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What the Heck Is Perimenopause?

“Is anyone else warm in here?” I ask this of my family on an almost daily basis. One of them almost always quickly replies, “Nope, it’s just you.” But I already knew that. I fan my face with a magazine and peel off a layer of clothing.

Perimenopause. Good times.

What Is Perimenopause? 

Menopause is clinically defined as a woman not having had a menstrual period for 12 consecutive months. Perimenopause begins several years before that. Dr. JoAnn Pinkerton, executive director of The North American Menopause Society (NAMS) explains: “The hallmark of perimenopause is the fluctuations in hormone levels. The ovaries gradually start to produce less estrogen, and follicle-stimulating hormone (FSH) levels start rising.  Menstruation cycles become irregular.”

The average age of menopause is 51, but hormonal changes can start in a woman’s 40s or even 30s. The average length of perimenopause is four years, but we’ve heard women say they suffered symptoms for a decade. The start of perimenopause is hard to pinpoint because blood tests can be inaccurate since hormone levels change often, Dr. Pinkerton says.

The Symptoms 

Perimenopausal symptoms and their severity vary greatly among women. Common symptoms include hot flashes, weight gain (especially in the stomach area), migraines, irritability, sleep issues, vaginal dryness, and mood swings.

Determining if perimenopause is the true cause of such symptoms can be tricky. Dr. Cynthia Stuenkel, past president of NAMS, explains, “Women coincidentally encounter many life stressors around the same age as perimenopause. Juggling work, kids, aging parents, etc. can also cause women to feel irritable, have trouble sleeping, or gain weight. It’s quite possible that these life stressors are the true catalyst for some symptoms or that the symptoms are being exacerbated by hormonal shifts.”

Women should make a list of symptoms they are experiencing to discuss with their doctors, especially because these symptoms can be signs of other, more serious health concerns.

“Episodic, cyclical hot flashes are common and not a cause for alarm,” Pinkerton says. “But suddenly waking up soaked in sweat could be a sign if something more dangerous, such as tuberculosis or a thyroid issue.”

Irregular periods are normal during perimenopause but could be the result of fibroids, blood clotting issues, or cancer. Dr. Stuenkel says, “If the woman is 42 or younger, she probably should have other disorders that can disrupt menstruation ruled out before attributing her lack of cycles to ‘the change.’”

Start by keeping track of your periods and document your symptoms before, during, and after, Dr. Pinkerton says. By charting symptoms in relation to periods, you can get a clearer picture of what is going on.

middle age woman sipping tea

The Coping Strategies 

There are many ways women can minimize the adverse symptoms of perimenopause. For starters, maintain a healthy lifestyle. This includes eating a healthy diet, exercising at least 30 minutes almost every day (including some weight training), and avoiding smoking or drinking in excess. Dr. Stuenkel says, “It’s best to be proactive and make these types of lifestyle changes before reaching menopause, when metabolism tends to slow down. It’s easier not to gain 10 pounds in the first place than to try to lose it.”

For women experiencing hot flashes, Pinkerton suggests avoiding triggers such as spicy foods, excess wine, and overheated rooms.

Emotional and mental symptoms can also be lessened. Dr. Pinkerton says, “Managing stress is the key to minimizing many other symptoms, such as brain fog, anxiety, and sleep disturbances. Consider self-calming techniques such as acupuncture, meditation, or behavioral therapy. If none of these work, ask your doctor about a low-dose birth control pill to control hormonal fluctuations or an antidepressant to ease emotional issues.”

And don’t underestimate sex. “Although many women experience a decreased sex drive as they enter menopause, using your vagina is one of the best ways to keep it healthy,” Dr. Pinkerton says. “Having sex is also good for your emotional well-being and helps you sleep better.” Women experiencing vaginal dryness can try over-the-counter lubricants or ask their doctor about hormonal creams.

Dr. Stuenkel reminds women to use birth control. “Just because you are not menstruating regularly does not mean you cannot get pregnant, so be sure to use protection.”

Most importantly, don’t fear perimenopause and the changes that may occur. “The most common misconception about perimenopause and menopause is how terrible it is going to be,” Dr. Stuenkel says. “Yes, it is a transition, and it can be a rough time. But it doesn’t have to be, especially if women know what to expect. It can actually be a very liberating time for women who are knowledgeable and make a priority of taking care of themselves physically and emotionally.”

Photos: Juanmonino, M-imagephotography

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