Navigating Perimenopause

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Every woman has her own feelings about approaching menopause. Some are apprehensive and view it as "the end of an era." Others can’t wait for those pesky periods to stop. Still more are too busy planning their second act to give it much thought. The truth is, every woman experiences this stage of life differently, with symptoms ranging from barely noticeable to unpleasant and intrusive.

Perimenopause, The Prelude to Menopause

Perimenopause and menopause are natural stages in your reproductive cycle. As you age, your ovaries begin to make less estrogen and eventually stop producing eggs. Your cycles may become increasingly irregular as you approach the transition to menopause.

Perimenopause may begin anywhere from your mid-30s to your mid-50s. In most women, perimenopause lasts for four to eight years – but it could be shorter or even much longer. The term perimenopause simply describes the time when your cycles are no longer predictable. It’s important to note that while your fertility is declining, you can still get pregnant, so don’t stop using birth control.

You are not officially in menopause until you’ve gone a full 12 months without a period. The normal range to reach menopause is between 45 and 58. In the US, the average age for menopause is around 51 or 52 years. Completing menopause before age 40 is considered premature menopause.

Your Periods During Perimenopause

The first sign that you are in perimenopause is often irregular periods. During perimenopause, your body’s estrogen levels rise and fall unevenly, and this is reflected in your menstrual cycles. They may get closer together or further apart, longer or shorter, or heavier or lighter. You may not be releasing any eggs, but breast tenderness and cramps may intensify. While changes in menstrual patterns are normal, perimenopause is not the only cause of changes in your menses. Talk to your healthcare provider if you:

• Bleed for more than seven days in a row
• Bleed between periods
• Change pads or tampons every one to two hours and notice large clots
• Have periods more frequently than every 21 days
• Experience spotting after sex

Symptoms of Perimenopause

The symptoms you experience during perimenopause are caused by changing hormone levels. When estrogen is higher, you may have PMS-like symptoms – cramps, mood changes, or breast tenderness. When estrogen is low, you may experience hot flashes and night sweats. These are the most common symptoms:

• Mood changes such as irritability, mood swings, or even depression – these may be due to hormones, sleep deprivation or circumstances in your life
• Changes in sexual desire
• Trouble concentrating
• Headaches
• Hot flashes
• Night sweats – hot flashes that occur when you are asleep and often wake you up
• Vaginal dryness and discomfort during sex
• Insomnia, which can occur with or without hot flashes
• Joint and muscle aches
• Increases in urinary frequency and urgency
• Increase in UTIs and vaginal infections
• PMS-like symptoms
• Weight gain – it’s very common for women in perimenopause to gain weight because hormonal changes slow their metabolism

Treating the Symptoms

Perimenopause and menopause are natural parts of life. There is no "cure" for the symptoms of perimenopause but if your symptoms are affecting your quality of life, do talk to your healthcare provider. They may recommend over the counter or prescription treatments such as:

• Antidepressants to help with mood swings or depression
• Birth control pills to stabilize hormone levels
• Gabapentin (Neurontin®), a seizure medication that relieves hot flashes in some women
• Vaginal creams to relieve dryness and discomfort during sex
• Hormone therapy in cream, gel, patch, or pill form

Pros and Cons of Hormone Therapy

Hormone therapy helps relieve some symptoms of perimenopause, but it is not risk-free. Taking either estrogen alone or estrogen plus progesterone can increase your risk of uterine cancer, stroke, heart attack, blood clots, gall bladder disease, and certain types of breast cancer. In general, healthcare providers recommend that women who take hormone therapy start it within 10 years of when they first experience symptoms and use it for less than five years.

Helpful Lifestyle Changes

A healthy lifestyle is always a good idea, whether you’re in your 20’s, in perimenopause, or no longer menstruating. Taking care of yourself enhances your wellbeing and may help reduce your symptoms:

• Eat a healthy Mediterranean style diet with plenty full of fruits, vegetables, whole grains, lean protein and healthy fats, such as olive oil
• Perform regular weight-bearing exercises such as walking, hiking, or strength training
• Improve sleep by avoiding screens before bed, keeping regular hours, and making sure your room is dark and a comfortable temperature
• Limit alcohol and caffeine
• Practice stress management techniques such as meditation
• If you smoke, stop
• Talk to your doctor about losing weight – weight loss increases your energy level and helps reduce hot flashes and night sweats
• Get at least 1,000-1,200 mg of calcium each day through diet and calcium supplements

Learn more about treating hot flashes and other symptoms.

Staying Healthy After Menopause

As you age, your yearly checkup becomes more important than ever. Your provider needs to establish a baseline to notice changes in your overall health.

Perimenopause triggers changes that continue after menopause and may affect your health long-term. As your estrogen levels decrease, your bones begin to lose calcium. They become less dense and more fragile, leading to osteopenia and possibly osteoporosis and increasing your risk for bone fractures. Your healthcare provider may recommend calcium supplements, extra vitamin D, and/or more weight-bearing exercises.

Once you are in menopause, you are at greater risk for heart disease and other cardiovascular health conditions. Declining estrogen levels can impact your blood cholesterol levels. Your LDL cholesterol, the "bad" cholesterol, starts to go up while your HDL cholesterol, the "good" cholesterol, goes down. Talk to your doctor about how often you should have your levels checked.

El Camino Health offers a Menopause Education Program to provide support and resources for women experiencing perimenopausal and menopausal symptoms. Learn more.

This article appeared in the June 2024 edition of the HealthPerks newsletter.