The Natural Journey of Perimenopause

Feel a sudden warmth in your body when you’re otherwise healthy? Wake up drenched in sweat but the room temperature is chilly? Welcome to perimenopause.

You’re probably familiar with the term menopause, but what exactly is perimenopause? As with all aspects of life, there is a natural progression in your reproductive cycle. As your estrogen and progesterone levels decrease and your ovaries slow the production of eggs, perimenopause typically unfolds over a period of years.

For some, it can be a matter of weeks. Others may experience symptoms over the course of a decade. Think of perimenopause as a journey, not a destination.

Perimenopause Age—What's The Average?

Since perimenopause is a process where symptoms ebb and flow, it may be hard to recognize the changes as they occur. For most women, perimenopause starts in their 40s, but some experience symptoms earlier. On average, these symptoms last four years. The average age of menopause for US women is 51.

Perimenopause Happens Over Time

You can begin perimenopause without even knowing it. As your ovaries make less estrogen and progesterone, your period may become lighter—or heavier—than usual or briefer and more frequent. This change in your body’s cycle is often the first sign that you’ve entered perimenopause.

Because you’re still ovulating, you can become pregnant during perimenopause even if you miss your period for a month or more. If you’re not trying to become pregnant, it’s important to use birth control until one full year after your last period. Talk to your doctor about the type of birth control that’s best for you.

Every Woman Is Different

Not all women experience perimenopause symptoms. These occur in varying degrees among 75 percent of all women, but you tend to hear about perimenopause from the women who experience severe symptoms, such as intense hot flashes, mood swings, and depression.

Most women have minimal or moderate issues, and there are factors such as obesity and stress that increase the likelihood of severe symptoms. With the help of your doctor, you can manage and even minimize perimenopause symptoms.

Diagnosing Perimenopause

It’s usually not necessary for your doctor to run tests to know you’ve reached perimenopause. But in some cases, other health conditions can cause similar symptoms. If your doctor is unsure about these health conditions, they can run blood tests that reveal increases in follicle-stimulating hormone (FSH) and decreases in estrogen.

Shifts in FSH hormones show that perimenopause is the cause. There are also tests that show levels of thyroid-stimulating hormone in the blood. If these levels are low, an underactive thyroid may be the cause of your menopause-like symptoms.

Perimenopause Symptoms

In the perimenopause stage, your hormones can fluctuate dramatically, which can make it hard to pinpoint the cause of symptoms. Skipping your period or experiencing a lighter or shorter than usual menstrual flow are some of the first signs.

Hot flashes, night sweats, and insomnia are the most common complaints among women experiencing perimenopause. Mood swings, anxiety, and depression often increase as well. As your hormone levels decrease, the following perimenopausal symptoms may occur one to two years before you reach menopause:

  • vaginal dryness
  • hot flashes
  • chills
  • night sweats
  • insomnia
  • moodiness
  • weight gain and slowed metabolism
  • thinning hair
  • dry skin
  • loss of breast fullness

These symptoms can come and go and may be brought on by triggers, such as stress. No two women experience perimenopause in exactly the same way. Keeping a diary of your symptoms and possible triggers may help you identify ways you can modify your lifestyle or diet to help you minimize the discomfort.

If your symptoms are embarrassing, uncomfortable, or disrupt your daily life, talk to your doctor about how you can best manage your perimenopause symptoms.

Perimenopause Treatment

There is no magic cure for perimenopause, but your doctor can help manage many of your symptoms through prescribed treatments, as well as home remedies. You should always talk to your doctor before starting any new treatment, including over-the-counter and herbal remedies. Some of the most common treatments include:

  • Hormone therapy: Helps reduce hot flashes and may prevent bone loss.
  • Vaginal estrogen: Relieves vaginal dryness, discomfort during sex, and some urinary symptoms.
  • Low-dose antidepressants: Help reduce hot flashes and mood disorders.
  • Gabapentin: Help reduce hot flashes.
  • Calcium and vitamin D supplements or other osteoporosis treatments: Aids in strengthening bones.
  • Vaginal lubricants: Increases comfort during sex.
  • Incontinence treatments: Various lifestyle changes and medical options for gaining bladder control.
  • Herbal and dietary supplements: May relieve hot flashes and other menopausal symptoms.
  • Exercise: Stimulates heart and bone health and maintains healthy weight.
  • Diet: Helps manage healthy weight.

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Natural Hot Flash Relief

 If you experience hot flashes, there are a variety of easy remedies that can provide relief.

  • Try the herbal remedy, black cohosh.*
  • Dress in layers that can be removed during a flash.
  • Wear fabrics that breathe easier.
  • Turn down the thermostat or use a fan.
  • Keep cold drinks on hand and splash cold water on your face.
  • Avoid caffeine, alcohol and tobacco.
  • Exercise regularly.
  • Avoid spicy foods.
  • Maintain a healthy weight.
  • Practice relaxation and meditation.
  • Consider acupuncture.

*Talk to your doctor before taking any over-the-counter herbal or vitamin supplement.

Is Insomnia Really a Wake-Up Call?

Hormonal swings are common during perimenopause and can impact your ability to get a good night’s sleep. These sudden shifts may also contribute to increased irritability, anxiety, and depression. Busy women, especially those juggling family and work, may ignore these symptoms until they impact their health and/or relationships.

If you’re consistently not sleeping through the night, it may be a wake-up call to take better care of yourself. Talk to your doctor about treatment options.

Is Hormone Replacement Therapy Right for You?

For some women, remaining on the birth control pill offsets perimenopausal symptoms. For others, hormone replacement therapy (HRT) provides relief well into menopause. Replacing lower levels of estrogen and progestin may be the answer to relief perimenopausal symptoms, but there are many other factors that you and your doctor should consider first.

Since the risk of taking estrogen goes up as you age, you and your doctor should consider lifestyle and genetic factors before determining whether hormone replacement is right for you. If you smoke, have a history of blood clots or stroke, or experience severe migraines, you should avoid HRT.

Perimenopause Ends

Perimenopause symptoms may come and go for years before your period stops altogether. You officially reach menopause 12 months after your last menstrual period.

When Should You See a Doctor About Perimenopause Symptoms?

With all the changes happening in your body during perimenopause it can be difficult to know what’s normal and what’s not. That’s why it’s important to talk to your doctor about any symptoms that cause discomfort or disruption in your daily life.

If you experience hot flashes exclusively at night, sudden weight loss or gain, or abdominal pain, swelling, or tenderness let your doctor know as these may indicate a more serious condition.

North American Menopause Society Certified

Our providers have been certified by the North American Menopause Society (NAM). NAM is the leading nonprofit organization dedicated to promoting the health and quality of life of all women during midlife and beyond through an understanding of menopause and healthy aging.