I’m sure you remember it as vividly as I do — the day you got your first period. In middle school, my friends and I eagerly awaited our turn. It seemed like such a mystical entry into womanhood at the time. An official sign that I would no longer be a girl, but a woman. We were all waiting for it, but few of us knew exactly what to expect.

What is premenopause?.. Premenopause is just as its name suggests — the time before menopause. This can include any time in the decades between the onset of menstruation and the onset of menopause symptoms. This time is unique to each woman. It may or may not involve regular periods, fertility, pregnancy, breastfeeding, and all that comes with a monthly cycle.

Premenopause should not be confused with perimenopause. The difference between the two lies in the presence of menopause symptoms. Over the course of your menstrual lifetime, hormones are constantly changing, but it isn’t until the telltale signs of menopause appear that you are considered to move out of the premenopause phase and into the perimenopause phase. This transition usually occurs when a woman is in her 40s or 50s, but can occur earlier or later for some women. So, let’s dive into what exactly is going on in our bodies from that first mystical period.

From Training Bras to Tampons

The onset of menstruation and onset of puberty are two different events in a woman’s life. Puberty is marked by the growth of breast tissue and increase in height. These events are followed by the onset of menstruation, which is influenced by a myriad of factors including genetics, environment, personal attributes, and lifestyle.

Mom Jeans and Genes: You’re Gonna Wear ‘Em Too

Our biological time clocks are passed down through our genetic code. Yes, you are very much like your mother, even if you never wanted to be. The age at which we begin our cycle seems to be strongly influenced by our mothers’ age of menstruation . The same goes for the age we hit menopause. Whenever your mom went through menopause naturally (without surgical removal of her reproductive organs), you’re more likely to be that age as well.

The Environment is Turning Girls into Women… Earlier

The average age a girl starts her period is roughly 12 years old in the United States, but it can occur as early as 8 years old . Aunt Flo is coming earlier than before. Over the last century, the age at which girls hit puberty has significantly decreased, falling by an average of about 3 months per decade. This change is controversial: Either the improvement of overall health of the general population is due to industrialization or the overexposure to toxic hormone disruptors in our food and environment is increasing estrogen in our bodies, as a result of industrialization.

what is premenopause
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Puberty and Periods: Size Matters

Personal attributes play a large role in the onset of puberty and menstruation. Varying body mass index (BMI) and height are strongly correlated with the age of menstruation. Basically, the more body fat girls have, the more likely they will hit puberty at an early age. There is even data that suggests that birth weight and the rate at which a baby grows in the first few months of life can affect the age of menstruation.

Lifestyles of the Caloric-Rich and Fertile

Nutrition and activity also seem to play an important role. Highly caloric diets and diets high in animal protein in early childhood have been associated with an earlier start. Athletes have been shown to have a delayed onset of menstruation, indicating that intense exercise can delay both puberty and menstruation.

The Menstrual Cycle

While most of us are fully (and painfully) aware of the symptoms of menstruation, many of us may feel as clueless as we did in middle school about what exactly is happening during our cycle. At times, menstruation can certainly feel like an aimless, wild ride, but there is a calculated plan to the ebb and flow of a woman’s hormones over her lifetime. Those special few days a month when a woman is menstruating may take the spotlight, but your body is working around the clock in an intricate series of hormonal shifts to regulate your cycle. All of this is to prepare for a possible pregnancy. Unfortunately, we can’t cue our reproductive organs about our plans for pregnancy, so every month, our bodies get fully ready just in case. If only we could be that prepared in our day-to-day life!

The menstrual cycle occurs in 4 phases:

  • Menstruation. The thickened lining of your uterus (endometrium) sheds from the body. On average, this lasts 3-7 days.
  • Follicular phase. This phase begins on the first day of menstruation. First, your ovary gets ready to recruit an egg while pumping out estrogen. Follicle stimulating hormone (FSH) is released from the pituitary gland in your brain, sending a message to your ovary to produce follicles (like tiny sacs) that contain immature eggs. Usually only one follicle will mature into an egg while the others die, so consider yourself the lucky one. This occurs around day 10 of a 28-day cycle. The growth of the follicles stimulates the lining of the uterus to thicken in preparation for a possible pregnancy.
  • Ovulation phase. The increase in estrogen during the follicular phase stimulates the release of luteinizing hormone (LH), which triggers the start of the ovulation phase. During this phase, the egg chosen to grow in the follicles of your ovaries is released and takes a trip down the fallopian tube with the intent of being fertilized by sperm. This egg is on a mission, completely unaware of your actual plans. This phase is when you are fertile and able to get pregnant. For most, ovulation happens on or around day 14. If sperm doesn’t fertilize it within 24 hours, the egg dies. Testosterone levels spike just before ovulation, putting you “in the mood.” Having sex in the days leading up to ovulation can still result in pregnancy, as sperm can live in the body, on the prowl for up to 7 days.
  • Luteal phase. The luteal phase wraps up the cycle. During this phase the egg goes through changes and progesterone is released, along with a smaller amount of estrogen. If fertilization occurs, your body kicks into gear and produces human chorionic gonadotropin (hCG). This is the hormone that tips off pregnancy tests. If the egg goes unfertilized, estrogen and progesterone levels begin to decrease and this triggers menstruation. Since the uterus will not be used as a home for a fertilized egg, it begins to shed its lining and your period begins, starting the cycle all over again.
  • What is premenopause? During the premenopausal phase of your life, periods are happening every month because your hormone production is regular (unless you have PCOS or some other underlying condition). When you start noticing your periods are becoming less predictable, that’s when premenopause is most likely ending and you’re headed to the next phase in your life: perimenopause.

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