In My Mid-30s, My Period Began To Ruin My Life. I’m Not The Only One

A grey dawn light was seeping around the edges of the blackout curtain when I finally fell asleep. I had landed in Toronto many hours before, with plenty of time to check into my hotel and get a good night’s sleep before a busy day. Instead, I lay awake for hours, listening to the whir of the air conditioner. At 9 a.m., I dragged myself out of bed to take a bleary shower, and spent the next 16 hours rushing between coffee dates and work events before collapsing into my hotel bed, where despite my exhaustion I found myself staring miserably at the ceiling for hours again. The next day, I got my period, right on schedule; when night fell, I actually slept. 

I flew home to Vancouver, but the insomnia followed me: two or three torturous nights at the tail end of every cycle that ended whenever the bleeding began. Sometimes, I could actually feel my impending period, like a stone dropping into a pool of water and finally sinking me into sleep. I tried cutting out caffeine after noon and alcohol entirely, exercising daily, avoiding screens before bed. Friends offered their own suggestions: visualizations, breathing exercises, apps for meditation or podcasts where actors whispered hypnotically dull stories. But whatever was happening to me ran deeper than Matthew McConaughey ASMR could reach.

Even though I was stupefied by sleep deprivation, the link between my monthly cycle and my insomnia was obvious. After dutifully running through a gamut of ineffectual sleep hacks, I went to my family doctor and begged her to medicate me. “Am I in perimenopause?” I asked. Like every other millennial woman, I had recently devoured Miranda July’s All Fours, a novel about a 45-year-old artist flailing through the transition to midlife, which she experiences as a kind of second adolescence; horniness and impulsivity abound as she tries to figure out the next steps in her career and marriage. Then the stakes are ratcheted up by a diagnosis of perimenopause. “We’re about to fall off a cliff,” July’s protagonist warns a friend, compulsively googling charts of hormones plunging to their deaths like stampeding bison. I was only 37—still very youthful, actually!—but it seemed like a reasonable question. “Are your periods regular?” my doctor asked. They were. “Then it’s not perimenopause,” she told me and prescribed a sleeping pill.

I began taking it at bedtime, a few days before I expected my period to arrive, and it helped me fall asleep. An hour or two of grogginess the morning after felt like an acceptable trade-off for dodging the red-eyed insomniac nights, but the existential question lingered: What was going on in my body? 

When I talked about it—which I did incessantly and neurotically—I discovered most of my friends in their mid- to late-30s seemed to be experiencing their own cyclical misery. They faced crushing depression, anxiety, rage, fatigue. Perimenopause is characterized by the irregular menstrual cycles that precede menopause, when your period stops altogether. But there didn’t seem to be any clinical diagnosis that fit what I and so many of my peers were experiencing: regular cycles that had nonetheless begun to ruin our lives, at least for three days a month. 

According to a 2022 study published in Archives of Women’s Mental Health that analyzed the premenstrual symptoms of more than 238,000 people aged 18 to 55, many symptoms worsen with age. Among them are sleep changes, hot flashes, absentmindedness and low libido. 

Jerilynn Prior, who was a professor of endocrinology at the University of British Columbia for more than 30 years before retiring this June, became interested in perimenopause for the same reason I did: her menstrual cycle began to wreak havoc on her life. “I had 10 years of sore breasts,” she says. Prior is now 82, and the literature at the time was even more scarce; her fellow clinicians attributed her symptoms to dropping estrogen levels, but as an endocrinologist—an expert in hormones—she was skeptical. In fact, she suspected it was higher estrogen levels causing her symptoms.

Prior, who founded the Centre for Menstrual Cycle and Ovulation Research at UBC more than 20 years ago, explains that the menstrual cycle is driven by two hormones operating in balance: progesterone and estrogen. Estrogen rises during the first half of the cycle, prompting ovulation; then progesterone rises in the second half, along with a second peak of estrogen. If no fertilized egg is implanted in the uterus, both hormones drop and menstruation occurs. This goes on for decades, until we run out of responsive eggs and both estrogen and progesterone level gradually decrease. After a year without a period, menopause has officially begun. 

Here’s the thing, Prior says: at birth, our ovaries can have more than a million immature follicles. We shed them rapidly over time, but by the time we reach perimenopause, we still have several thousand between us and menopause. To get rid of them, she says, “you have to break the feedback loop.” Estrogen goes up, peaking erratically, while progesterone gradually decreases; the off-kilter cycle operates like a busted carnival ride, flinging follicles in every direction. I feel a little nauseated at the thought of my ovaries spasming erratically like an Australian breakdancer, but Prior’s not finished yet. “Our brain reacts when there’s a rapid decrease in a hormone that used to be high,” she says. In response, stress levels spike, increasing the risk of negative moods, depression and insomnia. “It’s like a bomb.”

