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Are You in Perimenopause?

5 min read  |  May 28, 2024  | 

The few pounds you recently gained, and your bouts of insomnia might be perimenopause. Here’s what to do now.

It’s not unusual for women to experience anxiety, bouts of insomnia and decreased sex drive during the hectic years of investing in careers, raising children and caring for aging parents. This makes it easy to miss signs of perimenopause and to know when to get help from your provider.

Perimenopause marks the transition to menopause and can begin as early as the mid-30s. It lasts until menopause, which is the point when you haven’t had a menstrual period for 12 consecutive months. During perimenopause, you can simultaneously experience menstruation and symptoms of menopause.

Your provider can confirm if you’re in perimenopause based on your symptoms and lab test results.

While perimenopause is a natural phase that all women experience, recognizing its signs and understanding how to manage its symptoms can significantly improve your quality of life during this transitional period.

Common signs of perimenopause

Irregular periods

One of the earliest signs of perimenopause is a change in menstrual cycle patterns due to fluctuating progesterone levels. This may cause a shorter time between periods in what can feel like more than one cycle a month. For someone used to having 28 or 30 days between periods, this interval can shorten to around 25 or 26 days in perimenopause.

Weight gain and metabolism changes

Weight gain is a common and frustrating issue for women during perimenopause. Your metabolism naturally slows down, leading to weight gain even if your dietary habits remain unchanged. Maintaining the same weight once perimenopause starts means reducing calories and increasing exercise.

Sleep problems

If you’re suddenly waking in the night for no apparent reason, this might be an indicator of perimenopause. Hormonal changes in the brain can interfere with sleep, leading to fatigue and difficulty concentrating during the day.

Mood swings

Hormonal fluctuations also can cause mood swings, irritability and an increased risk of depression and anxiety.

Hot flashes

Hot flashes are the most well-known symptom of perimenopause and menopause. They subside eventually but can last several years. Speak to your provider if hot flashes interfere with your quality of life.

When to see a doctor for perimenopause care

If perimenopause symptoms are interrupting your quality of life, a provider who specializes in menopause care can help. Your provider may recommend lifestyle changes, over-the-counter treatments or hormonal replacement therapy (HRT) to relieve symptoms.

There are instances when it’s important to seek medical advice:

  • Heavy or unusual bleeding: If you experience very heavy periods, periods that last several weeks or spotting between periods, visit your provider to rule out other conditions such as fibroids, polyps or cancer.
  • Severe symptoms: If symptoms like hot flashes, mood swings or sleep disturbances are severe and negatively impact your quality of life, consider discussing treatment options with your provider.
  • Other health concerns: Speak to your provider if you have other health issues that could be exacerbated by perimenopausal symptoms, such as cardiovascular problems or osteoporosis.

Tips for managing perimenopause and menopause:

Establish the right provider for this new stage of life

It’s important to maintain annual exams with a gynecologist or healthcare provider. Perimenopause might be a reason to establish a new relationship with a provider who’s more familiar with menopause symptoms and treatment.

For example, if you typically get a pap smear at your primary care visits and are having symptoms of menopause, you may want to see a gynecologist who specializes in menopause. The North American Menopause Society lists providers with special certification in menopause care. Many providers, even without this extra certification, are well-versed in caring for women in this stage of life. Asking about a provider’s approach to hormone replacement therapy is a good indicator of who typically treats menopause symptoms. It’s important to find a provider who is knowledgeable and comfortable discussing HRT and other menopausal treatments.

What is hormone replacement therapy (HRT)?

HRT can be effective in treating hot flashes, night sweats, vaginal dryness and mood swings by replenishing estrogen levels. HRT is not suitable for everyone, so discuss the risks and benefits with your provider.

When using HRT, following up consistently with your provider if you experience any side effects is important.

If HRT is not right for you, other prescription medications can help you manage perimenopause symptoms, such as a low dose of antidepressants and vaginal creams, rings or tablets to relieve vaginal dryness.

Lifestyle changes to improve perimenopause symptoms

Besides HRT, eating a healthy diet, getting enough sleep and exercising are even more important in this new stage of life. The decrease in estrogen in perimenopause and menopause can increase cardiovascular risks. This makes taking care of your health by eating a balanced diet, exercising and getting enough sleep even more essential in this new stage of life.

  • Diet: A balanced diet rich in fruits, vegetables, whole grains, and lean proteins can help manage weight and provide essential nutrients. Foods rich in phytoestrogens, such as soy, flaxseeds and legumes, may help balance hormones naturally.
  • Exercise: Thirty minutes of regular physical activity, at least three to four times a week, helps maintain a healthy weight, boosts mood and improves sleep. Exercise also helps your muscles balance insulin, the hormone responsible for regulating blood sugar levels..
  • Sleep hygiene: Establishing a regular sleep routine, keeping your bedroom cool and avoiding caffeine and electronics before bedtime can improve your sleep quality.

Perimenopause is a natural part of aging, but it doesn’t have to diminish your quality of life. Recognizing the signs and exploring various treatment options, you can navigate this transition with confidence and ease. Establishing a good relationship with your provider and being open to discussing all options is key to managing perimenopause effectively.


Flavia Fairbanks Lima de Oliveira, MD, PhD

Written by Flávia Fairbanks Lima de Oliveira, M.D., Ph.D., a gynecologist with the University of Miami Health System


Tags: aging process, Dr. Flavia Fairbanks Lima de Oliveira, gynecology, women's health

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