It’s time to have the talk about perimenopause.
Millions of women in the U.S. experience symptoms of this natural stage of life, yet the condition is often overlooked, misunderstood, and underdiagnosed. Studies show that only 20 percent of women know what perimenopause is, and many health care providers don’t receive the training to recognize and manage its symptoms.
That big information gap leaves a lot of women left to “tough it out” or suffer through their rocky road to menopause.
What is perimenopause?
Perimenopause is the transition period between a woman’s reproductive years and menopause. During this stage, the ovaries gradually produce less estrogen, causing periods to become irregular or unpredictable.
As estrogen decreases, hormone levels fluctuate, which can feel like a not-so-fun rollercoaster ride. While it’s all a natural and normal part of life, perimenopause brings some physical and emotional symptoms ranging from uncomfortable to severe.
When does perimenopause begin?
Most women start to notice perimenopause symptoms between the ages of 40 and 44, but it can happen as late as your mid-50s or as early as your 30s.
The early onset of perimenopause isn’t fully understood, but factors that may contribute to it include:
- A family history of early menopause
- Smoking or tobacco use
- Early onset of menstruation
- A history of cancer treatment
- Surgical procedures, such as the removal of the uterus or ovaries
What are the symptoms of perimenopause?
Every woman experiences perimenopause differently. Some may have few or no symptoms, while others deal with a myriad of issues that can vary from mild to severe. Some women even compare perimenopause to puberty.
The most common early sign of perimenopause is changes to your period. Your menstrual cycle may become shorter or longer, heavier or lighter, or happen less frequently.
In addition to irregular or missed periods, there are more than 30 other symptoms associated with perimenopause. The most common ones that women experience are:
- Hot flashes: Fluctuating estrogen levels can cause a sudden feeling of intense heat, sweating, and flushed skin. As many as three out of four women report hot flashes during perimenopause.
- Sleep disruption: Hormonal changes may make it difficult to stay awake or fall asleep. Night sweats can also disturb sleep.
- Vaginal atrophy: Low estrogen causes vaginal tissue to lose elasticity and thin, leading to dryness, pain, irritation, and bleeding after sex.
- Mood changes, anxiety, or depression: Hormonal changes, combined with other perimenopause symptoms, can impact both your physical and mental wellbeing.
- Weight gain: Hormonal imbalance can cause changes in your metabolism, or how the body converts food to energy. They can also lead to changes in eating patterns.
Other common signs include:
- Joint pain
- Bladder leaks
- Decreased sex drive
- Brain fog
- Changes in hair, skin and nails
As if perimenopause isn’t challenging enough, many women in their 40s and 50s are also managing other stressful life events. Midlife often brings more responsibilities, such as caring for aging parents, guiding teens into adulthood, juggling career pressures and coping with age-related health issues. These additional stressors can worsen the physical and mental symptoms of perimenopause.
How long does perimenopause last?
Many women mistakenly believe that perimenopause lasts for around a year. The reality is that the average length is closer to four years, according to the National Institutes of Health. Some women may experience it for a few months, while others take a decade to make the transition.
The only way to know you’ve made it past perimenopause is when you haven’t had a period for at least 12 months. At that point, you’re in menopause.
Can I still get pregnant when I’m in perimenopause?
You may be less likely to get pregnant as your fertility declines during perimenopause, but it’s still possible. Even if your periods are irregular, you’re still ovulating.
Until you’ve gone a year without a period, you should continue using contraception if you don’t want to get pregnant.
How is perimenopause treated?
Not all women need treatment for their perimenopause symptoms. However, if your symptoms bother you or interfere with your quality of life, it’s time to talk with a health care provider. They may recommend medication to relieve your symptoms.
Depending on your needs, your provider may suggest:
- Hormone therapy (HT): HT is most often used to treat common symptoms in women who go through perimenopause at what’s considered a normal age. The treatment uses estrogen or estrogen and progesterone to increase hormones.
- Hormone replacement therapy (HRT): Similar to HT, HRT is typically used to manage symptoms in women experiencing early perimenopause (before age 40).
- Birth control pills to stabilize hormone levels.
- Antidepressants to help with hot flashes, mood swings, anxiety, or depression.
- Prescription medications to reduce hot flashes, such as Gabapentin (Neurontin); Oxybutynin; and Fezolinetant (VEOZAH).
- Vaginal creams to alleviate pain during sex and ease vaginal dryness.
What can I do about my perimenopause symptoms?
As your body changes, it might be a good time to reassess your wellness routine. While not a replacement for medical treatment, a few lifestyle changes may help regulate hormones and metabolism and ease your perimenopause symptoms:
- Eat a healthy diet: Focus on fruits, vegetables, whole grains, lean proteins, and healthy fats. Avoid sugary drinks, desserts, and foods high in saturated fats, which can make symptoms worse.
- Exercise regularly and incorporate weight-bearing exercises, such as walking, hiking, and strength training.
- Create a cooler environment: Lower the thermostat or use a fan.
- Improve your sleep experience: Turn off your phone, computer, or TV at least an hour before bedtime.
- Find ways to destress: Yoga, meditation, or deep breathing can help improve sleep, anxiety, depression, and fatigue.
- Avoid triggers: Steer clear of alcohol, caffeine, spicy foods, and tobacco products, which can worsen symptoms like hot flashes.
When should I see a doctor for my perimenopausal symptoms?
Many women have mild perimenopausal symptoms that don’t need treatment. But if you’re concerned about your symptoms or if they interfere with your day-to-day life, you should seek medical advice.
While its symptoms are more common than women realize, they can overlap or mimic those of other health issues, including thyroid disorders, fibromyalgia, anemia, and neurological conditions. A health care evaluation is the only way to ensure you have the right diagnosis and treatment.
You should also see a health care clinician if you:
- Show signs of early perimenopause: Symptoms before the age of 40 may signal an underlying cause.
- Have abnormal bleeding: While irregular periods are common in perimenopause, other conditions like infections, fibroids and polyps can also cause irregular bleeding. Seek medical care if you experience:
- Very heavy periods or you notice large blood clots
- Periods that last several days longer than usual
- Spotting or bleeding between periods
- Bleeding after sex
- Periods less than 21 days apart
Indigo is here for life’s ups and downs
If you’re experiencing perimenopause symptoms or just don’t feel like yourself, don’t dismiss it as nature taking its course. Perimenopause symptoms are real, and it’s important to listen to your body and advocate for your health.
Indigo is here to support you through your perimenopause journey. And we’re open every day from 8 am to 8 pm to make it easier to get the care you need on your busy schedule. You can walk into one of our convenient neighborhood locations or book a same-day or next-day appointment online.
One of our friendly clinicians will evaluate your symptoms, review your medical history, and perform a physical exam to help determine the right diagnosis. If necessary, we’ll refer you to a specialist.
If you’re dealing with anxiety or depression, Indigo Virtual Care offers mental health screenings for adults 18 and older. Simply complete a quick questionnaire on your favorite device and connect with a trusted clinician via video.
