Menstrual Cycle Changes in Perimenopause (Episode 571)

Full Transcript: Episode 571

Lisa Hendrickson-Jack:

This is the Fertility Friday Podcast. Today I’m sharing a brand new episode in my FAM research series. I’m talking about a paper that actually re-examined the data from another paper that I have used in most of my writings. So this is a paper that I drew from in the Fifth Vital Sign. I also shared some of the same data in Real Food for Fertility and this is a paper that I frequently reference in our FAM practitioner program. So I’m referring to a study that I often just call the Treloar study. It was a very unique study done at a very interesting time. So this study drew data from women regarding their menstrual cycles and they did this in the 40s and the 50s and so the reason that that’s relevant is because the pill didn’t come to market until 1960. So this study has an extremely large data set of women with what I would term virgin cycles because there was no birth control pill. So you get a really interesting sense of the natural fluctuations in the menstrual cycle across a variety of different reproductive stages. So in this study they examined over a quarter of a million menstrual cycles. They had a significant number of women and they did this over a significant period of time.

And so the original study, the Treloar study that was published many years ago, it assesses this data and actually places it across the reproductive lifespan. So a lot of the subsequent data and information that we have to define the average menstrual cycle length and how it changes. So let’s say during the first few years after menarche, after a woman’s first period, during the middle life phase is what he terms it when your menstrual cycles have kind of stabilized, and also during the 10 years leading up to menopause, this study data set provides just a really interesting and very unique insight into the natural changes that happen in a woman’s menstrual cycle over this period of time. So I found a study where they actually went back to this original data set and they re-examined specifically the perimenopausal cycles. And so that’s what we’re going to be talking about today. And I mean the overall point is for us to get a general sense of what is typical and what the research shows us are the typical fluctuations as a woman approaches menopause.

Now, of course, this data set is of women who had never used the birth control pill because it hadn’t even been invented yet. So, it does give us a really interesting and unique insight. And the women of today who are going through perimenopause now may have some different challenges given that most women do have a bit of a pill history and we do have a lot of unique stressors that could be affecting the cycle. But either way, this data gives us an interesting insight into what is typical and how the cycle changes as we approach our final cycle. So without further ado, let’s go ahead and dive into the study together.

So as I mentioned, this study is actually going back to that same data and reassessing it. And it’s interesting to read through what they’re talking about and the researchers and like why they’re doing this. And so essentially what they’re saying is that when the initial researchers analyzed the data set, they weren’t looking at the pre-menopausal data in the most accurate way. So that’s their argument. And so, for example, one of the things that you will typically see that we’ll get into more as women approach their last period, particularly in the one or two years before their final period, is that many women will experience these longer cycles. So, even if you’ve cycled relatively normally and consistently throughout your reproductive life, as we’ll talk more about, in those two years or so leading up to your last period, that tends to be when we see the most fluctuation.

So, apparently in the original study, they were doing it based on calendar years. So if you think about it, if women are more likely to have long cycles, like let’s say 90-day cycles, 80-day cycles, then during that specific period of time, you would be most likely to kind of go over across a year. So like let’s say you had your period in October, if you’re having a 90-day cycle, then that cycle might end the following year, you know, January, February, or what have you. And so apparently in the original study whenever there was a cycle that kind of overlapped between one year and another they actually excluded that data. And so they only counted the data that was within that calendar year. And so what these researchers are arguing is that given that this time is very unique and very specific, if we want a better idea of how women are experiencing these premenopausal years then we shouldn’t be looking at it in terms of a calendar year.

What they’re saying is we should identify their menopause. So basically, typically menopause is the word for a woman’s last period in the same way that menarche is the word for a woman’s first period. And menopause is not defined when you have your last period because you don’t necessarily know at the time if it’s your last period. So, you may have been having some sporadic or irregular cycles leading up to this point, but you don’t know that it’s your last period, or at least we don’t define it as menopause until 12 months have passed. So, when you have this last period, retrospectively, a year later, we look back and define that as menopause.

So, what the researchers are arguing is that, okay, we shouldn’t be looking at calendar years. We should be looking at the date of menopause as we’ve defined it and then count back 365 days from there, you know, count one year, two years from there. So, it’s a subtle distinction, but it’s interesting. And when they decided to reexamine the data with this little change, and they changed a few other things, but I would say that’s the main change, they’re able to get a better picture instead of based on a calendar year, but based on okay, so what’s happening 10 years before her last period, making the data kind of unique to each person in that way, 9 years before her last period, 5 years before her last period, 2 years before her last period, one year before her last period. And when they did that, the data did change. So some of the data and information did change, and that’s what we’re going to be talking about today.

