Everything You Need to Know About Perimenopause

Everyone knows about menopause—the permanent cessation of menstruation and the end of a woman's reproductive years. But it doesn't happen overnight. There’s a different stage you may not be aware of. It’s a phase termed perimenopause, or menopausal transition.

What is perimenopause?

If you're of a certain age, you may notice your premenstrual symptoms are getting more intense. Or maybe your flow has gotten lighter or heavier—and your cycle suddenly has a new timetable.

These symptoms are your body’s way of telling you that you're heading into a new phase: perimenopause.

Perimenopause is the stage leading up to menopause, or 12 consecutive months when a period stops, that typically occurs in a woman’s late forties or fifties. Perimenopause can begin several months or years before menopause hits.

During perimenopause, women experience a decline in estrogen production, resulting in fluctuating periods: Common symptoms of perimenopause include experiencing a longer or shorter cycle and even skipping some periods entirely.

Consistent changes of a week or more in the length of your menstrual cycle are a sign of early perimenopause, while 60 days or more between periods is a sign of late perimenopause.

The hormonal changes occurring during the menopausal transition can impact the body physically and mentally.

Common signs of perimenopause include:

• Breast tenderness
• Mood swings
• Brain fog
• Vaginal dryness
• Dry eye syndrome
• Trouble sleeping
• Hot flashes and night sweats
• Incontinence and urinary tract infections (UTIs)
• Changes in sex drive
• Loss of bone density and increased risk of osteoporosis
• Changing cholesterol levels and a higher risk of heart disease

For some people, birth control pills or cancer treatment may make it difficult to know when you’re in perimenopause. Cancer treatment may cause early menopause.

Treating perimenopausal symptoms

For decades, women who experience symptoms of menopause were told these physiological changes were simply a normal part of aging (which they are) and to deal with it. There wasn’t anything to be done.

"[Now,] women are no longer expected to tolerate and deal with the conditions and problems they once were," said Brooke Faught, a nurse practitioner and the clinical director of the Women's Institute for Sexual Health in Nashville, Tennessee. "They have options."

Hormone replacement therapy (HRT)

Hormone replacement therapy, or menopausal hormone therapy (MHT), is a common treatment to relieve perimenopausal and menopausal symptoms.

MHT, a type of HRT, can be administered in the following ways:

• Pills
• Skin patch
• Vaginal ring, gel, cream or spray

MHT may not be right for everyone and shouldn't be used by women older than 60. Talk to your healthcare provider about whether hormone therapy is right for you.

Lifestyle changes

Focusing on your diet is another strategy that can help ease symptoms of menopause. For some women, a diet incorporating soy products can be beneficial. A scientific analysis published in a 2015 issue of the journal Climacteric found plant isoflavones from soy (which constrain estrogen-like compounds) and other sources reduced symptoms such as hot flashes by 11 percent.

Also beneficial: getting back to basics with a healthy diet that limits inflammatory trigger foods, such as sugar and alcohol.

Some women believe herbs and supplements can help. They report relief from taking the herb black cohosh (via capsule, liquid or tea). A 2018 study suggested those who took black cohosh daily for eight weeks reported significantly fewer and less severe hot flashes than before they started the supplement.

However, as the North American Menopause Society (NAMS) reports, black cohosh has also been linked to liver problems. More research on this supplement is needed.

It's easy to get sucked into the supplement route—vitamins and herbal cocktails that claim to do magic are everywhere. But beware, Faught said, because supplements don't require or receive approval from the Food and Drug Administration (FDA).

However, she added, there are some—such as Serenol and Relizen—that, when used under the guidance of a healthcare provider, can bring relief by providing a mild-but-similar effect to antidepressants such as Prozac and Zoloft, which are sometimes prescribed to manage hot flashes and mood changes.

Be sure to talk to your physician before adding any supplements to your regimen, so they can talk through the proper dosage and any risks or potential side effects.

Touch therapy

Stalwart feel-good standbys acupuncture. One study suggested women receiving acupuncture experienced significant improvement in three sessions, with a max benefit at the eighth acupuncture session.

Massage is another noninvasive option. This study suggested a link between an hour of massage twice a week and a reduction in insomnia and anxiety.

Lasers and radio frequency

Newer therapies that employ lasers and radio frequencies claim to resurface the vaginal skin, which may help ease burning with urination, vaginal dryness and pain during intercourse. More research is needed on these treatments.

It's important for women to seek providers who specialize in treating perimenopause and menopause because they'll be more well-versed in newer innovations than general internists and gynecologists, explained Angelish Kumar, M.D., a certified menopause practitioner, urologist and founder of Women's Urology New York.

The bottom line

"Some women have mild symptoms and aren't troubled by them," Faught said. "For others, the symptoms are bothersome enough to impact daily functioning and happiness. And that's the perfect time to work with a healthcare provider to create an individualized treatment plan that fits your lifestyle and enhances your quality of life."

Perimenopause hits every woman differently, so treatments certainly should be—and now can be—more customized to include both medical and lifestyle approaches. Speak with your doctor to learn more.

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