental misery for years before coming to see her. “It’s always been thought of as a ‘natural process,’” Iyer says. “And women have been taught to grin and bear it.”
As Dunford phrases it: “As women, we tend to go, ‘Oh, it’s not that bad, when, actually, yeah, it is.”