Many years ago, Mary Jane Minkin needed a domain name for her website. Her husband posed a question: “What do you call a French minor in college who becomes a gynecologist?” With that, the pseudonym Madame Ovary was born.
Despite the moniker, “I have to confess that [Gustave] Flaubert is not my favorite French author,” said Minkin, clinical professor in the Department of Obstetrics, Gynecology, and Reproductive Sciences at Yale School of Medicine and a practicing gynecologist.
Through her website, MadameOvary.org, and in her clinical work, Minkin has dedicated her career to sharing medically accurate information about menopause, perimenopause, and other women’s health topics. She has written seven books, including “The Yale Guide to Women’s Reproductive Health,” “A Woman’s Guide to Menopause and Perimenopause,” and “A Woman’s Guide to Sexual Health.”
In recent years, perimenopause, or the transitional period before menopause, has become a more frequently discussed topic, both through social media and in popular culture. Because it was once taboo, there has often been confusion and misconceptions around perimenopause and the years leading up to menopause.
“When I was a little girl, it was thought that you went to bed one night premenopausal, and you woke up the next morning post-menopausal,” Minkin said. “It would be very lovely if that happened, but it doesn’t.”
During perimenopause, the ovaries begin producing less estrogen, leading to menopause symptoms such as hot flashes and sleep disruption. Perimenopause may begin as early as your mid-30s, and it can last for only a short time or for years.
In an interview, Minkin explains the causes behind perimenopause, how it affects women’s health, and gives advice for navigating this life transition.
The interview has been edited for length and clarity.
What is the experience of perimenopause like?
Mary Jane Minkin: The ovaries tiring out is what this whole process is about. Periods start to get very wacky, and the period wackiness is related to the ovulatory dysfunction. We don’t ovulate as well. We don’t make as much progesterone and estrogen. When we ovulate — when the egg is released — the rest of the ovary starts making progesterone. That helps control the lining of the uterus. Without the control of the lining of the uterus, people can start bleeding irregularly. Women can also get urinary symptoms. This is something that people don’t realize; they may not recognize it as being related to menopause. The changes in your bladder and vagina tend to be later. But usually, hot flashes and sleep disruption are the early markers of perimenopause.
What are some of the biggest misconceptions about perimenopause?
Minkin: For many years, menopause was totally dismissed, as was perimenopause. There was no teaching of menopause and perimenopause. They were kind of put into the closet. It’s very easy to ascribe everything to perimenopause, and it’s really easy to ascribe nothing to perimenopause.
But the key thing is if you’re not feeling well and we think this may be perimenopause, even in the absence of being able to prove anything, we can think about some interventions that could help.
How does perimenopause affect women’s health?
Minkin: Women can bleed a lot. If you’re losing a lot of blood, don’t sit and suffer. We have a lot of tricks to help take care of it, like putting in a progestin-coated IUD, or trying birth control pills, or, more rarely, we can take out the uterus if we need to.
Perimenopause can also interfere with women’s mental health, especially if they’re not sleeping. If a woman has a history of depression, like postpartum depression, she’s got about a threefold increased risk over Jane Doe of having a recurrence of a depressive episode. So emotional or mood changes can certainly happen.
We also know that sleep deprivation is not good for your metabolism. Sleep seems to be crucial for weight loss or controlling your weight. One of the common complaints we hear from women going through the menopausal transition is “I’m gaining weight.” If we get people better sleep, they will be able to control their weight much better.
What advice would you give to someone going through perimenopause? How can they find care and support?
Minkin: Of course, they can go to my website or check out menopause support organizations like Red Hot Mamas. It’s important to talk about menopause, and there are a lot of resources for information. That’s number one.
Number two, you can visit the website of the Menopause Society and plug in your zip code to find menopause interested practitioners and menopause certified practitioners [who have passed a special exam], including nurse midwives and PAs.
