Perimenopause is a weird time—unlike when you get your first period, there’s no obvious marker that signifies you’ve started, and the symptoms vary widely between women. So you may be months or years into it before you realize what’s happening, particularly if it’s on the early side. (Most women enter perimenopause in their 40s, but some start in their 30s, and blood tests to detect whether you’ve started are unreliable.)
Dr. Stephanie Faubion, the medical director of The North American Menopause Society and medical director for the Mayo Clinic Center for Women’s Health, has five tips for recognizing and managing the symptoms of perimenopause.
1. Be Prepared for Wacky Periods
Your periods may get very heavy, or they may get lighter. They may arrive closer together or further apart. They may switch from one to the other—early one month, late the next. If you’ve had a regular schedule, don’t expect it to last. Most women have menstrual changes for 7 to 10 years before menstruation finally ends altogether.
“Ovaries do not turn off like a light switch. It’s not like one day they’re working, one day they’re not,” says Dr. Faubion. “They kind of flicker and flutter. So you can have these times when the ovaries work perfectly, and then without any identifiable trigger, things start to get wacky for a while. It’s really all over the map—there isn’t one thing that we can say will predictably happen for you.”
2. Treat Hot Flashes and Night Sweats
Hot flashes already?! Most women associate hot flashes and night sweats with menopause (about 80 percent of women get hot flashes after menopause), but a significant portion of women (35 to 50 percent) also get them during perimenopause, which can be disconcerting if you have no idea why you suddenly feel like you’re on fire.
For some women, they’re a rare occurrence and not bothersome enough to treat, but if yours are frequent or interfering with your life, then talk to your doctor. Dr. Faubion says that you shouldn’t count on this being a short-term problem; “We now know that hot flashes and night sweats last a median of 7 to 9 years, and about a third of us are going to hot flash moderately to severely for a decade or longer.” So consider long-term solutions.
“Hormonal contraception, like a birth control pill or ring, will stop hot flashes and night sweats during perimenopause—and it also takes care of contraception,” says Dr. Faubion.
3. Deal with Vaginal Dryness
Women are often reluctant to talk to their doctors about vaginal dryness, but this is a health issue that doesn’t go away; it gets worse with time. You can use vaginal moisturizers daily (just like facial moisturizer, except … down there) and lubricant during sex, but there are also effective medications available by prescription.
“You don’t necessarily have to have systemic hormone therapy to manage vaginal dryness; just vaginal products that contain low-dose hormones will help if that’s the only symptom. They’re given as a cream, vaginal insert, vaginal tablet, or vaginal ring,” says Dr. Faubion.
4. Practice Good Sleep Hygiene
Night sweats are one of the main reasons for sleep disruption during perimenopause, but sleep problems also increase around this time even without overheating problems. Expect that you may have more trouble falling and staying asleep, which means you have to work hard to maintain good sleep habits.
First, consider dressing lighter for bed and trying wicking or cooling sheets or sleepwear. But also watch your sleep routine: Dr. Faubion says to make sure you’re keeping consistent sleep and wake times (not going to bed significantly later on the weekends), staying away from screens before bed, and curtailing your alcohol and caffeine intake.
5. Make Dietary Changes
The most common complaint she hears from women in perimenopause is, “I’m gaining weight for no reason! I haven’t changed anything!”
What she tells them is this: “If you haven’t changed anything, then you will gain weight. Somebody changed the rules of your body and didn’t tell you. What’s worked for you your whole life isn’t going to work now.”
During this time period, our metabolic rate slows down: we lose muscle mass and burn fewer calories while doing the same activities. While exercise is great for lots of reasons, Dr. Faubion says it’s not effective for weight loss. “Exercise will help you not gain, and help you keep off weight that you’ve lost, but it will not take weight off—so you have to cut calories.”
While you’re eating healthier, also consider adding calcium: risk of osteoporosis increases during this time, and you can improve your odds just by adding another daily cup of milk (fortified almond or soy milk works, too).
As a final asterisked point, Dr. Faubion urges women to remember that even though their fertility is in decline during this time, they still need to use contraception to prevent pregnancy until they’ve been period-free for an entire year. Until that point, there is always a chance of a surprise “good egg.”
And even though there’s a lot to grumble about in the slide to menopause, keep the silver lining in mind: you’re getting ever closer to a period-free life!
Jenna Glatzer (www.jennaglatzer.com) is the author or ghostwriter of more than 30 books, including authorized biographies of Celine Dion and Marilyn Monroe. Her latest book is Waiting in the Wings: How to Launch Your Performing Career on Broadway and Beyond with Broadway star Tiffany Haas.