Managing Perimenopause

Engage with the West Michigan Woman Community!

Years before menopause, these sneaky symptoms can be confusing.

While most women don't reach menopause until after age 50, the symptoms of perimenopause begin much earlier. They often take women by surprise in their late 30s or 40s.

Rather than brushing them off, women's health experts say it's important to notice what's happening and talk to their providers.

"We have so many solutions to a whole variety of symptoms," said Sarah Arnold, MD, an obstetrician and gynecologist at Corewell Health. "There's no reason people have to suffer or be uncomfortable."

The first sign of perimenopause is a marked irregularity in menstrual periods.

"They may be closer together or further apart," Dr. Arnold said. "They can become heavier, or lighter."

Other changes can include mood swings, problems concentrating, trouble sleeping or changes in sexual desire. Migraine headaches and incontinence are less common symptoms.

For some, night sweats cause problems, more commonly associated with the year or so around menopause.

It helps to understand just how complex and variable the process is," Dr. Arnold said. "Patients come to me with so many questions," she said. "Often, they'll ask if we can test their hormones. ... But it's not that easy."

Some health problems, such as high blood pressure, can often be reduced to a set of numbers. Hormones are far more complicated.

"I could measure your estrogen one day and get a very different reading the next," she said.

There's tremendous variability in symptoms, Natasha Peoples, a nurse practitioner at Corewell Health, said.

"Some people suffer with extreme discomfort," Peoples said. "Yet there are also plenty of women who aren't nearly as affected. We often say that perimenopause is a little bit like puberty. It's unpredictable and everyone does it differently."

The duration of menopause also varies. While 51 is the average age of menopause, anywhere from age 40 to 58 is normal.

Perimenopause, meanwhile, can last four to eight years.

Many women sometimes suffer in silence, ignoring the changes and powering through. But it doesn't have to be that way. Medications can help manage everything from unwanted chin whiskers to a sleepy libido.

Lifestyle changes also help tremendously, Dr. Arnold said. She offered her tips for key changes:

To put it simply: Water is essential to temperature regulation. Drink plenty of it—it can help when you're battling hot flashes or nausea.

"Even a $200,000 Ferrari can't cool itself without water in the radiator," Dr. Arnold said. "It takes as little as two-tenths of a percentage shift in temperature to trigger a hot flash."

Physical activity can work wonders for all your body functions—physical, mental and emotional. Get into a habit of moving more. Even short walks can work wonders.

"It helps with moods. It helps people sleep better," Dr. Arnold said.

Many women gain weight during these transitions, in part because of shifting body composition. While there are plenty of reasons to strive for healthy body weight, menopause offers a new incentive.

"The more we weigh, the more pressure we put on our bladder," Peoples said. "That's a consideration for those who experience symptoms of incontinence in menopause."

Research has shown yoga significantly improves psychological symptoms linked to hormonal changes. It can often help with managing anxieties.

"You don't have to go crazy with anything intense, but even a few minutes sitting on your mat and stretching gently before bedtime makes a big difference," Dr. Arnold said.

While many people are introduced to Kegel exercises during pregnancy, these pelvic-floor strengtheners are also beneficial during perimenopause.

There are plenty of helpful how-to articles online about Kegel exercises and strengthening the pelvic floor. Your provider can also give you pointers.

It's important to talk about symptoms with a provider.

"We can deal with the most troublesome ones first," Dr. Arnold said.

Irregular periods, for example, may be managed by low-dose birth control pills. Tell your provider if your periods have become closer than 21 days—from Day 1 to Day 1—or if they've become heavier.

A class of antidepressants called SSRIs may help with some symptoms, such as might sweats and hot flashes, even in people who aren't depressed.

Depression and anxiety also merit a conversation. Hormonal changes can make symptoms worse, and it doesn't help that perimenopause typically occurs when women are in a high-stress part of life. They may have teenagers, or they may be caring for elderly parents.

"They are often mid-career, with plenty of work stress," Dr. Arnold said.

For low libido, medications may also help.

"We even have a nurse practitioner trained in sex therapy, with plenty of healthy strategies," Dr. Arnold said.

Peoples said it's exciting that both menopause and perimenopause—long-neglected areas of research—are finally attracting more attention.

"There are medications in development that target the brain neurons that trigger hot flashes," Peoples said. "And they're looking at the questions we've always had: Why do some women get these flashes and others don't?"

As women learn more about perimenopause, they'll find less to dread and more to look forward to.

"For many people, this is a beautiful time of life," Peoples said. Some women may experience an increase in libido and develop a better handle on stress.

"There's time to relax, the freedom to travel," Peoples said. "There are so many upsides. It just depends how you work with perimenopause symptoms, making sure that you're advocating for yourself."

Written by Sarah Mahoney for Corewell Health HealthBeat Blog.

This article was republished with permission and originally appeared at Corewell Health HealthBeat Blog.

 Photo Courtesy of Corewell Health. 


More stories you'll love