And contrary to popular belief, Prior says this bomb might go off years before your period skips a beat. “There’s monumental evidence that the hormonal changes and the experiential changes occur for many—probably all—women before the cycle changes,” Prior says. She’s come to think of this period as a sort of very early perimenopause, which may be characterized by symptoms like hot flashes, mood changes and sleeplessness, and can last for several years before the actual menstrual cycle becomes irregular. 

I wondered aloud why no one had suggested this. “Not a lot of physicians are studying perimenopause,” Prior says. “And not a lot of clinicians or scientists believe what women say.”

I knew what she meant. The onset of my debilitating cycles coincided with raising young children while managing a demanding career, an endless heap of laundry and a cat who was always throwing up. Many people had gently suggested that perhaps I was sleeping poorly because I was stressed out. Tracey Lindeman, journalist and author of Bleed, a heavily researched and furious book about endometriosis, was familiar with this kind of suggestion, too. “Perhaps you just need to get off your phone, get into nature, get into woodworking, go on a vision quest,” she writes in Bleed, summarizing the kinds of advice that women get when their bodies revolt. 

Lindeman, who suffered from debilitating pain for 24 years before she was diagnosed with endometriosis—a disease in which tissue similar to uterine lining grows outside of the uterus, and which affects about 10 percent of people who menstruate—heard every version of this. In Bleed, she profiles several others who had their experiences dismissed or minimized. Other menstrual disorders, including polycystic ovarian syndrome or premenstrual dysphoric disorder (an extreme, debilitating variant of PMS), go untreated in a system that treats menstrual pain as imaginary. In the late 19th century, physicians dismissed their female patients as hysterical; the way our medical issues are treated now can feel remarkably similar.

Friends told me about doctors suggesting they lose weight, take up yoga or have a baby to cure their menstrual issues; others sought relief in naturopaths and acupuncturists, who were often compassionate and helpful but expensive because their services are not covered by any of Canada’s provincial health plans. (There is little scientific evidence for the effectiveness of these approaches, though many people find comfort or relief in them.) “Let me ask you something,” Lindeman says. “Do you think the care you received would be different if you were trying to get pregnant?” I did, actually—the only time my period had ever merited medical interest was when it took me more than a year to conceive my first child. In Bleed, Lindeman recounts the experience of a woman who suffered from undiagnosed endometriosis for years before mentioning to her doctor that she was trying to conceive, a disclosure that prompted a flurry of diagnostic attention. For many people, it can seem like your suffering is disregarded unless it’s standing between you and a pregnancy. 

Suggesting that a dysfunctional menstrual cycle is the product of stress is worse than useless—what am I supposed to do, single-handedly end capitalism between daycare drop-offs?—it’s also backward. The problem, Prior emphasizes, is hormonal. It’s real. “It’s not all in our heads,” she says. All the bubble baths and breathing exercises in the world can’t fix it. So what can? 

One promising treatment, says Prior, is progesterone, which is available as a prescription. She recently published the results of a randomized controlled trial of women experiencing problematic perimenopausal symptoms such as hot flashes and night sweats; the group prescribed 300 mg of oral progesterone reported more relief than those who received a placebo. (Conveniently for those suffering from insomnia, like me, a common side effect of progesterone is sleepiness.) While some of my friends were considering going on hormonal contraception to mitigate their symptoms, Prior said there is no scientific evidence that it’s effective for perimenopause. Prior also recommends keeping a record of symptoms, which can be useful evidence in doctor’s appointments. “And have someone to talk to,” she adds. “Someone who is not necessarily going to try and fix things, but who will just listen.” Because the worst part, she acknowledges, is feeling alone.

As I discovered when I started talking about my insomnia, what was happening to me was not unique. It was just something we’re not used to acknowledging: the long, liminal process of aging, an unspoken and invisible transition.

At the end of All Fours, the narrator is nearing 50. She’s accepted aging is not the end of her life, or the death of her sexuality; she has published the book that she wrestled with in the preceding pages, avoiding the cliff. Prior has a similarly reassuring perspective to offer. “I promise you menopause is better,” she says. “It’s not the horror show everyone says.” We all get there eventually, if we’re lucky enough to grow old. In the meantime, we don’t need to suffer alone.