So hopefully, I know that I took a little bit of time to kind of go through and outline that. So, I hope that that was valuable and helpful for you to understand it, but I don’t just want to start jumping into all of this data and not having kind of laid that foundation. So, put simply, what they’re doing in this study is they’re actually looking at, they’re arranging the data set based on the woman’s last period and how many years leading up to it, so that we can get a really good sense of what this trajectory looks like.

So, a little bit of background information that I’ve already alluded to is that when we’re looking at, you know, the word premenopause or perimenopause, these words are often thrown out. Even the term menopause, many women don’t realize that menopause is a word for the last period. Menopause itself is not a transition. Like it’s not the word for the transition phase, it’s the word for the event. Whereas perimenopause, premenopause, these words tend to be used to refer to that transition. And so generally speaking in an overall sense that the term perimenopause is intended to refer to that transitional period, that 10 years leading up to the last period.

And so the question I think that’s really interesting from a cycle charting perspective is what do we typically see during this time? So there’s a lot of discussion around the symptoms but what about the cycle itself? I think that there’s a lot of cycle abnormalities that women experience at all ages. And I think that when you’re in that perimenopause phase, there’s some unique challenges, unique hormonal changes that make you more susceptible to cycle challenges. But I think this study kind of shows us from the perspective of the cycle length, the overall cycle length, how much is that actually changing?

And so when we get into the actual data, there’s a few interesting things like when they kind of went through and re-examined it that they found and what changed the most was how the last four years, in terms of the overall cycle length, for the last four years specifically. And so just to give a general sense of what they found, I don’t know how surprising this is. I feel like it’s not surprising to me, but when they looked at the cycle changes, so they have a table in their study, and in the table, they break it down from 10 years before the last period all the way up to one year before the last period. And like I said, they are defining it in retrospect, and menopause is defined as when you’ve gone a year without a period.

So, I think a lot of women would assume that there’s just going to be tons and tons of cycle variations and changes and irregularities during this 10-year period of time. But when we look at the actual data, the changes are a bit more subtle. So if I were to kind of sum it up in a sentence, the changes that occur the 10 years leading up to menopause, and this is again on average, this is the data overall because women are going to experience individual fluctuations, is a lot of women typically see an initial but subtle shortening of their cycle.

So, when we get into what the researchers refer to as like the middle life phase. So, what that means is if any of you remember puberty, you didn’t just like, well maybe you did, but I don’t, I don’t know. I don’t know anybody who did this, but you didn’t just wake up with breasts. You didn’t just like have a flat chest and then you just woke up with full breasts. So, puberty was this stage of transition and it took several years for the hormones to do their thing for you to kind of gradually grow into this. And at the very beginning stage when you had your breast buds, they were forming and growing. And there was this kind of in between stage where you just weren’t really sure how this was going to play out, you know. We can think about that same logic for the period.

So during those first few years after menstruation, when we look at that data set, we see a significant amount of fluctuation in the overall cycle length. So you’re going to see longer cycles, shorter cycles, more regular cycles, and you’re going to see a broader range and a bigger average cycle length during that time. But once we get past those initial few years after menarche, we get into what he refers to as a middle life phase. Now again, I’m referring to natural cycles, if you are on hormonal contraceptives that are interfering with that natural cycle, that’s not what we’re talking about. We’re talking about the actual ovulatory menstrual cycles.

And so during that middle life phase after you’ve kind of gone through that menstrual puberty, if you will, then we see the cycle stabilize and you can look at all kinds of studies. You know, there’s a lot of interesting studies that have come out recently because there’s so many charting apps now and a lot of these apps, they’re gathering so much data about women’s menstrual cycles and they’re able to then collect this data. So there’s studies that are being done now on huge data sets from these charting apps. And what you typically find is that the average cycle length is about 29 days. And so during this kind of middle life phase, so after your period has grown up, so to speak, and before you start diving into that premenopause phase, that’s the middle life phase. The average cycle length tends to be about 29 days. And this is where we get those kind of average numbers that you’ve heard me talk about and that I’ve talked about in my books where a healthy cycle range is typically between about 24 and 35 days, average about 29 days. In the earlier years in the kind of pre or post menarche years it might range a lot more. You know 21 to 45 days could be more of a typical average during those early years because there’s more cycle fluctuations.

