Several years before menopause, women enter perimenopause as estrogen levels decrease. Perimenopause symptoms can include hot flashes, sleep problems, and more.
When you haven’t had a menstrual period for a year, you’ve reached menopause. But, unless your ovaries are surgically removed, the cessation of monthly periods isn’t sudden. It’s preceded by the midlife transition known as perimenopause.
If you aren’t prepared for perimenopause, you may be surprised at how the hormone shifts that mark this period in life can impact how you feel, physically and emotionally.
Perimenopause usually starts between the ages of 45 and 55, when a woman’s ovaries stop releasing eggs regularly and hormone levels, especially estrogen, fluctuate. The result is unpredictable, even skipped, menstrual periods, along with a host of other perimenopause symptoms that can last from just one year to 14 years. Most women have some symptoms from hormone shifts for an average of seven years, according to the National Institute on Aging (NIA).
Of course, not every woman experiences perimenopause the same way. Some barely notice the transition, while other women can be downright miserable when symptoms hit.
The good news: Perimenopausal symptoms will eventually pass and, until they do, you can find relief with lifestyle changes, self-help strategies, and medical help, if necessary.
Understanding perimenopause symptoms
When perimenopause symptoms first develop, it’s a good idea to talk to your doctor to make sure you are experiencing mid-life changes associated with menopause and not symptoms due to another health condition. Usually, there’s no need for tests. Your doctor can identify you are in perimenopause by asking questions about your age, symptoms, and family history.
If there’s any doubt about your perimenopausal transition, blood tests may be ordered to check your follicle-stimulating hormone (FSH) and estrogen levels to make sure hormone changes are the likely explanation for your symptoms, the NIA explains.
However, the National Institutes of Health (NIH) points out there are no lab tests to predict when in life perimenopause will start, or whether the symptoms will be mild or difficult.
Even if your mother or other women in your family experienced a difficult time with perimenopause, that doesn’t mean you will. Perimenopause symptoms are different for every woman, and they are nothing to fear.
“Most people don’t have severe symptoms. Most people have mild or less frequent symptoms,” said Hadine Joffe, MD, an NIH-supported menopause researcher and psychiatrist at Brigham and Women’s Hospital.
Frequently reported perimenopause symptoms
Hot flashes, also called hot flushes, are the most common symptom, affecting as many as three out of four women during perimenopause, the U.S. Office on Women’s Health (OWH) reports. Some women have only a few hot flashes over the course of a week; others may deal with 10 or more episodes during the day and wake up with hot flashes at night.
Hot flashes usually last from one to five minutes and can make you feel slightly warm, or like you are burning up from the inside out. A strong hot flash may cause sweating and chills. Your face and upper body can temporarily turn beet red, too.
Difficulty sleeping soundly is also high on the list of perimenopause symptoms. Reduced levels of the hormone progesterone can make it hard to fall and stay asleep, according to the OWH, and sweat-producing hot flashes caused by dropping estrogen can wake you up, too.
Low levels of estrogen during perimenopause cause thinning and drying of vaginal tissue. The result can be burning and itching, and sometimes painful sex.
In addition, lower estrogen levels can weaken the urethra (the small tube-like organ that carries urine from the bladder to outside the body when you urinate). And this can lead to stress incontinence: urine may leak when you sneeze, cough, or laugh.
If you experience mood swings with your monthly periods or suffered from postpartum depression, you may be more likely to have mood changes during perimenopause, the OWH explains. The risk for depression and anxiety is higher during perimenopause, too, but may be caused not by hormone shifts but life changes – like children leaving home, a divorce, or the death of a parent.
There’s help for perimenopause symptoms
Living a healthy lifestyle in midlife – exercising, eating nutritious meals, and keeping weight under control – is the best thing you can do to reduce the risk of age-related illness and to help get through perimenopause as easily as possible. And there are many self-help strategies, and medical help, if necessary, to reduce perimenopause symptoms.
If hot flashes plague you, the NIH and OWH offer these tips:
- Wear lightweight clothing. Dress in layers so you can remove clothes as needed.
- Keep your bedroom cool. Keep a fan nearby.
- Avoid smoking, caffeine, spicy foods, and alcohol, which can trigger hot flashes.
- Drink cold water when you start to feel a hot flash.
- Take several deep, slow breaths to help relieve hot flash sensations.
- When hot flashes remain disruptive, talk to your doctor about medications. If hormone replacement therapy (HRT) is appropriate for you, a low dose of HRT is often adequate for many women. SSRI antidepressants have also been found to help women stave off hot flashes.
If irregular periods and spotting are a problem, and you don’t want to become pregnant, discuss low-dose birth control pills with your doctor. They suppress ovulation, regulate periods, reduce vaginal dryness, and can eliminate hot flashes, too.
Over-the-counter (OTC) vaginal moisturizers, applied twice weekly, replenish vaginal moisture and elasticity. In addition, OTC vaginal lubricants can make intercourse comfortable again. If you still have problems with vaginal dryness and discomfort during perimenopause, your doctor may prescribe vaginal estrogen (available in a cream, ring, tablet, or gel).
Practicing Kegel exercises to strengthen your pelvic floor muscles often help relieve perimenopause-linked stress incontinence.
Getting enough rest can go far to boost your mood and relieve perimenopause-associated fatigue. One of the best ways to get a good night’s sleep is to commit to regular physical activity during the day. Avoiding caffeine in the afternoon and not eating or drinking anything several hours before bedtime can also help sleep, and so can keeping your bedroom dark, quiet, and cool.
When it comes to mood swings, depression and anxiety during perimenopause, exercise and a good night’s sleep are often effective. The OWH advises getting serious about reducing stress in your life, too. Set limits for how much you can do and look for healthy ways to relax, including yoga, reading, and taking time to enjoy the outdoors. If you find anxiety or depression increasing, talk to your doctor to see what therapies are right for you.
July 12, 2019
Janet O’Dell, RN