Missing Periods? It May Be Perimenopause

Menopause, which usually occurs in a woman's late 40s or early 50s (the average age is 51), is the natural point in time when the menstrual cycle stops for good. But many women begin experiencing what we think of as menopausal symptoms months, or even years, before their last period. Skipped periods, for example, are a normal part of the menopausal transition, also known as perimenopause.

But it can be difficult to know whether your missed period is due to the natural process of perimenopause or a hormonal condition, and when you should talk to your OB-GYN about menopause.

We'll walk you through the common signs and symptoms of the menopausal transition—including irregular periods—so you understand what's normal, and what might be a more serious underlying disorder.

Why your period may become irregular during perimenopause

Missed periods are a normal part of the menopausal transition, which refers to the period leading up to menopause.

"Skipped periods in your late 40s are not uncommon," said Tara Scott, M.D., medical director of integrative medicine at Summa Health System in Akron, Ohio.

But they may also occur in women in their 30s.

During your menstrual cycle, your brain secretes follicle-stimulating hormone (FSH), which triggers your eggs to develop and prepare for ovulation, Scott explained. Eggs with the best chance of becoming fertile are released first. When you enter perimenopause, you're left with around 3,000 eggs, as opposed to the 20 million you start with at birth.

"During the [menopausal] transition, these old eggs can't 'hear' the signal, so the brain has to increase the FSH or 'shout' to get the eggs to grow. Missed periods occur when there is no egg responding, so ovulation does not take place," Scott explained.

Talk to your OB-GYN about your missed periods

Unfortunately, missed periods can be a sign of many different health conditions, making it hard to know exactly when you're in perimenopause. This means it's also difficult to know when to discuss your skipped periods with your doctor.

Ruling out pregnancy should be your first step, because this is the most common reason for a missed period in any woman who can still become pregnant, according to Brynna Connor, M.D., an Austin, Texas-based physician and healthcare ambassador at NorthwestPharmacy.com.

Once you know you're not pregnant, Connor suggested seeing your primary care physician or OB-GYN to discuss your missed periods, especially if you've not had a period for more than 90 days.

Missed periods can occur for a variety of reasons, whether you're in perimenopause or not. Other common causes include low estrogen, polycystic ovary syndrome (PCOS), hormonal fluctuations, malnutrition, eating disorders, thyroid problems, pituitary problems, overexercising, sleep disturbances and stress, said Kathleen Jordan, M.D., chief medical officer at Midi Health in Los Altos Hills, California.

Additionally, skipped periods may also indicate premature menopause (before age 40) or early menopause (before age 45), or result from certain malignancies and treatments of cancer or certain medications, Jordan added.

This is why it's so important you speak with your doctor. They can check for these conditions and test to see if you're in perimenopause.

For example, a blood test for anti-Müllerian hormone (AMH) can help predict if you are in or near perimenopause, Jordan explained. AMH is produced in the ovaries, and the levels in your blood can be used to diagnose a variety or reproductive conditions, including perimenopause, menstrual disorders and ovarian cancer.

Additional perimenopausal symptoms

If you suspect you might be in perimenopause or simply want to be on the lookout, there are a variety of symptoms you can expect, including hot flashes, sleep disruption and fatigue, Scott said.

But more concerning than missed periods is heavy bleeding, according to Scott, particularly if you're older than age 40. This could be a sign of endometrial hyperplasia, which is a precursor to uterine cancer. In addition, Scott noted that pain and weight loss are not normal symptoms and should be checked out right away.

While perimenopause symptoms are typically expected to hit in your 40s, that doesn't mean you should overlook any of these symptoms if you're in your 30s. Premature menopause, now called primary ovarian insufficiency (POI), can come with serious health side effects.

"Studies have shown that premature menopause is associated with a markedly increased risk of heart disease, osteoporosis and cognitive decline, such as Alzheimer's disease," Scott said. "If you start skipping periods in your late 30s, my suggestion is to get your hormone levels checked."

Jordan agreed, noting that common signs your symptoms might be caused by something else include being younger than 40, experiencing constant or escalating pain, weight loss and other atypical symptoms. However, figuring out if your symptoms are a side effect of the menopausal transition can be challenging.

"Take, for example, midlife insomnia," Jordan said. "The hormone changes with menopause increase insomnia, but the prevalence of sleep apnea, or obstructed breathing, and restless leg syndrome also increases in women in midlife. So women should be screened for each of these independent sleep issues."

The bottom line

Menopause is a normal part of a woman's life and knowing what to expect can help you prepare and get screened for other disorders—such as cancer—if you start experiencing abnormal side effects.

If you skip your period more than once, are younger than 40 or are experiencing any other symptoms in tandem, talk to your OB-GYN to find out if you've entered the menopausal transition.