But when we get into that 10 years leading up to menopause, what tends to happen is an initial shortening of the cycle. So instead of the average being more like 29 days overall, if we were to look specifically at 10 years leading up to menopause based on the data in the study we’re talking about today, the average cycle length was about 26, 27 days. And so we see this kind of shortening. And what tends to happen, how this plays out when you’re charting your cycles, is you might notice that a lot of your cycles are a little bit on the shorter end. So maybe your cycles used to have the occasional 30-something day cycle or whatever every now and then, but now you’re seeing that a lot more of your cycles are on the shorter end. And you may even get an occasional short cycle. So a lot of women in this age range might start to notice the occasional 25-day cycle or 26-day cycle or 24-day cycle. And so this is typically how it’s playing out.

So in this data set it’s kind of reflecting that but it shows that during that kind of year 10 before your last period, like during that, let’s say 5 to 10 years before the last period, it’s somewhere in there with having some shorter cycles and then occasional cycle fluctuations. So this is not a hard and fast rule. Again this is general data that they’re putting together but this tends to be the trend. But what’s interesting is then during the last years leading up to menopause. So four years before your last period, but I would say most notably during the two years leading up to menopause, but kind of starting at that four years before your last period, that’s when we start to see just a greater variety of cycle changes. So you still may have shorter cycles, but you might start to have the occasional long cycle.

When these researchers adjusted the data to be specific to the how many years leading up to the last period instead of calendar years, what they found was that the second year leading up to the period, the average cycle length was more like 45 days, indicating that women during that two years before menopause were having more of these long cycles. So, it’s really kicking up the average. And then the year leading up to their last period, the average cycle length was 80 days with a huge range in terms of cycle fluctuations. And that was one of the most interesting, I suppose, differences when they actually recalculated this data using the actual kind of last menstrual cycle date and the years leading up to it. It really showed how much fluctuation is specifically concentrated in those last two years most significantly and even in years three and four. So it really starts four years leading up to menopause where we start to see more fluctuation, but it’s most significant during those two years leading up to it.

So, I think this is really helpful information so that you get a sense of what’s happening if we’re not informed about how this transition looks and what it looks like during this 10 years leading up to menopause, but how that changes as we get to those immediate years leading up to it. I think that it might be cause for concern, cause for worry, cause for stress. If we’re not, especially for women who’ve, you know, cycled pretty consistently throughout their lives, I feel like it can really throw you off, make you think that there’s something wrong. But what we really need is a deeper understanding of how this phase works.

I think that there’s an overall sense in our culture of denial around aging. And we have a lot of resistance to this transitional phase when we’re moving from cycling to not cycling. Maybe a bit of an identity crisis. I personally haven’t gotten to that stage yet. I’m still cycling, but I’m in my early 40s. And so, we’ll see how this goes. But I think that because our culture has such a negative connotation around aging and around menopause, we really think of it as a health condition characterized by all of these different health concerns. We don’t really take the time to reflect and consider that it is a natural transition similar to puberty. We’re transitioning into a next phase of not cycling. And I think that that can be a really positive shift when you think about it from an energetic perspective when as women we’ve spent most of our lives essentially having this menstrual reproductive energy going from us. We’re producing eggs every month. We’re having children. We’re breastfeeding. We’re giving out our energy. We’re caretaking. Now, I know this is stereotypical, but just go with it for a minute. When we shift from this kind of giving our life force energy to not ovulating anymore, I think it’s an opportunity for us to kind of shift that focus and maybe turn more inward. Maybe look at some of our interests now that we have all this energy left for ourselves. Now, I’m just talking from a not scientific perspective for a moment and I like to kind of share some of these ideas so that you can at least have heard somebody speaking positively about this transition and change.

Another piece of this to consider is that when we look at our menstrual cycle as a vital sign and start to understand what the normal parameters are and have a better understanding of what would be considered normal during the premenopause phase, then we can still look at our menstrual cycle as a vital sign during those years. So what I mean by that is we wouldn’t call all of the most egregious symptoms of perimenopause normal and we’d want to really consider if we’re having an extremely rough time and you’re having a ton of symptoms and it’s feeling awful, what is your body trying to tell you?

The 40s is a very interesting time frame. As someone who’s worked with a lot of women in their 40s and being in my 40s myself, there’s a lot going on. Our bodies are changing. We are more insulin resistant naturally. So, it’s harder to get the weight off, easier to put it on. Even if we’re doing the exact same things we were doing before, we have less resilience. So, in our 20s, we could have gotten away with staying up all night and drinking and not eating and whatever it is that we were doing. And now, our bodies are less resilient. And so, you have less leeway there. There’s a lot of things that you could have been getting away with in your 20s. Now, you can’t get away with them anymore. And to add insult to injury, it’s a time when we’re typically very busy. I know for myself, raising little kids and having aging parents has been one of the biggest challenges of my life. And I also have a thriving business that keeps me very, very occupied. I’ve never met a woman in her 40s who isn’t really busy.

