Perimenopause isn’t a term we hear often, but it’s something we should be talking about. It refers to the time in life when one’s body begins transitioning to menopause. Menopause is defined as when an individual has gone one full year without a menstrual period, and the average age of menopause in the U.S. is 51. Before this marker, perimenopause is associated with fluctuations in hormone levels, primarily estrogen, and, for many, shorter menstrual cycles and/or menstrual irregularities. These changes herald the end of one’s reproductive years.
Perimenopause is a natural part of aging and occurs as the ovaries gradually shut down. According to Harvard Medical School, perimenopause lasts an average of 3-4 years. Some experience symptoms for just a few months, though, while others are affected for more than a decade. People experience a range of symptoms during this time. According to Johns Hopkins Medicine, the most common perimenopausal symptoms include:
- Mood changes
- Changes in sexual desire
- Trouble concentrating
- Headaches
- Night sweats
- Hot flashes
- Vaginal dryness
- Trouble with sleep
- Joint and muscle aches
- Heavy sweating
- Having to pee often
- PMS-like symptoms
Contrary to the jokes we often see and hear in the media related to perimenopause, the experience of these symptoms is anything but funny. Some struggle significantly; as you can see, many aspects of life can be impacted. It’s important that we acknowledge the challenges associated with perimenopause, in others and ourselves.
Mood complaints are one of the more disturbing concerns experienced with perimenopause. Depression, anxiety, and irritability may set in or intensify. Those who have a mental health history, including any experience of trauma, are more likely to struggle at this time. Mood changes, akin to premenstrual syndrome, are also common during this time. Perimenopausal individuals might notice irritability, weepiness, moodiness, fatigue, and difficulty concentrating as they surf the waters of perimenopause.
Another major complaint of perimenopause are the vasomotor symptoms, the hot flashes and night sweats emblematic of this time. These are episodes of significant heat, predominantly in the upper body (the head, neck, chest, and back), often accompanied by sweating and flushing. Vasomotor symptoms are uncomfortable, stressful, and may be experienced as embarrassing by some.
Weight gain often accompanies perimenopause. Fat, in the form of adipose tissue, helps with estrogen production, so as this hormone drops, the body scrambles to produce more however it can. And, as hormones decrease, so does muscle mass, slowing the metabolism down. Genetics also play a role. Perimenopausal weight gain tends to accumulate around the abdomen, and many complain of bloating as well. Not surprisingly, we see a spike in eating disorder symptoms during this time, as individuals respond to weight changes with dieting and other forms of restrictive eating.
So what to do? How can people cope with perimenopause more effectively? Frankly, like many other (mostly) women’s issues, perimenopause is under-researched and under-funded. It would be really helpful if we were able to dedicate more time, attention, and money to understand how better to help people experiencing perimenopause. Here are few things to keep in mind for now:
Education: Learn about perimenopause. Do your research to gain a better understanding of what you’re experiencing. Sometimes, just knowing more is beneficial. It helps us to make sense of our experiences and reminds us we’re not alone. Sure, there’s a lot of information online and on social media, but if you’re going to use that, use it as a springboard for more research. Read reputable websites and books. Ask your medical professionals for information that is specific to you. An informative and engaging read is Heather Corinna’s What Fresh Hell Is This? Â A podcast that focuses on the physical and mental health impact of menopause and perimenopause can be found here.
Symptom management: Sometimes, the best approach is to address specific difficulties associated with perimenopause. For instance, interventions to help with vasomotor symptoms include lowering the air conditioning/using a fan when possible; wearing loose-fitting, layered clothing; staying hydrated; avoiding smoking; engaging in relaxation techniques, and taking certain medications (see below). The fatigue associated with menopause might be addressed with more rest and sleep, if possible. Trouble concentrating might be targeted by taking more frequent breaks while working and tracking concentration throughout the day to understand the best times in which to perform activities that require more concentration.
Therapy: Accessing professional support during menopause may be helpful to some and critical to others. Having an outlet to process symptoms and changes, as well as some guidance with coping can go a long way in getting through this time. Therapy seekers might look specifically for providers who are experienced in working with perimenopausal individuals and who lean into more behavioral solutions. While traditional talk therapy might always be useful, coping with perimenopause generally calls for a more behavioral, solution-oriented approach. Seeking out more seasoned providers might increase the likelihood of finding someone with lived experience.
Medications: A big decision point in perimenopause is whether or not to use medications. The most commonly talked about medical intervention is hormone replacement therapy (HRT), which can be delivered in various ways. If you’re considering this as an option, it’s important to have a detailed conversation with your provider regarding specific benefits and risks for you. Other medications that are commonly prescribed for those in perimenopause include antidepressants (to help with mood and vasomotor symptoms), anticonvulsants (same), and creams (for vaginal dryness). Herbs and other forms of complementary medicine are also available. It’s important to do your research on the efficacy of all interventions, as well as their applicability to you.
Acceptance: Perimenopause is challenging, as is aging, especially in an agist culture. So often, we focus on what we’re losing regarding beauty, ability, etc. One of the ways that people can get through perimenopause effectively is to shift their focus from loss to acceptance and even to what they’re gaining. Instead of fighting agains these natural changes, what if you leaned into them? Sure, they’re uncomfortable, but this is how it is. Bodies change. That’s a fact. So what if, and this is admittedly much easier said than done, we allowed for this reality rather than rejected it? And what if we focused on what we’re gaining, rather than what is lost? Increased clarity in our lives? A focus on other aspects of your identity? Greater boundaries and self-assuredness? These are shifts commonly referenced by menopausal folks.
Self-care: We hear this one a lot, and it’s especially important during perimenopause. When our bodies are changing and experiencing uncomfortable symptoms, it’s extra important to regulate what we can and to treat ourselves with kindness and compassion. Develop a sleep hygiene routine, going to bed and waking up at about the same time and reducing stress and stimulating sources (including your phone!) before bedtime. Do what you can to address stress levels in general. Engage in regular movement, if possible. Nourish your body. Stay hydrated. Be mindful of the use of mood-altering substances. Seek out social support and community. And finally, approach yourself with kindness, compassion, and grace.
Perimenopausal can be a challenging time but it doesn’t have to be an impossible one. The more we learn and accept and treat and care, the more effectively we might cope. And the more we talk about perimenopause, the greater likelihood that institutions and organizations will devote more time, attention, and money to study this critical stage of life, aiding folks for generations to come.