Perimenopause is the six to 10 years in a female’s life before her last menstrual period. When a woman hasn’t had her period for 12 months — and there’s no other cause, such as pregnancy, for the lack of periods — she’s considered to be in menopause.
The average age for menopause is 51, so that means many women start perimenopause in their early or mid-40s. Some women reach menopause before age 51, which means that perimenopause starts even earlier for them.
You can think of perimenopause as puberty in reverse, says Dr. Mache Seibel, a women’s wellness and menopause expert at Beth Israel Deaconess Medical Center/Harvard Medical School in Boston and author of “The Estrogen Fix.”
During puberty, you become more sexually aware. In perimenopause, you may have a lower libido and experience vaginal dryness. During puberty, your period starts, and many women (although not all) start a predictable period schedule. In perimenopause, your periods often are more or less frequent until they stop completely. The parallels between puberty and perimenopause continue from there, he says.
What Is Perimenopause?
Yet some women aren’t aware of what perimenopause is. They “don’t have the information they need to be prepared for the changes that occur. In general, all of the changes that hit in midlife can take women by surprise,” says Dr. Stephanie S. Faubion, the Penny and Bill George Director of the Mayo Clinic Center for Women’s Health in Jacksonville, Florida, and medical director of the North American Menopause Society.
Before perimenopause and menopause, two hormones — estrogen and progesterone — work like a pair of agile figure skaters, moving in sync to enable your body to ovulate and sometimes become pregnant, Seibel says. Once you enter perimenopause, these two hormones no longer work as well together as they did before. There can be higher or lower levels of each hormone at unpredictable times, and that’s what leads to many of the imbalances in perimenopause.
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Perimenopause can cause a variety of uncomfortable symptoms for women, including:
— Abnormal bleeding during periods.
— Bladder symptoms, such as having to urinate more often or leaking urine.
— Brain fog.
— Discomfort during sex that’s caused by vaginal dryness.
— Erratic periods. For instance, you may have periods that are two weeks apart and then have them six weeks apart. Then, you may not have a period for six months and then have one yet again, says Dr. Mary Jane Minkin, a clinical professor of obstetrics, gynecology and reproductive services at Yale University in New Haven, Connecticut.
— Hot flashes. This is a sudden and intense feeling of warmth that often affects the face, neck and chest.
— Night sweats.
— Cramping or other discomfort during periods (more than usual).
— Weight gain.
Some women sail through perimenopause with minimal symptoms. Others are hit by a wallop of uncomfortable changes. Most women fit somewhere in between these two extremes, says Dr. G. Thomas Ruiz, an OB/GYN at MemorialCare Orange Coast Medical Center in Fountain Valley, California.
8 Ways to Find Relief From Perimenopausal Symptoms
There are some ways that perimenopausal women can find relief from the more troublesome symptoms they experience. Here’s how.
1. Exercise. As if you needed another reason to get moving, right? Regular physical activity has a laundry list of benefits for the body. Specific to perimenopause, exercise can:
— Curb hot flashes.
— Improve your mood, so you’re better able to manage mood swings.
— Help you sleep better.
— Combined with healthy eating, it can help you manage your weight.
The current federal guidelines recommend 150 minutes of moderate-intensity exercise each week, which you can break down to 30 minutes daily over five days. You also should do at least two weekly strength training sessions per the federal guidelines. Strength training is important due to the loss of muscle mass with age.
2. Get quality sleep. Good sleep during perimenopause can be challenging. In addition to the normal stresses of life that affect sleep, you also may experience night sweats or have hormonal roller coasters that wake you up at odd times. That said, the more you try to maintain a normal sleep schedule, the better your body can cope with hormonal changes. To help get a better night’s sleep, remember to:
— Go to bed and wake up around the same time.
— Avoid distractions such as your phone.
— Avoid caffeine or alcohol close to bedtime. You may think alcohol helps with sleep, but it actually can make sleep worse, Minkin says.
— Do some light stretching or yoga and deep breathing before bedtime. This should make your sleep more restful. However, save any strenuous exercise for the daytime. Vigorous physical activity too close to bed can make it hard to go to sleep, Faubion says.
3. Eat healthy. Eating more whole foods and vegetables helps the body in many ways. In perimenopause, you might notice you start to gain weight. This is caused by aging and a slowing metabolism, not perimenopause or menopause, Faubion says. However, that midlife weight gain often happens at the same time as perimenopause, which is why they are lumped together. Additionally, the loss of estrogen tends to redistribute fat to the midsection, Faubion explains.
Ask your health provider or a registered dietitian for advice on how to eat healthy and how to maintain a healthy weight or lose weight if it’s needed.
4. Try lubricants or moisturizers. If you have vaginal dryness that leads to discomfort during sex, there are some over-the-counter products you can try. There are long-acting gels that contain polycarbophil that you place in the vagina two or three times a week, or they can be applied externally, Minkin says. There also are lubricants you can use during sex. However, don’t make the mistake of using petroleum jelly to help vaginal dryness as it’s been shown to increase the risk for a common infection called bacterial vaginosis. Also, let your doctor know if you start having more yeast infections after using lubricants regularly.
5. Use tried-and-true methods to relieve period pain and cramping. During perimenopause, some women have to chart the waters of tougher periods, menstrual headaches, cramping and other uncomfortable symptoms. There’s no magic pill or strategy to get rid of these symptoms, but you can continue to use what’s worked for you in the past, be it over-the-counter pain relievers, warm compresses on the abdomen or simply more rest. Nonsteroidal anti-inflammatory drugs such as ibuprofen and naproxen used during PMS or during your period are particularly helpful because they inhibit a hormone called prostaglandin that is involved with cramping, Ruiz says. Some women also may find this type of medicine decreases blood flow.
6. Learn about herbal remedies for hot flashes. Some women use over-the-counter herbs in pill or tea form such as black cohosh to relieve hot flashes, with mixed results. The herb is thought to work by having an effect on hormone-sensitive tissue in body areas such as the uterus and the breasts, according to NAMS. Black cohosh has a generally good safety profile, although researchers continue to investigate a possible connection with liver problems. If you hear of a friend who found black cohosh successful, just keep in mind that you may or may not have the same result, Ruiz cautions. A review of 16 randomized, controlled clinical trials published in 2012 in Cochrane Database of Systematic Reviews focused on black cohosh in perimenopausal and postmenopausal women. The review didn’t find sufficient evidence to support its use for menopausal symptoms.
7. For abnormal bleeding, talk to a doctor about low-dose birth control pills or a progesterone IUD. Bleeding that is a lot heavier than normal during your period occurs in about 20% of perimenopausal women. For women with a normal-sized uterus, a low-dose birth control pill or an IUD that releases the hormone progesterone can help regulate your body enough to cut down on abnormal bleedings or hot flashes. There is also a newer low-dose contraceptive ring called Annovera that can be used, Minkin says. All of these serve as birth control methods, and that’s still needed until your periods stop completely.
Women with a larger than average uterus may need to consider other types of therapy, such as a hysterectomy to remove the uterus, Ruiz says.
8. Know when to see a doctor for perimenopausal symptoms. The occasional heavy period is normal, but you’ll want to let your doctor know if you have bleeding that lasts two or three weeks or bleeding that seems abnormally heavy, Ruiz says. You also should talk to your doctor if you are having trouble managing perimenopausal discomfort.
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