So when we take all these things into consideration, I think that part of it might be that we’re not willing to submit to these changes. We’re not willing to accept that our body is changing now. And maybe we don’t have the capacity to do things in the same way that we used to do. And maybe that means we have to modify what we’re doing. Maybe we have to elevate our self-care. Maybe we have to take a step back from certain activities. Maybe we have to learn to say no to things. And maybe that all of those things play out in our menstrual cycle. And if the menstrual cycle is totally unbearable and it’s horrible and it’s awful and you’re experiencing all of the symptoms, you have fatigue, your bleeding is so heavy that you don’t even — it actually terrifies you whenever you have your cycle — like if these things are happening, then it’s not something that we can say, “Oh, that’s just perimenopause.” I mean, I have not gone through it yet, so I’m sure I’ll have a lot of more specific, nuanced opinions when I get there.

But I do want you to consider just some of those comments, some of those thoughts. Because what I’ve observed is that when you’ve had the opportunity to chart your cycles leading up to this phase of transition, you’ve already had the experience and practice to start to dance with your cycle. When you chart your cycles and you start to see what happens when you don’t get good sleep, when you don’t eat well, when you don’t do whatever you need to do, if you’re exercising, if you’re not getting enough protein, if you have a certain sensitivity to something and you’re not taking care of it, you see that reflected in your cycles. And so the more that you chart your cycles and develop that body literacy, the more that you come in communication with your body.

The way I always talk about it is that I’ve been charting my cycles for a very long time and I’ve had the opportunity to kind of grow into this knowledge. And so I know that I have limits and when I get really busy and things kind of fall off the rails, I see that in my cycles. I don’t like how I feel. I’m very attuned to it. And so I’ve had to learn that I have limits and I’ve had to concede to that. Sometimes it’s hard. And as I get older, it’s more pronounced. I really do need to get my sleep. I really do need to eat well. I really do need to make sure I get my exercise because I don’t like what happens when I don’t. And I’m certainly not interested in having really hard, ridiculous cycles either.

And so, when you haven’t had that opportunity to do that, then I think that we can get into this thought that it’s all just because I’m in perimenopause, but it could just be your body trying to whisper at you, trying to hint to you what’s going on. But if you’re not responding, the whispers become screams and shouts and yells until you actually do something about it. So just some food for thought.

So as I wrap up on the study today, like I said, the interesting part about it was that they revisited this data to do what they called a more accurate calculation of what is actually going on in this 10-year period before menopause. And what they found that was different from the original study was significantly more cycle fluctuation specifically in those four years leading up to menopause. So there was that four years before the last period and especially the two years leading up to it. They saw just a significantly higher cycle fluctuation. I mentioned that the average cycle length the year before menopause according to their data was about 80 days. And the two years leading up to the last period was 45 days. Now that is an average because that means that some women are going like four, five, six months between their periods at the very end before they have their last one where it’s like, is this going to be the last one? Is this going to be the last one?

And with that said, not everyone has that same experience. So, I’m sure there’s some women whose cycles don’t necessarily fluctuate as much and they kind of come pretty consistently until they just kind of drop off. But definitely this data shows that there’s significantly more fluctuation, especially during those last two years. And that makes a lot of sense. If you’ve spoken to anybody or had any clients who are in that phase, that’s typically what they’re telling you. Like, I don’t know, this is the last one. It’s been kind of sparse lately. And that’s kind of how it goes.

So, I hope that you enjoyed today’s episode. If you are wanting to dig deeper into the study, I’ll be sure to include the link to the abstract for the study that I’m talking about as well as the original study. I will provide those links in the show notes page. And if you can think of someone who you think would be interested in this topic, who would benefit from hearing today’s episode, the share link is fertilityfriday.com/571. If you’ve been loving the FAM research series episodes, you can head over to fertilityfriday.com/research for the full link to all of our research episodes. I think we’re probably close to a hundred of these episodes now. So, I’ve had a great time diving into all of these research studies and sharing them with you.

So with that said, I hope you have a wonderful weekend whenever you’re tuning in to the show. And of course, as always, until next time, be well and happy charting.