Understanding perimenopause: symptoms and treatment

For many women, perimenopause can be complex and confusing. When does it begin? When will it end? Are my symptoms normal? What’s going on with my hormones? These are common questions that beg sound answers. If you’re entering into the period of perimenopause, or are in the throes of it as we speak, read on to gain a better understanding of its symptoms and treatment.

What is perimenopause?

Perimenopause is a period of time in a woman’s life that’s characterized by irregular menstrual cycles and hormone fluctuations that are a precursor to menopause. It can last for anywhere from a few months to a decade, but the the average is four years. Perimenopause ends when it’s been a year since your last period, which also marks the beginning of menopause, the time when your ovaries no longer make eggs. While menopause marks a set point in time, perimenopause simply means near or around menopause, as peri is the Greek word for near or around. This denotes a transitional time. And, as we all know, transitions can be downright challenging.

Perimenopause typically happens to women in their 40s, as this marks the average decade in a woman’s life when the ovaries don’t work as well as they used to. During this time, the hormones estrogen and progesterone both decline. Some women experience symptoms as early as their 30s, and in rare cases, in their 20s. Everyone is different. At some point, all women will experience a decline in estrogen and progesterone, and the estrogen decline will become even more dramatic in the last couple years of perimenopause. At this time, women typically begin experiencing symptoms of menopause.

Perimenopause symptoms

The following are the most common symptoms of perimenopause. They range in scope. Some symptoms are mild, others severe. Most are normal. If you’re confused about what’s going on, visit your OBGYN to discuss symptoms and treatment. You’re not alone. All women must journey through this transition, however difficult it may be. Have compassion for yourself.

Night sweats and hot flashes

One of the most infamous perimenopausal symptom is the dreaded hot flash. This may come on in the middle of the night. You wake up in a strange sweat, unable to sleep. Your sheets are damp with sweat and it’s not because your bedroom temperature is too hot. These sweats occur because of hormonal fluctuations. While some of us associate hot flashes with menopause, they’re actually one of the most common symptoms of perimenopause.

Hot flashes typically last between 5 and 10 minutes, and 35-50% of women report getting them. While many women get them in the middle of the night, they can also come seemingly out of nowhere during daytime hours. Hot flashes range in severity from an overall feeling of warmth to extreme sweating. Your upper body might sweat, and your face may become flushed. You may experience a rapid heartbeat, and even tingling in the fingers.

For the majority of women, hot flashes become a thing of the past 1-2 years after menopause begins. However, some women continue to experience hot flashes for years after menopause. Hormone replacement therapy can help with hot flashes, as can certain pharmaceutical drugs.

Hot flash triggers

Hot flashes seemingly come out of nowhere, but there are certain triggers that might exacerbate them, such as:

• Drinking alcohol
• Experiencing more stress and anxiety than usual
• Drinking or eating too much caffeine
• Smoking cigarettes
• Being in a hot room or hot climate
• Eating extra-spicy foods
• Having your head below your heart when you bend over

Heavy bleeding and irregular periods

Many women experience heavy bleeding during perimenopause. This happens due to your body’s decrease in progesterone, which is the primary hormone that regulates the endometrium. Less progesterone equals a thicker endometrium, which in turn results in heavier periods. Some women also get fibroids, which are small growths on the uterus. This also happens when progesterone wanes.

With the hormonal fluctuations that happen during perimenopause, it stands to reason that your periods will also become irregular. This can be disconcerting for many women. Know that it’s normal and a natural part of the perimenopausal process. Your period may be heavy one month, and light the next. It may last for 2 days, then a full week. Irregularity is the theme here and the best thing to do is go with the flow, so to speak.

Vaginal dryness

Your vaginal tissues become drier and thinner during this time due to the drop in estrogen levels. As a result, you might experience vaginal dryness, which can make sex painful. It can also lower your libido and cause itching and soreness. You may want to try a lubricant to make sex more enjoyable. A healthy sex life can be of benefit during perimenopause, so find ways to get yourself in the mood and continue enjoying your love life.

Difficulty sleeping

Your hormones are responsible for so many bodily functions, sleep included. Many women experience sleep issues during perimenopause due to ever-changing hormones. Give yourself plenty of time to fall asleep and know that there’s good reason for sleep troubles. Approximately 40% of perimenopausal women report sleep disturbances. If you’re one of them, you’re certainly not alone.

Commit to a regular sleep routine and enjoy relaxing activities before bedtime, such as hot baths and calming aromatherapy remedies. If you experience vaginal dryness, hot baths can exacerbate this issue, so pay attention do that. A nighttime yoga routine that calms the mind and body can also help relax you before bed.

