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Don’t Sweat Perimenopause: Tips for Managing This Transition

You feel like you stepped from the comfort of an air-conditioned office into the worst heatwave of the summer. Beads of sweat form on your upper lip, sweat rolls down your back and your face feels flushed. No one around you seems warm or uncomfortable. What’s going on?

If you’re a woman in your 40s or early 50s, there’s a good chance you’re experiencing a hot flash, one of the most common side effects of perimenopause. At this time in your life, your hormones change as you approach menopause, leading to hot flashes and a range of symptoms caused by a drop in estrogen levels. 

“Beginning somewhere in your 40s, you will begin to notice fluctuations in your period,” said Jennifer Hofmeister, PA, an OBGYN physician assistant with Banner Health in Loveland, CO. “Some women coast right through into menopause without noticing anything besides changes in their periods. But others can have debilitating symptoms.” Perimenopause often lasts about four years but it can be much shorter or longer. Once you’ve gone 12 months without a menstrual period, you’re considered to have reached menopause.

You might notice these signs of perimenopause

Hofmeister outlined some of the most common symptoms of perimenopause and the steps you can take to alleviate them. 

  • Hot flashes. Studies show about 75 to 80% of women will experience hot flashes—they are one of the most common symptoms of perimenopause. Hot flashes often occur when you are sleeping. They are called night sweats and can leave your pajamas and sheets drenched.
  • Trouble sleeping. During perimenopause, some sleep problems are caused by night sweats. But some women find their sleep disturbed even without hot flashes. 
  • Depression or anxiety. This stage of life is a period of significant change for many women. You may have children leaving the house, be caring for aging parents and have a demanding career. You may look back on your past and worry about your future. It’s not uncommon for mental health problems to arise.
  • Mood changes. If you’re not sleeping well during perimenopause, you may be irritable or have mood swings. Some women, however, notice changes in their mood even when they’re getting restorative sleep.
  • Vaginal pain. Low estrogen levels can make your vaginal tissue less elastic and lubricated, so sex may be painful due to vaginal dryness. 
  • Weight gain. It’s common for women to gain weight during menopause, and the weight is more likely to be in the abdomen rather than the hips and thighs. It’s possible that lower estrogen levels may slow down your metabolism.
  • Cognitive changes. In perimenopause, you may find that you’re more forgetful, and it’s harder to pay attention and stay on task. Your cognitive ability should return to normal over time.
  • Bone loss. While you might not notice any signs of bone loss, you can start to lose bone as your estrogen levels drop, putting you at higher risk for osteoporosis.

How to treat perimenopause symptoms

Many of the symptoms of perimenopause are interconnected. If you’re having trouble sleeping, you might be irritable. If you’re having hot flashes, you might have trouble sleeping. If you’re depressed or anxious, you might overeat and gain weight. Fortunately, many of the treatment options can help with multiple symptoms.

Hofmeister said the first line of defense is to focus on nutrition and lifestyle habits. She suggests that women get about 30 minutes of moderate exercise most days of the week, make healthy food choices, try to get a good night’s sleep and limit alcohol, caffeine and sugary snacks that can affect your blood sugar and insulin levels.

For hot flashes, you can lower the temperature in your house, dress in layers so you can quickly shed some clothing when you need to, use fans and avoid common triggers like spicy foods and alcohol. If you’re overweight, losing weight may help with hot flashes.

To combat bone loss, Hofmeister said you should get at least 1,500 mg of calcium daily and recommends a vitamin D supplement. “Roughly one year before menopause and a few years into menopause, women can experience significant bone loss,” Hofmeister said.

To improve your sleep and mood, try to get more exercise.

Medication options for treatment

Many women find that diet and lifestyle changes help alleviate symptoms. If you have severe perimenopause symptoms, you can try medication.

  • Hormone therapy. You can take estrogen or low-dose birth control pills to treat hot flashes and other symptoms of perimenopause. Many women find hormone therapy helpful—you can talk to your doctor about the pros and cons of different options to decide what’s right for you.
  • Vaginal estrogen. You can use vaginal creams, rings or tablets to apply estrogen directly to the vagina to relieve dryness and irritation. With this treatment, estrogen is only absorbed into the vaginal tissues, so it doesn’t cause the side effects you might experience with an estrogen pill. 
  • Antidepressants. Antidepressants can be effective in treating hot flashes—they may be an option for women who are unable to take estrogen. 

The bottom line

Perimenopause is the time of transition to menopause when you no longer have menstrual periods. During perimenopause, your hormone levels can fluctuate, leading to a range of unpleasant symptoms. Lifestyle changes and medication can help. 

Need help managing perimenopause symptoms and the menopausal transition?

Schedule an appointment with an OBGYN.

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