I’m often invited to speak on issues of hormonal health to groups of women in their forties. Looking out over the audience, I see an amazing diversity among the women, some are still girlish, some are distinctly mature; some are fashionably slender, some are rounding out; some look energetic and alert, some a little tired. But what I can’t tell by looking is who is a grandmother, who a first-time mother of a preschooler, who a single woman over the span of adult life, who a divorced or widowed woman newly entering the category of “single woman.” Who of these women has chosen to pass up childbearing and remain “child free”? Who has been struggling for decades with infertility and is now considering adoption, and who is taking advantage of the innovative options for conception yielded by a virtually exploding technology? Who is in a stable, long-term relationship, and who is, for want of a better word, dating?

Such an audience, in all its diversity, is a perfect symbol for the subject: the forties, the transitional decade in a woman’s life. It’s the diversity itself that makes my audience a perfect symbol, because Although the decade is marked by changes as distinct as those between ages 10 and 20 each woman goes through them at her own pace and with her own physiological and hormonal “style.” The changes are the same, but the ways of undergoing them, and to some extent the time it takes to do so, are related to the individual.

The random person on the street, be it a woman or a man, wouldn’t necessarily agree that individual styles evolve within this decade of change. That’s because, in our youth-oriented culture, the forties have a bad reputation: too often they’re viewed as the last, desperate period of a woman’s real life before the end, menopause, that is, after which old age sets in with a vengeance. This stereotype is pervasive; I often hear it expressed by clients when they first come to my women’s health clinic, Full Circle. All too often they feel they’re headed toward a fall, speeding toward the cliff that will mark the end of their lives as attractive, productive, sexual women, so much so that they interpret the various changes they experience in body and psyche only as dreaded signals that they are fast approaching “the change.” The true nature of the forties decade, its physical, intellectual, and emotional qualities, are an indistinct blur, like the terrain outside the window of a supersonic train. My goal at my clinic is to shatter the “end of life” stereotype, to explain the particular processes and changes that characterize the forties, and to slow down the train.

The “last chance” stereotype persists for a good reason: we have too little information to the contrary. Even many of the most supportive books on menopause focus on it as if it suddenly happened sometime at the end of the forties or the beginning of the fifties, as if it were an event unrelated to anything that came before. In fact, although menopause is indeed a milestone on a woman’s developmental path, it is also a link in a long chain of events, physiological and psychological, that precedes it. To a greater or lesser degree, we experience these events as changes, and sometimes as distressing symptoms, in our bodies, our emotions, our sexuality, and in other areas of our lives. To a greater or lesser degree, the medical world has tended to brush aside these changes as “just signs of aging,” developments not worth treating and to which we women might as well just become accustomed. For this reason, most women get neither the information they need to understand what’s happening to them nor the advice or treatment, often pretty minimal, that could ease any discomfort they might experience.

There’s one more reason that the forties decade has remained in the shadows for us, and I say “us” accurately, for I am 47 as I write this. We women in our forties now are baby boomers, and during our teenage years our mothers were 1950s “ladies,” strapped by the conventions and conformities of that particularly stringent decade. In an effort to prevent all the “terrible symptoms” associated with menopause from developing, many of our mothers underwent hysterectomies before they plummeted off that cliff. Others followed the rules by simply not speaking of the “change of life,” and their silence added an aura of ominous gloom to the subject. So most of us have no role models for adapting to the changes in the transition decade with interest, initiative, and a commitment to self-care.

It is my aim, both in my clinic to change all that by filling in the information gap. Handily enough, although medical science has generally ignored the forties as vague and uninteresting, it has given a name to this portion of the developmental arc. That name is perimenopause, and the goal of my work as a medical caregiver and educator is to make that term as familiar to the general public as menopause is today.

The prefix peri literally means “that which surrounds,” but the word perimenopause is used to refer to the events leading up to menopause. For some women, perimenopause lasts less than a decade; for others, it is somewhat longer. Individuals experience perimenopause differently, just as they do the transition into fertility during puberty. Still for most women, the period of perimenopause roughly corresponds to the years from 40 to 50, and for those who fall outside that decade, the changes are the same.