Make sure your bedroom is conducive to sleep. Blackout curtains, white noise, and an optimal room temperature support good sleep. Get rid of all electronics and close down the computer and cell phone an hour or so before you hit the hay. Read a book that relaxes you, and surround yourself with warm lamplight and candlelight. Keep an aromatherapy diffuser on your bedside table and fill it with lavender or marjoram essential oils.

Mood swings

One thing you can count on during perimenopause is your changing mood. You may be up one minute and down the next. You might feel as if you’re riding an emotional roller coaster you can’t get off. Your mood swing might be more severe if you’re sleep deprived. Take it easy and do things that bring you joy. This is your time to pamper yourself with love and care.

Mild memory issues

Those fluctuating hormones are also responsible for bouts of forgetfulness. You may find yourself misplacing your keys and reading glasses. You might have trouble focusing and getting work done. You may not remember things that came so clearly to you before perimenopause. Again, this is normal, so don’t freak out. The forgetfulness should pass post-menopause.

Bone loss

Lower estrogen levels sometimes result in bone loss. If you suspect this might be the case, make sure you’re exercising regularly and getting plenty of weight-bearing activity in. Take vitamin D supplements, as well as calcium. Spend time walking and resisting a sedentary lifestyle. In severe cases, medication may be in order.

Low energy

You may find your energy levels aren’t what they used to be. You’re likely to be more tired and fatigued during perimenopausal years. Enjoy an afternoon siesta when you can. Naps can be a godsend during this time. Don’t feel bad if you feel lazy. This is your body’s way of coping with the hormonal fluctuations. Give yourself the rest you need.

How hormone replacement therapy can help

As you know now, your hormones affect nearly every area of your life. When it comes to tinkering with them, we need to use the necessary caution. The goal with hormone replacement therapy is to balance the hormonal fluctuations that accompany perimenopause. But, because we’re all so different, and because hormone replacement therapy affects each woman differently, we must be guided with patience and expertise if we’re to follow this route. There are no one-size-fits-all hormone replacement therapy methods. It’s a treatment that needs to be carefully tailored to fit each woman’s body.

The gist of hormone replacement therapy involves taking medications that contain hormones, especially the ones your body is lacking (or making lower levels of). For women whose perimenopause symptoms are severe, hormone replacement therapy can be a godsend. Many scientific studies provide solid proof that this treatment has many benefits for perimenopausal women, especially those who experience severe vaginal dryness, painful sex, night sweats, hot flashes, and significant bone loss. Hormone replacement therapy also helps prevent osteoporosis.

Hormone replacement therapy isn’t for every woman, but it might be for you. Two primary forms of HRT exist. Estrogen replacement therapy (ERT) replaces only estrogen and works for women who’ve undergone a hysterectomy. Estrogen-progesterone therapy (EPT), replaces both hormones, and is typically prescribed to women who still have their uterus. The hormonal changes that accompany perimenopause can be wild and wacky. Finding balance is the aim of HRT, as well as relief from overwhelming symptoms. Seek expert advice and guidance as you navigate these profoundly feminine changes.

Support hormonal shifts naturally

You can make your perimenopausal years more manageable by leading a clean, healthy lifestyle. Here are a handful of ways to support your hormones naturally:

• Clean up your diet by feeding your body nutrient-dense foods. If you have foods in your fridge or pantry that are processed, refined, or packaged, throw them out. Hydrogenated oils, refined grains and sugars can make female issues worse.
• Make sleep a priority. While trouble sleeping is a perimenopausal symptom, do your best to rest well. You’ll be helping matters immensely if you give more attention and care to your sleeptime. Keep to a regular schedule and pamper yourself with natural relaxation aids when possible.
• Exercise regularly. Your hormones need exercise no matter where you are in life. Make movement fun by practicing yoga or pilates, walking nature trails, biking around your neighborhood, or swimming in a salt water pool or natural body of water. (Chlorine isn’t great for hormones, but if swimming is your thing and there’s no other option, by all means hit the pool!) Cardiovascular exercise will brighten your mood and help you sleep better at night.
• Relieve stress. Perimenopausal hormonal shifts can really stress you out. Do your best to relieve stress and anxiety by whatever healthy means work for you. Exercise, massage, yoga, and meditation are all great options. Keeping a journal can help you make sense of it all. While you may want to find relief in alcohol, enjoy your spirits in moderation, as alcohol can further depress your system, and make wacky hormones even wackier!

At OB/GYN Associates of Alabama, we can help you understand how to experience optimal sexual health and transition into and out of both perimenopause and menopause as smoothly as possible. Contact us to request an appointment today.