November 2022

The Change Before ‘The Change’: Perimenopause

You know you’ve reached menopause when you haven’t had a period—not even spotting—for 12 months in a row. But “the change” usually approaches gradually, starting in a woman’s mid- to late 40s. This stage is called perimenopause.

In the time leading up to their last period, many women report irregular periods and other symptoms of menopause, such as hot flashes and trouble sleeping. How you handle this transition can affect both how you feel and your long-term health.

Perimenopause problems

Perhaps you’ve already noted changes in your periods: how often they come and how long and heavy they are. You may also start to experience vaginal dryness, sleep problems, and hot flashes. Experts blame these symptoms on changing levels of estrogen and progesterone produced by the ovaries.

Reduced estrogen also triggers two less noticeable but more health-threatening changes. As menopause approaches, women’s bones begin to thin, and their risk for heart disease rises.

Other common symptoms—mood changes, joint stiffness, urinary incontinence—could be less related than you think to approaching menopause. Instead, they may be a normal part of aging.   

Smoothing the path

To relieve symptoms of perimenopause, some women opt for hormone therapy. These treatments may help reduce hot flashes and vaginal dryness while regulating periods and maintaining bone strength. However, they do come with some risks. Ask your health care provider if hormone therapy is right for you.

Instead of hormone treatments, your doctor may prescribe antidepressants or other drugs to relieve hot flashes. But steer clear of supplements like black cohosh and DHEA. There’s no evidence they are effective, and some can be dangerous.

What else can you do to relieve symptoms during these crucial transition years? Limit your intake of alcohol and caffeine, which can trigger hot flashes. Dress in layers, and keep your environment cool. And be sure to make exercise part of your routine. In addition to improving hot flashes, staying active can help protect you from heart disease and bone loss.