Perimenopause is your body getting ready to shift from the hormonal cycles that support fertility to new hormone levels in menopause. This transition usually begins in your early 40s to early 50s. It often lasts 4 to 8 years before your final period, and wild swings in your hormone levels can kick off a range of symptoms.
Your doctor can help
If the perimenopause symptoms are disrupting your life, it’s important to reach out to your health care team. Treatments are available to address the following symptoms and can help you feel like yourself again.
Heavy or irregular bleeding
If you’re experiencing heavier periods or breakthrough bleeding in between your periods, your health care professional may recommend a low-dose birth control pill or an IUD with progestin.
If you’re looking for a nonhormonal option, nonsteroidal anti-inflammatory drugs (NSAIDs) or tranexamic acid (Lysteda) may offer some relief. These can reduce prostaglandin levels, which are elevated in women with excessive menstrual bleeding. With heavy or irregular bleeding, a pelvic ultrasound may be recommended to check for polyps, fibroids or other causes.
Hot flashes
A low-dose birth control pill can offer relief if hot flashes are frequent or severe (or both frequent and severe) and difficult to manage in your daily life. An IUD along with an estrogen patch, which could also improve your mood, may be another option.
Mood or mental health changes
If you’re experiencing new anxiety or depression in perimenopause, tell your health care team right away. A low-dose antidepressant in the last two weeks of your cycle may help you get back to normal. For some women, a low-dose hormonal contraceptive can improve mood symptoms.
Headaches
New or worse menstrual-related migraines are a common symptom of the unstable hormones in perimenopause. If headaches are a problem, continuous low-dose birth control can help.
What you can do
Some symptoms of perimenopause are best tackled through changes you make to your daily routine and habits. What’s more, they can set you up for better health in menopause and beyond. While these aren’t flashy solutions, they can make a real difference in your health and happiness — now and in the long run.
Minimize weight gain
Extra pounds often start to creep on during this stage, even if you’re eating and exercising like you always have. Unfortunately, increasing activity alone usually won’t combat these midlife body changes.
Some shifts in your metabolism and body shape are related to aging rather than hormones. Both men and women tend to lose muscle mass and gain weight starting in midlife. But some changes, particularly in body composition, are likely related to the loss of estrogen. For instance, even if your weight doesn’t change overall in perimenopause, some weight tends to be redistributed to fat around the middle. This is not only annoying for buttoning your jeans — it may affect your
health. An increase in belly fat can raise your cardiovascular risk and risk of diabetes, even if your weight overall is in a healthy range.
The good news is that making some adjustments to your habits in this stage can have a lasting impact. A 2022 study published in the journal Menopause suggested that the perimenopause transition may be the most opportune time to focus on daily habits to improve your metabolism and minimize the changes to your body composition.
In particular, researchers suggested it may help to focus on preserving muscle mass in the menopause transition, through a diet higher in protein and lower in carbohydrates and activity such as resistance training. (As a bonus, activity that builds muscle helps protect against the loss of bone density during the menopause transition too.) In addition, moderate to high-intensity exercise also may help you fight the drop in metabolism that’s common in midlife. But more study is needed to know exactly how to fight these effects.
Limit alcohol
While you might enjoy a glass of wine to relax with friends or unwind at night, cutting back on alcohol can actually help your body deal with perimenopause symptoms. Alcohol increases anxiety and can disrupt sleep. In addition, some research has found that drinking alcohol can trigger and intensify hot flashes. And even if you have healthy eating habits overall, drinking the same amount that you used to may lead to weight gain.
Relevant reading
The New Rules of Menopause
The ultimate guide, offering real talk about menopause, straight, honest info for managing symptoms and the keys to optimizing your health for the long run – from one of the top doctors in the field of women's health and other experts from Mayo Clinic.
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