Managing Perimenopause: In Transit to Menopause

It’s inevitable that our bodies change with each life stage. Perimenopause, meaning “around menopause” are the transition years that lead up to menopause, the time when a woman’s periods and reproductive years end. Though each woman experiences perimenopause, and some more than others, managing perimenopause still seems to be this secret no one wants to talk about.

By demystifying and understanding how to mange perimenopause, we can navigate it successfully. And that’s something worth celebrating instead of fearing.

Stages of perimenopause

Perimenopause begins when your ovaries start to run out of viable eggs and wind down their function as a result. This causes fluctuations in the female hormones, especially estrogen, and progesterone, and this causes the symptoms of perimenopause (and menopause)[1].

Women start perimenopause at different ages; often beginning in the 30s or 40s and lasting for 5 to 10 years before menopause starts.  If you’re an otherwise healthy women over 45, perimenopause can be diagnosed by your physician or gynaecologist based on your symptoms and medical history. 

A blood test can measure your hormone levels such as estradiol (the strongest of the three estrogens produced) and FSH and AMH (hormones that control ovulation) and these may be suggested by your healthcare professional. If you’re using hormonal birth control though, these measurements may be invalid.

Initially, decreasing estrogen levels cause the most common perimenopause symptom, a change in your usual menstrual cycle. You may notice menstrual irregularity as your cycles may become longer or shorter or lighter or heavier than usual and you may even skip periods. Although these changes in menstrual bleeding are normal in perimenopause, they shouldn’t be overlooked. It is worth reporting to your healthcare professional since abnormal bleeding can be a sign of a problem.

As you progress through perimenopause, you may start to experience even greater menstrual cycle irregularity, along with hot flashes, skin changes, mood changes, sleep problems, and vaginal dryness. Your period will become occasional and eventually your periods will stop altogether.

After 12 consecutive months without a period, perimenopause ends and menopause begins. According to the American College of Obstetricians and Gynaecologists, the average age that women enter menopause is 51 years.

How to manage perimenopause symptoms

Every woman experiences the symptoms of perimenopause differently. Some have many symptoms and others have none, and these symptoms can also be mild or severe. For some women, symptoms come in waves and get worse before a period, as this is when estrogen levels are at their lowest in the menstrual cycle.

Hot flashes

A hot flash is a sudden feeling of heat that rushes to the upper body and face that lasts from a few seconds to minutes or even longer. Some women have hot flashes rarely and others have them daily. About one in ten women and men have hot flashes throughout their lives. Hot flashes that happen at night (known as night sweats) can wake you up.

Skin changes

Estrogen helps maintain our skin’s moisture and hydration. As estrogen levels begin to decline in the 30s, our skin thins and dries, causing wrinkles; and becomes unevenly pigmented. Skin changes can occur in perimenopause, including dryness, but breakouts can occur too. Perimenopause is sometimes called “reverse puberty” because of the breakouts and mood swings that can occur.

Mood changes

Mood changes are very common in perimenopause. Seventy percent of women report increased mood changes or irritability during perimenopause. Mood swings happen because estrogen and progesterone levels fluctuate throughout perimenopause into menopause. Lack of sleep can further affect mood. One thing you can do is find what triggers your mood. Knowing the cause can help you handle the stress better. 

Think about practicing mindful meditation or yoga to help manage perimenopause mood swings. 

Sleep problems

You may have insomnia (trouble falling asleep), or have trouble staying asleep and night sweats can disrupt your sleep too. Around 56% of women get less than seven hours of sleep a night during perimenopause. It’s worth discussing this with your healthcare professional if you aren’t getting enough sleep and if a sleep supplement might be a good option for you.

Vaginal changes

As your estrogen levels decrease, the lining of the vagina may become thinner, drier, and less elastic. It’s incredibly common, with studies showing that around 50-60% of women experience vaginal dryness. Reduced estrogen can also cause it to feel itchy, irritated or painful during sex.

Managing perimenopause

To be proactive in navigating this time of transition, educate yourself about perimenopause and its associated changes. Well known and trusted sources of information include the North American Menopause Society (NAMS) and the American College of Obstetrics and Gynecology.

Keep up a healthy lifestyle

Ensure you’re having a nutritious diet, sleeping well, exercising regularly (according to the CDC around 30 minutes per day, 5 times each week) and reducing stress. These are essential ingredients for maintaining good health and your overall wellbeing. Regular exercise, a healthy  diet as free as possible, from processed foods and added sugars, and de-stressing techniques like meditation and yoga can also help.

Check in with your health care provider to manage any existing health conditions, and have any new conditions or symptoms checked without delay. In particular, keep up your cervical, bowel and breast cancer screenings because these are important to keep you healthy now and into the future. Take note of your weight and blood pressure and try to keep these in the healthy range.

To combat the risk of reduced bone density from declining estrogen levels in perimenopause, focus on weight-based/ resistance and cardiovascular activities, and ensure that your diet has enough vitamin D and calcium.

Encourage an honest, open dialogue with your gynaecologist. You won’t be their first patient to experience perimenopause symptoms and concerns, nor will you be their last. In fact, the American College of ObGyn recommends young women have a first appointment between the ages of 13 and 15 to begin a trusted relationship early on, so that it’s easier to feel comfortable discussing and addressing perimenopause symptoms if they occur.

Know yourself and monitor your symptoms

It’s important to tune in to your body, because your perimenopause experience will be uniquely yours. The management and treatment of your perimenopause symptoms will depend on your individual needs.

Seek professional help if your symptoms become severe and interfere with your daily life by talking to your physician or gynaecologist. For example, if you experience significant and prolonged mood changes, your physician might suggest therapeutic options (such as antidepressants or psychotherapy) which are often very effective[1]. Vaginal dryness symptom relief is possible with the use of a high-quality, water-based vaginal moisturizer daily and doing so is important for maintaining your sexual activity and overall wellbeing.

Maintain intimacy

Honest communication with your partner is key to success in maintaining your intimacy and sex life. Know that women may take longer than men to become aroused – on average take 4-5 times longer than men.

Practicing pre-sex intimacy and using lubricants and moisturizers can help. These are available over the counter in stores and online, including FemmePharma’s Mia Vita Intimate Skin Care Line. Have an open mind to sex beyond penile penetration. If sex is too painful, cultivate intimacy in other ways – through conversations, other forms of touching (such as massage, hugging, back rubs) and kissing.

Practice self-care

Find practices to nurture your body, mind and soul, such as time in nature, yoga, meditation, spa treatment (at home or in a salon) or engaging in a hobby such as gardening, swimming or painting.

Reach out to others

Managing perimenopause symptoms is not a journey you have to take alone. Don’t hesitate to seek help from trusted sources such as knowledgeable friends or health professionals who will help you understand how to manage perimenopause.

Sources

1. Maki et al., Menopause: The Journal of The North American Menopause Society. Vol. 25, No. 10, pp. 1069-1085