What You Need to Know About Perimenopause

By Candice Wagener

While most women are familiar with menopause, many are unaware of the often lengthier preface to menopause, known as perimenopause. However, since symptoms of perimenopause vary for each woman in terms of frequency, intensity and duration, it can be difficult for a woman to pinpoint exactly when it starts for her. Overlooked yet very real, perimenopause is a common occurrence in a woman’s life that deserves some attention.

Dr. Beth Wiedel with Madison Women’s Health discusses this very topic with patients several times a week. Affecting women anywhere from their late 30s to their early 50s, perimenopause is a time “where the ovaries aren’t quite functioning like they used to,” says Wiedel. The ovaries haven’t shut off, she says, but they’re flickering like old-fashioned fluorescent lights.

In fact, the biggest indicator that a woman is going through perimenopause as opposed to menopause is that the symptoms are inconsistent. For some women symptoms may come and go for weeks or months at a time. For others, they may feel no changes at all but still be in perimenopause, says Wiedel.

The duration and intensity of symptoms are completely individualized. As hormones fluctuate, women may experience irregular bleeding, more intense PMS, vaginal dryness, hot flashes, night sweats and sleep disturbance. If, all of a sudden, you find yourself waking up throughout the night for no good reason, perimenopause could be to blame. Women who have a history of depression and anxiety may see an increase in symptoms there, too.

Also common is weight gain, because decreasing estrogen levels may lead to a reduction in metabolism. Women who maintained a certain weight for years will suddenly find themselves with an extra five to 10 pounds they just can’t shake. Increased exercise and decreased calories are your best bets for counteraction. “You need to do things to speed up your metabolism again, because it’s notched down a bit,” says Wiedel. “And I always warn women that [metabolism tends to slow down] even a bit more when you hit menopause, so this is a good practice run.”

In fact, 30 minutes of moderate- to high-intensity cardio daily can improve nearly every symptom of perimenopause (and menopause). Eating an array of healthy foods and limiting your intake of carbs, sugar and unhealthy fats will also keep you feeling better.

Women might seek treatment to help alleviate symptoms if they’re interfering with everyday health and happiness. Wiedel stresses the importance of exploring those symptoms and their impact with your healthcare provider. “This is actually a natural thing for you to go through,” says Wiedel. “But if this is impacting your ability to function the way you want to, then we’ll talk about treatments and pinpoint the symptoms that are really bothering you.”

Wiedel also says a lot of patients ask her about testing their hormone levels to see if they’re in perimenopause.

“Lab tests are just a snapshot in time,” she explains. “If we check your hormone levels two months later, we’ll have a different result. That’s why we treat perimenopause on the basis of symptoms — and not lab tests.”

To cover the broadest range of symptoms (including period regulation, PMS and hot flashes), options include the birth control pill or hormone replacement therapy (which contains smaller doses of estrogen and progesterone than the Pill). To address vaginal dryness specifically, options include hormonal and non-hormonal oral and topical medications that are absorbed into the genital tissues to help them become more elastic and moist.

Unfortunately, these medications don’t address sleep disturbances. When necessary, Wiedel will recommend a non-habit-forming sleep aid, some of which were designed as antidepressants originally, so they may have the added benefit of helping with mood fluctuations.

Although there are supplements out there like ginseng and soy to help alleviate perimenopause symptoms, Wiedel doesn’t recommend them to her patients because herbal supplements aren’t as strictly regulated by the FDA.

Like any major change in your health, whether it’s impacting your daily routine or not, it’s important to have an open discussion with your healthcare provider in order to rule out any other scenarios and narrow these changes down to perimenopause. Because every woman’s symptoms and intensity can be so variable, it’s important to get support and an outside perspective on what you’re experiencing. And, keep in mind, the average age of onset for menopause in the U.S. is 511⁄2. Once you’ve reached that milestone of going an entire year without a period, you can hopefully breathe a little easier and lean into this new chapter in your life.

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