During puberty, brain chemicals switch on a girl's ovaries, starting a cascade of physical changes that herald her entry into womanhood. At perimenopause, the ovaries begin to run out of eggs and stop responding to those chemicals, a natural progression leading to menopause. Various coping strategies are available, but regardless of what course a woman chooses, she should do so carefully. The transition to menopause varies among women, as does the onset of puberty, says Dr Margery Gass, director of the menopause and osteoporosis centre at the University of Cincinnati College of Medicine. Although most women reach perimenopause at about age 46, it can occur as early as 35 or as late as 55, doctors say.
Smoking can speed up onset by two years.
Perimenopause can last a few months or up to a decade. Schiff of Massachusetts General says women should not rush to a physician at the first sign of menstrual irregularities, unless they're very symptomatic. Plus we don't want to cause undue anxiety. Dr Charles Hammond, chairman of OB-GYN at Duke University in Durham, advises that menstrual cycles lasting fewer than 21 days or bleeding lasting more than 10 days merit a medical consultation. Heavy bleeding, which can produce anemia, could signify development of uterine growths called fibroids or precancerous conditions.