By Dr. Sherry Ross
By the age of 45 or so, there’s a good chance you already considered how perimenopause would affect you. There’s no accident that this period of hormonal disruption has been referring to for years as “the change.” You’ve most likely wondered: how will “the change” change me?

It’s different for everyone, but the constant questions I hear are: Will I have crazy uncontrollable bleeding for weeks on end? Will drenching sweats come on when least expected? Will sex become painful and sexual intimacy a thing of the past? To you all I say hold on there. First let’s talk about what exactly happens in perimenopause.

Perimenopause happens when your ovaries cease to function consistently, thereby upsetting your normal hormonal rhythm. This hormonal change usually happens within a couple years of menopause, but for some it can happen much earlier. The erratic and disruptive symptoms of perimenopause tend, however, to mark the beginning of menopause. Every decade brings about some emotional and physical change, but for women, the decade of one’s forties may pack the biggest punches of all. Between the typical 40-something anxieties of shifting relationships (divorce and dealings with hormonal or college-bound teens), self-esteem issues, job challenges and other midlife stresses, one’s 40s are challenging enough without the hormonal upheaval. In your forties, it’s not just life’s stresses that are affecting you emotionally and physically, it’s “the change,” the symptoms of which include, unfortunately:

  • Irregular, erratic and heavy periods
  • Night sweats and hot flashes
  • Mood swings with depression and anxiety
  • Short term memory loss and trouble focusing
  • Low sex drive (libido)

In order to be certain that you are, indeed, hitting up against perimenopause and not some other disease or disorder that may resemble it, such as PMS, thyroid disorder, depression or early Alzheimer’s, it’s important to check in with your healthcare provider. A thorough medical history should be taken, along with a blood panel and a pelvic ultrasound in order to complete the final diagnosis.

Treatment and Tips for Perimenopause

There are many different symptoms of perimenopause, and each may be treated differently.

  • Heavy and irregular periods – The best treatment for this problem tends to be with hormones. Low dose oral contraception is at the top of the list as a way to control periods. Experiment with different pills in order to find the one with the least side effects. Other means of treatment include: cyclic progesterone, IUD with progesterone (Mirena), Hormone Replacement Therapy (HRT), and non-hormonal alternatives such as acupressure and herbal therapy.
  • Hot flashes – Dressing in layers and staying in cool temperature are the first steps in dealing with these flashes. Air conditioning is your friend! Plan ahead. Bring a cooler with ice to put to your hands or feet. If you know that hot beverages, spicy foods, red wine and hot climates bring on hot flashes, avoid them (if possible). Herbal remedies may include black cohosh and other traditional Chinese medicine. Also, acupressure may help with mild hot flashes.
  • Mood swings – Antidepressants are effective in controlling depression, anxiety and panic attacks. A therapist may also give added support. And, of course, exercise, the elixir to all. When you exercise there’s a natural release of mood-boosting endorphins and serotonin, the “feel good” hormones that your body can naturally produce.
  • Low sex drive (libido) – Testosterone therapy may be helpful for low libido. For help with a dry vagina, vaginal lubricants such as KY and extra virgin coconut oil are a good and cheap investment. Sometimes, once you gain control of the annoying hot flashes, irregular bleeding and emotional distress of perimenopause, sexual interest is regained and your libido is rescued.
  • Lifestyle and healthy eating – I’ve said it numerous times in answer to many problems, a well-balanced and colorful diet of fruit, vegetables, whole grains, and nuts and a limiting of saturated fats, oils, sugar and dairy will help! Find an exercise routine that will keep you interested well beyond this perimenopausal period.
  • A good night’s sleep – A given? Unfortunately, it’s usually a luxury. We all crave it, but hot flashes can mess with one’s sleep patterns. First and foremost, avoid excessive caffeine and alcohol (if you don’t care to give it up entirely). Seriously, consume your favored vices in moderation. They’re not bad, per se; it’s just better to have less. I’d shoot for one large cup of coffee in the morning and not more than three to four alcoholic beverages a week. Set a regular bedtime, limit your liquids after dinner (so you need not take a midnight bathroom break) and try a warm bath before bed. Is your mattress comfortable and supportive? If not, make it so. And lastly, put your electronic devices (phone included) far from your night table. You don’t need the lure or the light of them at bedtime.
  • Acupuncture – This ancient Chinese treatment for maintaining health and vitality by balancing energy flow works for many and most medical conditions. For women especially, headaches, lower back pain, menstrual cramps and the nausea and vomiting related to pregnancy are helped through acupuncture. Even though the studies are not conclusive, hot flashes and heart palpitations may improve with acupuncture treatment. The believers are devout and many. This simple, ancient treatment can work well without causing side effects.
  • Reassurance – Sometimes what we need most is a thorough understanding of exactly what is happening physiologically, if only to realize that what we’re going through is normal and, most important, that we are not crazy. Therapy and support groups are often helpful in navigating this hormonal obstacle course.
  • Perimenopause can be a challenging and confusing time in a woman’s life. The good news is that the symptoms of this hormonal havoc are, for the most part, temporary—which means that they can last one to eight years, depending upon your body’s reaction to your ovaries shutting down the production of estrogen. During this period life starts to move in slow motion and it seems like the hormonal upheaval will never end. Be aware that there are helpful remedies and sensible solutions. It’s always best to follow up with your healthcare provider so you don’t feel as though you are going crazy!