Medical experts (and society) are finally starting to take menopause seriously. But navigating pre-menopause symptoms, a.k.a. perimenopause, can frankly still be kind of infuriating. The problem? “It’s sort of a retrospective diagnosis,” says Mary Jane Minkin, M.D., a menopause specialist and clinical professor of obstetrics and gynecology at Yale.
Perimenopause (which literally means “around menopause”) is the time when your body’s hormone production starts to decline and you begin the transition into menopause. “Perimenopause marks the beginning of a continuum of irregularity and unpredictability with each cycle,” says Lizellen La Folette, M.D., a board-certified OB-GYN and medical advisor for Stripes. “The process is gradual and each month brings a full state of flux. Depending on your ovaries and follicles (technically termed your ovarian reserve) perimenopause can begin in your 30s or earlier.”
Most people with ovaries enter perimenopause sometime in their 40s, though some women experience early menopause symptoms as young as their mid-30s. “During perimenopause, estrogen and testosterone levels start to decline in an inconsistent manner, thereby causing a wide range of menopause-like symptoms,” says Somi Javaid, M.D., a fellow of the American Congress of Obstetricians and Gynecologists and founder and Chief Medical Officer of HerMD. In the fallout, irregular menstrual cycles, hot flashes, night sweats, mood changes, and impacts on your sex life are all common. “Symptoms may appear gradually over time, although some women can remain completely asymptomatic.”
In other words, it’s hard to definitively diagnose perimenopause before you officially enter menopause (which starts after you’ve gone a full year without a period—the average age of which is 51). “Blood work is also not spectacularly helpful during this time,” says Dr. Minkin. “The problem is the ovarian function is declining, but it’s not a linear curve. Some days your ovaries are going to be cranking out a ton of estrogen and some days they’ll be cranking out nothing. When you go to check somebody’s lab values, they may be in perimenopause but have a totally normal estrogen level because blood was drawn on a good day for their ovaries.”
That doesn’t mean you and your doctor can’t still treat pre-menopause symptoms. Here’s what you need to know.
What are some pre-menopause symptoms?
Symptoms of perimenopause very closely mirror menopause symptoms. They include:
- Hot flashes and night sweats (FYI: “Women can experience more night sweats and hot flashes during perimenopause than in menopause,” says Dr. La Folette.)
- Mood swings
- Weight gain
- Breast changes
- Irregular periods
- Bladder changes, including the frequent urge to urinate and incontinence
- Trouble sleeping
- Fatigue
- Hair thinning or hair loss
- Vaginal dryness and pain during sex
When you start experiencing any of these symptoms, it’s time to start a conversation with your doctor. “The conversation with your doctor should be twofold,” says Dr. La Folette. Since your risk of cardiovascular disease also increases during this time, “first, establish a baseline understanding of your cardiovascular health by knowing your numbers: blood pressure, blood glucose, and cholesterol. Then track and discuss changes in your moods and cycles.”
What are treatments for perimenopause symptoms?
Since pre-menopause and full-blown menopause symptoms are largely the same, perimenopause is often treated with standard menopause treatments. “This starts with a doctor-patient conversation where we discuss the benefits and risks of hormone replacement therapy (HRT), and then the woman gets to decide,” says Dr. La Folette.
For years hormone therapy has been controversial, thanks to a 2002 study that linked the use of estrogen therapy to an increased risk of breast cancer. Subsequent research has exposed flaws in the original study’s design and found that the benefits of hormone replacement therapy far outweigh the risks. “Hormone therapy is the most effective treatment for perimenopausal symptoms,” says Leah Millheiser, M.D., an OB-GYN, NAMS-certified menopause practitioner and the chief medical officer of Evernow. During perimenopause, this could come in the form of a low-dose birth control pill to help even out fluctuating hormone levels, or as a combination of estrogen and progesterone therapy. (Keep in mind, you can still get pregnant in perimenopause.)
Aside from standard menopause treatments, lifestyle changes make a big difference in treating pre-menopause symptoms. “I recommend maintaining a healthy weight, exercising regularly, and getting plenty of sleep. And watch your alcohol intake, as drinking can exacerbate sleep problems,” says Dr. La Folette. For vaginal dryness, she recommends a gel lubricant like Vag of Honor.
Bottom line, talk to your healthcare provider about treatment options if you think you’re experiencing signs of perimenopause.
Macaela MacKenzie is a writer and editor specializing in wellness. She writes about self-care, mental health, fertility, and women’s equality with a focus on breaking down stigmas in women’s health.
