Perimenopause and You

Dec 17, 2015

The Change Before the Change

Perimenopause is the phase just before menopause when a woman begins the transition into permanent infertility.  During this time, menstruation becomes more and more infrequent until ultimately it ends. This transition can last between two and 10 years. Symptoms can start appearing for some women as early as their mid-30s. Other women don’t see signs until their 50s. 

Perimenopause is the result of your ovaries producing less estrogen. As this happens, periods become irregular. says, “your cycle may shorten by a day or two and then by several days, and your flow may go from light to super heavy…Eventually, you’ll have fewer and fewer periods, though they may still be heavy.” Once a woman has gone 12 full months without a period, menopause has begun and perimenopause is over. 

Every woman will experience the symptoms of perimenopause differently. Some women barely notice the transition while others suffer greatly from the effects. The most common physical signs of perimenopause are hot flashes, night sweats, difficulty sleeping, breast tenderness, vaginal dryness and a loss of libido.  Other rarer symptoms include hair loss, irregular heartbeat, and changes in body odor. There are also emotional signs that your estrogen levels are shifting, including frequent mood swings, anxiety and depression. 

While every woman will experience perimenopause eventually, there are certain factors that can cause a woman to start this stage early. The first cue comes from family history. A history of early menopause may be a sign. Certain cancer treatments, such as pelvic radiation or chemotherapy, can also lead to early menopause, as can having a hysterectomy where your ovaries remain intact. Even though the ovaries have the ability to continue producing estrogen, the surgery can lead them to shut down early. 

Making certain lifestyle changes ahead of time can extend the time before perimenopause and ease symptoms as they occur. Eating a healthy diet that is full of fruits, vegetables, lean proteins, and complex carbohydrates will help. It is most important to avoid simple carbohydrates and sugars. This type of diet is most effective for maintaining a healthy weight. Making an effort to maintain your weight is important because irregular estrogen levels cause the body to hold on to fat. This is why many women find that they start to gain weight during this time, particularly around the abdomen. Exercise will not only help with weight loss but improves mood. It can also help fight off insomnia. 

Leading a stressful life can trigger early menopause. Activities like yoga or meditation and breathing techniques have been shown to help perimenopausal women lower stress levels and sleep better.  One of the worst things for perimenopause is smoking. The Mayo Clinic reports that, “The onset of menopause occurs one to two years earlier in women who smoke, compared to women who don’t smoke.” 

According to, there are a variety of medicines that can help to ease the pains involved with perimenopause. Antidepressants have been shown to reduce the number of hot flashes a woman experiences and helps stabilize mood. Clonidine and gabapentin also help to reduce the amount of hot flashes. Ospemifene helps slow the vaginal changes that lead to painful sex. Birth control and progestin pills can help to lessen the amount of menstrual bleeding each month and regulate its occurrence. 

Because this phase of life is triggered by a loss of estrogen, it makes sense that replacing the estrogen would relieve some of those symptoms. A woman suffering from the symptoms of perimenopause will generally be prescribed a combination of estrogen and the hormone progesterone. 

Progesterone is needed to reduce the risk of developing endometrial cancer that taking estrogen alone would cause. The 2002 Women’s Health Initiative study linked hormone therapy use to increase in the risk of breast cancer when used long term but it is believed to be safe for short-term use. 

The general rule of thumb when using hormone therapy is to stick to the lowest effective dosage for the shortest amount of time to lessen the risk of breast cancer. Despite these risks, hormone therapy is still a viable option for women without a history of blood clots or breast cancer and who don’t suffer from heart or liver disease. 

The hormones can be taken in a variety of ways. There is a hormone patch that you can wear. There is also a pill and a gel form of hormone treatment. A vaginal cream or a vaginal ring can be used to alleviate vaginal symptoms such as dryness or itching. 
Bioidentical hormone therapy is custom made by compounding pharmacists. They are specially created for the individual’s particular set of symptoms. These hormones are believed to be closer to the natural hormone. The downside to using bioidentical hormones is that, unlike commercial hormone products, these hormones are not regulated by the FDA. 

There are also various alternative methods and home remedies to help ease the symptoms of perimenopause. Black cohosh, which is available over-the-counter, has been said to ease a variety of the most common perimenopausal problems. According to the Mayo Clinic, it is recommended for short-term use only and has been linked to liver damage in some cases. It is recommended that you consult a doctor before trying it. Soy contains phytoestrogens. This natural form of estrogen can help to keep your bones, heart and breasts healthy as the body stops producing its own estrogen. 

Perimenopause is an inevitable part of aging but its symptoms can be controlled to a certain extent. Staying attuned to your body and taking good care of your health will ease the transition into infertility. Not any one treatment is right for everyone. It may take some trial and error to find the right combination of treatment. Stay current on the available options so that perimenopause doesn’t hinder your quality of life.

About the Writer

Regina Creason

Contributing Writer

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