The time leading up to menopause can be a frustrating phase of life for many women. Whether it’s interrupted sleep from night sweats, random hot flashes, wild mood swings, stubborn weight gain, or all of the above, it can seem as if your hormones devised a special brand of torture.
Believe me, I know: I’m 55 and I’m still experiencing some symptoms. But I can attest that it does get better.
Menopause vs perimenopause
First, let’s define some terms:
- Menopause begins when a woman has not had a period for 12 months.
- Perimenopause is when physiological changes occur that begin the transition to menopause.
Symptoms of perimenopause
Any combination of these symptoms may occur due to the fluctuation and decline of estrogen and progesterone levels:
- Hot flashes
- Night sweats
- Irregular periods
- Mood swings/mood changes
- Vaginal dryness
- Vaginal pain
- Vaginal pain during sex
- Urinary tract infections (UTIs)
- Heart palpitations
- Weight gain, especially around the stomach
- Poor concentration or brain fog
I’ve seen patients in perimenopause, the time leading up to menopause, in their 40s all the way through to their 60s. The average age for menopause is in the early 50s. Menopause before age 40 is considered premature; usually an autoimmune response is linked to these cases.
Remember that this is a natural part of the aging process; menopause isn’t a disease to be “cured.” It’s important not to get caught up in comparisons. Every woman’s experience is different. Some women battle symptoms during perimenopause. Others breeze through perimenopause only to confront symptoms when they enter menopause.
How to relieve the symptoms
In the meantime, there are many tools that can help:
Exercise has numerous benefits. Not only does it improve your mood, enhance your memory, boost your libido and support your bone strength, it also can help you sleep, provided you don’t exercise too close to bedtime. Try to get outside so you can get some vitamin D naturally from the sun.
If you don’t have good sleep, it’s almost impossible to treat anything else or have the energy to make helpful lifestyle changes. Over-the-counter medications or melatonin are not habit-forming and can be helpful. Be cautious with prescription sleep aids as those can be addictive; discuss the risks with your doctor.
To support bone health, make sure you are getting enough calcium and vitamin D even before you begin perimenopause. Our bone density naturally declines after our 30s.
For women experiencing vaginal dryness or pain during sex, over-the-counter water-based lubricants can help. They may also help reduce the incidence of UTIs. For severe cases, prescription vaginal estrogen creams may help.
Women suffering from intense hot flashes and night sweats are often surprised that selective serotonin reuptake inhibitors (SSRI) antidepressants may help. In addition to easing the physical symptoms, they also may improve the mental symptoms. Other drugs used off-label that may ease symptoms include a high blood pressure drug and a neuropathy drug.
Birth control pills
Besides doing their obvious duty of preventing pregnancy when used correctly, the hormones in birth control pills help even out irregular periods and may balance mood swings, too. Even if you don’t use birth control pills, have a birth control plan in place because it is still possible to get pregnant during perimenopause.
Hormone replacement therapy (HRT)
Hormone replacement therapy (HRT), replacing the declining estrogen and/or progesterone, is usually a last resort because studies have shown that HRT can increase a woman’s risk of breast cancer, heart attack, blood clots and stroke. Make sure you discuss the risks and benefits of HRT with your doctor.
Many of my patients have reported relief from symptoms with supplements. These can include soy, black cohash, evening primrose oil and wild yam. Discuss these with your doctor.
Perimenopause and menopause mimickers
Some of the perimenopause and menopause symptoms, such as heart palpitations, weight gain and brain fog, may look like other conditions. Make sure your doctor does a full screening to rule out:
With a little patience and support from your doctor, you too can make it successfully through the perimenopause and menopause gamut.