Although perimenopause is a perfectly normal transition in every woman’s life, many of us are still in the dark about it and at an even greater loss when it comes to treating its many symptoms. Fortunately, our medical expert is here to help you understand what perimenopause is, what symptoms you’ll likely experience, and what options are available to treat them.

My mother never talked about it much. What exactly is perimenopause?

Perimenopause is the natural transition a woman goes through as she approaches menopause and her ovaries stop releasing eggs. Women begin to transition into perimenopause when the number of ovarian follicles, or sacs containing the egg, start to diminish and produce fewer hormones.

When can I expect to enter perimenopause and how long will it last?

The average age of perimenopause is 47, with the late phase occurring around age 49. Most women in the United States reach menopause at age 51. The perimenopause transition can last 4 or more years, however, there is quite a bit of variability. If the process starts earlier, the duration can be much longer and vice versa (late onset, shorter duration). Other factors such as your ethnicity and weight (more specifically, your body mass index) will also have an influence on how long it will last.

Other than hot flashes, what other symptoms will I experience?

The most common symptoms women report during perimenopause are hot flashes, poor sleep, vaginal dryness and painful intercourse. About 80% of women will experience hot flashes, a sudden intense feeling of warmth in the face, neck and chest often with heavy sweating. Hot flashes, as you may be experiencing, can last for several years after you have entered menopause.

Up to 50% of women will experience vaginal dryness which may be accompanied by urinary symptoms. You may also have trouble falling asleep, find that you wake up early, and experience interrupted sleep. Mood swings are also common during perimenopause and there may be a higher risk of you experiencing anxiety and depression as well.

Why is my period all over the place since entering perimenopause?

In the early stage of perimenopause, you may notice irregular menstrual cycles with shorter intervals (fewer than 21 days), more days of bleeding, and occasional missed periods. Some women may skip this early phase entirely. In the late transitional stage, the length of time between periods gets much longer and can increase to more than 60 days, and you are more likely to experience symptoms such as hot flashes. If you have no periods for twelve months, you have reached menopause.

I’m not sure if I’m in perimenopause or not. Can it be diagnosed?

Since the onset of perimenopause is caused by a decrease in the functioning of your ovaries and a reduction in the hormones they produce, you may be wondering if there are laboratory tests that measure these, and if the results can tell you with certainty if you are perimenopausal. Unfortunately, the answer is no. Follicle stimulating hormone (FSH) is often measured but is not always a reliable indicator because it varies so much. Levels of anti-mullerian hormone (AMH) can predict when you might reach menopause within 4 years, but the test is not commercially available.

So, the bottom line is that your age, menstrual history and symptoms are the most reliable factors that determine if you are perimenopausal. But this approach will only work if you do not already have a history of irregular periods or underlying health issues that may obscure your symptoms.

I don’t know what’s worse, my hot flashes or vaginal dryness. What can I take to get some relief?

There is a very long list of FDA approved estrogen preparations to treat hot flashes in menopausal women.  Estrogen containing creams, rings or tablets can also be used to improve vaginal dryness and some urinary symptoms during the transition phase and through menopause. Birth control pills and other forms of hormonal contraception such as patches and vaginal rings can reduce hot flashes and night sweats and are FDA approved for use until menopause. It’s recommended that you start with lower dose birth control pills, which are probably safer.

I’m not comfortable taking hormone treatments. Are non-hormonal therapies effective?

For women who may not want to take hormone therapy or are unable to take it for health reasons, there are a few FDA approved medications that are effective in reducing symptoms. Paroxetine mesylate can be prescribed to treat hot flashes, and Ospemifene is an alternative medication approved for vaginal dryness. Remember, there are also over-the-counter lubricating gels such as Astroglide and K-Y jelly or moisturizers such as Replens and Vagisil that can bring relief.

Antidepressants, known as selective serotonin reuptake inhibitors (SSRIs), may also help reduce hot flashes. Gabapentin, a drug that is normally used to control seizures, may be very effective for treating hot flashes that occur mostly at night. There are no menopause-specific treatments for sleep disturbances, though your healthcare provider may recommend behavior modification techniques to help with problems falling asleep, and medications that increase the production of melatonin which can also improve sleep.

What alternative or herbal treatments help treat perimenopause?

There are many alternative therapies being used to treat menopausal symptoms and studies are ongoing to determine their safety and effectiveness. Research suggests that relaxation techniques, mindfulness, and cognitive behavioral therapy can reduce some menopausal symptoms and are safe. Hypnosis, when performed by a qualified hypnotherapist, has also been shown to improve sleep, sexual function and reduce hot flashes by as much as 50%.

A variety of herbal products are often used by many women, but the results from studies are not consistent, and more studies are needed to determine their benefit and safety. For example, studies on the North American plant Black Cohosh (Cimicifuga Racemose) have found that even though the evidence is not conclusive about its benefits, there is enough positive evidence that suggests more research is warranted.

Remember that herbal products have the potential to interact with any number of medications, so if you are considering taking herbal products to treat menopausal symptoms, it’s important to consult a healthcare provider who is qualified in integrative and holistic medicine.

I’ve been hearing a lot about plant-based “hormones.” What are they and are they effective?

Phytoestrogens are compounds that come from plants and can behave like estrogen in your body.  There are two types of phytoestrogens: isoflavones are found in soybeans, red clover, chickpeas, and legumes, and lignans are found in flaxseed, whole grains, certain fruits and vegetables. Studies have reported very mixed results about whether or not phytoestrogens, when taken from food or supplements, are able to reduce menopausal symptoms.

Perimenopause is so difficult. What advice do you have to help me get through it?

Perimenopause is certainly not without its challenges, but a wise patient with a healthy attitude towards the inevitable once said, “This too shall pass.” Knowing it won’t last forever and having a clearer understanding of what to expect during perimenopause and how to manage it should help you stay the course. If you think you might be in perimenopause, take heart and schedule an appointment with your gynecologist to discuss the treatment options that are right for you.

Margueritte Mabry is a medical writer who writes about health topics related to women’s health and alternative medicine. She is also an award-winning short fiction author. She received her M.D. from Temple University School of Medicine and completed a four-year residence in Obstetrics and Gynecology at Mount Sinai School of Medicine in New York City.

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