Health and Fitness

Perimenopause: Symptoms, Treatments, and More

Maybe your periods have gotten a little unpredictable or you’ve found yourself waking up weirdly sweaty in the middle of the night. Have you stepped into premenopause?

Well, no — but that’s only because premenopause isn’t really a thing. But you might be dealing with perimenopause, which is the medical term for the phase leading up to menopause.

So how can you know for sure that this is what you’re dealing with? And more importantly, how can you cope — and when will it actually end? Here’s everything you need to know.

Real quick, before diving into the details, let’s clear up the difference between premenopause and perimenopause:

  • Premenopause is simply the time of your life before you hit menopause. Basically, you’re premenopausal from the time your periods start until they stop.
  • Perimenopause is the phase in which your body transitions from its reproductive years to menopause. During this time, production of the hormone estrogen starts to fall, which causes your period to become irregular and eventually stop altogether.
  • Menopause is when your body’s estrogen factory turns off completely and your periods totally stop. You’ll know you’re there once you’ve gone a full year without a period.

How can you tell if you’re in perimenopause? The first sign is typically a change in your usual menstrual cycle. Your periods might start coming earlier or later, and you might even miss some months altogether. When your period does come, it could also be heavier than usual.

Perimenopause can cause more than just wacky periods. It’s also common to experience symptoms like:

It’s absolutely still possible to get pregnant during perimenopause, but you could face more challenges. Your ovaries release fewer eggs during this time. Plus, less regular periods could make it harder to figure out when you’re most fertile.

Everyone’s body is a little different, so it’s hard to pinpoint an exact time when you’ll enter perimenopause — and how long it will last before you reach menopause.

Perimenopause typically starts in your late 40s or early 50s. But it can sometimes come sooner, as early as your mid-to-late 30s. Again, an irregular menstrual cycle is usually the first sign that things are ramping up.

Some folks will only experience perimenopause symptoms for a few months before their periods fizzle out. But more often, you’ll be in it for the long haul — anywhere from 4 to 10 years.

As you reach the homestretch to menopause, you might notice that your symptoms intensify as your estrogen levels start dropping at a faster rate.

You’ll know you’re past perimenopause and have finally reached menopause once your periods have stopped for a full year. The average age for this momentous event? 51.

Perimenopause symptoms can range from annoying (I definitely did not expect my period today) to straight-up miserable (I wake up drenched in sweat every night and trying to have sex hurts).

But no matter what hand you might be dealt, there are ways to help manage your discomfort and help you feel more yourself.

Hormone therapy

Hormone therapy involves taking estrogen and progestin — or just estrogen if you’ve undergone a hysterectomy.

Systemic hormone therapy, which is given as a pill or patch, is the best option for managing hot flashes and night sweats. If vaginal dryness is your only issue, you can use a local therapy like a vaginal ring, tablet, or cream.

The treatments come with some big risks, though. Hormone therapy can increase your chances for heart disease, breast cancer, endometrial cancer, blood clots, and gallstones, and they’re not recommended if you’ve recently undergone treatment for breast cancer.

Your doc can help you weigh your individual pros and cons and help you figure out the right move for you.

Other prescription drugs

If you have severe symptoms but want to avoid hormone therapy, you have other options. Hot flashes and sleep problems can also be managed with certain antidepressants, antiseizure meds, and blood pressure meds.

Selective estrogen receptor modulators (SERMs) can help with hot flashes and vaginal dryness.

Over-the-counter lubes

Vaginal dryness that isn’t super intense can often be managed with drugstore products. Water-based lubricants like Astroglide or K-Y Jelly can be good if the dryness only bothers you during sex. You could even try coconut oil (just be aware that this can make latex condoms less effective).

If it’s more of an ongoing issue, you can opt for a vaginal moisturizer like Replens or Vagisil. Unlike lubricants that sit on top of your skin, moisturizers are designed to absorb into your tissue to hydrate it.

FYI: Steer clear of any lubes or moisturizers with glycerin, which can sometimes cause itching or burning.

Lifestyle changes

Managing your daily routine might be enough to keep mild to moderate perimenopause symptoms in check — and these may be worth trying before moving on to prescription treatments. Try things like:

  • Avoiding hot flash triggers. Notice that caffeine or spicy foods tend to bring on hot flashes? Steering clear or limiting your intake can make a difference. Wearing layers that are easy to remove, keeping your bedroom cool at night, and not smoking can also help keep hot flashes in check.
  • Eating a plant-based diet. Soy-based foods, chickpeas, lentils, flaxseed, and whole grains contain phytoestrogens — plant estrogens that could potentially help ease symptoms.
  • Exercising. It’ll help you sleep better and boost your mood. Aim for at least 30 minutes of moderate to vigorous movement every day. Yoga can be particularly helpful if you’ve got stress or anxiety.
  • Managing your weight. Having a higher body mass index seems to make people more prone to hot flashes — but research shows that losing weight can help.

Natural remedies

One of the most popular supplements for perimenopause symptoms is the herbal extract black cohosh. But experts say there’s not enough quality evidence to recommend it, and it might potentially pose a risk to your liver. It could also be unsafe if you have or are at high risk for breast cancer.

Isoflavone supplements derived from soy or red clover are another possible option, but again, there’s not much proof that they’re useful, and they could potentially raise the risk for breast cancer.

The bottom line? Herbal supplements aren’t an automatic no, but they may not be the best option. If you’re thinking about taking an herbal supplement to wrangle your symptoms, talk with your doctor first.

Perimenopause is a completely normal part of life. If you’re able to handle the symptoms on your own, there’s no need to get medical attention.

But if issues like hot flashes, mood swings, sleep problems, or vaginal dryness are affecting your quality of life, you should absolutely loop your doctor in.

You should also give your OB-GYN a heads-up about significant changes to your periods. While some irregularity is normal during perimenopause, you should call a doctor if your periods:

  • are extremely heavy
  • go on for more than 7 days
  • come with spotting in between them
  • are fewer than 21 days apart

Perimenopause is the transitional phase before you reach menopause where your periods become irregular and then stop altogether. It can often last for years and cause symptoms that range from annoying to intense.

The good news is that there are plenty of ways to manage whatever you might be dealing with. Start by talking with your OB-GYN.



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