Understanding the signs, symptoms of perimenopause can help
Published on Friday, November 1, 2024
By: Rachel Vanderford, rvanderford@umc.edu
One day everything is going smoothly, and the next, you’re battling hot flashes, sleepless nights and mood swings. Welcome to perimenopause, the phase of life where hormonal shifts can feel like a roller coaster ride, turning daily routines into unexpected twists and turns.
Perimenopause, meaning “around menopause,” refers to the period leading up to menopause when a woman’s body undergoes significant hormonal changes. It can last anywhere from a few months to several years. During perimenopause, estrogen and progesterone levels fluctuate, leading to irregular menstrual cycles. This is the transition phase before menopause is reached, which is when a woman hasn’t had a period for 12 consecutive months.
Perimenopause generally begins in a woman’s 40s, but some women may notice symptoms in their late 30s. The average age for the onset of perimenopause is 45, though it can vary widely depending on individual health and genetic factors. The transition usually lasts about four to eight years, with menopause typically occurring around age 51.
The symptoms of perimenopause can be diverse and unpredictable due to fluctuating hormone levels. Common symptoms include irregular periods, hot flashes and night sweats, mood swings, irritability, anxiety, brain fog, difficulty sleeping, vaginal dryness, decreased libido, weight gain, bone pain, changes in skin and hair texture and fatigue.
“Every woman experiences perimenopause differently,” said Dr. Sheila Bouldin, professor of obstetrics and gynecology. “Some may have only mild symptoms, while others experience more intense changes. Many perimenopause symptoms, such as fatigue, mood swings or irregular periods, can overlap with other conditions like thyroid disorders, depression or stress.”
To distinguish between perimenopause and other health concerns, women should consult with their health care provider for a thorough evaluation. Blood tests can measure hormone levels, such as follicle-stimulating hormone and estradiol, which can indicate if a woman is in perimenopause.
During perimenopause, estrogen and progesterone production by the ovaries becomes irregular. Estrogen levels can fluctuate dramatically, causing many of the symptoms women experience. Progesterone levels also decline, leading to changes in the menstrual cycle and sometimes heavier or more irregular bleeding.
“Because ovulation can be unpredictable, I recommend women consider contraception. Nonhormonal options can also help manage symptoms, and in certain cases, low-dose oral contraceptives are effective for patients with irregular bleeding due to perimenopause and vasomotor symptoms," Bouldin said.
These hormonal shifts can also impact several other systems in the body, including sleep patterns, mood regulation and bone density.
"One of the most effective treatments for menopausal vasomotor symptoms is hormone replacement therapy, though it may not be suitable for every patient,” she said.
HRT can help stabilize hormone levels and reduce symptoms like hot flashes and vaginal dryness. Other treatments include antidepressants for mood regulation and medications for bone health or sleep issues. It’s important for women to discuss these options with their doctor to determine the best approach based on their individual health.
“These issues require a multi-faceted approach,” said Josie Bidwell, associate professor of preventive medicine and director of the UMMC Office of Well-being. “Priorities include seven to nine hours of sleep, which will help maintain our circadian rhythm, decrease food cravings and provide the energy we need to get and stay active. Exercise and stress management are also crucial pieces to include.”
“The key to getting restorative sleep is having a plan and sticking to a routine,” she said. “Good sleep rarely happens by accident."
Start by setting a consistent bedtime and wake-up time to get your body into a rhythm. Watching TV or scrolling your phone or laptop right before bed can disrupt your circadian rhythm and cause difficulties winding down and staying asleep. Bidwell recommends removing screens an hour before bed to help fall asleep faster.
As estrogen levels decline during perimenopause or menopause, some women may experience decreased bone density—leading to an increased risk of osteoporosis—and a loss of lean muscle mass, which can result in reduced strength and metabolism. Bouldin said patients will also often complain of bone pain during this time. To combat this, Bidwell suggests a combination of aerobic and muscle-strengthening exercises but notes that “the best type of exercise is the one you will do consistently.”
Mental health also plays a foundational role in overall health regardless of life stage—perimenopause and menopause are no exception. The hormonal fluctuations during perimenopause can have a significant impact on mental health, contributing to mood swings, anxiety, depression or irritability. Women may also experience cognitive changes, such as memory lapses or difficulty concentrating. Support from health care providers, therapists and support groups can help women manage these changes. Cognitive behavioral therapy has been shown to be particularly helpful for addressing mood swings and anxiety.
“We do see some increase in depression, anxiety and mood changes during this time period,” Bidwell said. “Some of this may be compounded by the fact that women in their 40s and 50s may often be at the height of career and family pressures. The PHQ-4 screening tool is a quick four-item screener for depression and anxiety. If you score above zero, it is worth discussing with your health care provider about strategies to combat these feelings.”
It can often feel overwhelming when you look at all the things that can be impacted by these hormonal shifts and the steps it takes to combat negative effects. To create sustainable lifestyle adjustments, start small. Instead of focusing on accomplishing them all at once, focus on just one thing until you become consistent with it. Once you’re comfortable with that, you can add in another healthy habit.
“Don’t be afraid to talk about these things with your health care provider,” Bidwell said. “A lifestyle medicine clinician is also a great partner in helping you build a sustainable lifestyle change. You are most definitely not alone in dealing with menopausal issues.”
“The best advice for women preparing for menopause is to stay informed, maintain open communication with healthcare providers, and prioritize self-care,” said Bouldin. “Understanding the changes their body is going through can help women feel more empowered during this transition. Emphasizing a healthy lifestyle, seeking support, and exploring treatment options can also make the journey smoother and more manageable.”
Call 601-815-9114 for more information or to schedule an appointment with the Department of Obstetrics and Gynecology, or 601-984-2233 to reach the Department of Lifestyle Medicine.
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