Maybe your periods have gotten a little unpredictable or you’ve found yourself waking up weirdly sweaty in the middle of the night. Have you stepped into premenopause territory?
Well, no — but that’s only because premenopause isn’t really a thing. But you might be dealing with perimenopause, which is the actual term for the phase leading up to menopause. (Kinda confusing, right?)
So how can you know for sure that this is what you’re dealing with? And more importantly, how can you cope — and when will it actually end? Here’s everything you need to know.
Real quick, before diving into the details, let’s clear up the difference between premenopause and perimenopause.
- Premenopause is simply the time of your life before you hit menopause. Basically, you’re premenopause from the time your periods start until they stop.
- Perimenopause is the phase in which your body transitions from its reproductive years to menopause. During this time, production of the hormone estrogen starts to fall, which causes your period to become irregular and eventually stop altogether.
- Menopause is when your body’s estrogen factory turns off completely and your periods stop altogether. You’ll know you’re there once you’ve gone a full year without a period.
How can you tell if you’re in perimenopause? The first sign is usually a change in your usual menstrual cycle. Your periods might start coming earlier or later, and you might even miss some months altogether. When your period does come, it could also be heavier than usual.
For many women, perimenopause causes more than just wacky periods. It’s also common to experience symptoms like:
- hot flashes
- insomnia and night sweats
- vaginal dryness, which can make sex painful
- having to pee more often, or having more frequent UTIs
- heart palpitations
- mood swings
- breast tenderness
- acne flare-ups
As for getting pregnant during perimenopause? It’s absolutely still possible, but you could face more challenges. The ovaries release fewer eggs during perimenopause. Plus, less regular periods could make it harder to figure out when you’re most fertile.
Every woman’s body is a little different, so it’s hard to pinpoint an exact time when you’ll enter perimenopause — and how long it will last before you reach menopause.
Perimenopause typically starts in your late 40s or early 50s. But it can sometimes come sooner, as early as your mid- to late 30s. Again, your periods becoming irregular is usually the first sign that things are ramping up.
Some lucky women only experience perimenopause symptoms for a few months before their periods fizzle out altogether. But more often, you’ll be in it for the longer haul — anywhere from 4 to 10 years.
As you reach the homestretch to menopause, you might notice that your symptoms intensify as your estrogen levels start dropping at a faster rate.
You’ll know you’re past perimenopause and have finally reached menopause once your periods have stopped for a full year. The average age for this momentous event? 51.
Perimenopause symptoms can range from annoying (I definitely did not expect my period today) to straight up miserable (I wake up drenched in sweat every night and trying to have sex hurts).
But no matter what hand you might be dealt, there are ways for managing your discomfort and feeling more normal.
Hormone therapy involves taking estrogen and progestin — or just estrogen, if you’ve undergone a hysterectomy.
Systemic hormone therapy, which is given as a pill or patch, is the best option for managing hot flashes and night sweats, and it can also ease vaginal dryness. If vaginal dryness is your only issue, you can also use a local therapy like a vaginal ring, tablet, or cream.
The treatments come with some big risks, though. Hormone therapy can increase your chances for heart disease, breast cancer, endometrial cancer, blood clots, and gallstones, and they’re not recommended for women who’ve recently undergone treatment for breast cancer.
Your doc can help you weigh your individual pros and cons and help you figure out the right move for you.
Other prescription drugs
If you’re dealing with severe symptoms but want to avoid hormone therapy, you have other options. Hot flashes and sleep problems can also be managed with certain antidepressants, antiseizure meds, and blood pressure meds.
Selective estrogen receptor modulators (SERMs) can help with hot flashes and vaginal dryness.
Vaginal dryness that isn’t super intense can often be managed with drugstore products. Water-based lubricants like Astroglide or K-Y jelly can be good if the dryness only bothers you during sex.
If it’s more of an ongoing issue, you can opt for a vaginal moisturizer like Replens of Vagisil. Just steer clear of any lubes or moisturizers with glycerin, which can sometimes cause itching or burning.
Making some changes to your daily routine might be enough to keep mild to moderate perimenopause symptoms in check — and they may be worth trying before moving on to prescription treatments. Try things like:
- Avoiding hot flash triggers. Notice that caffeine or spicy foods tend to bring on hot flashes? Steering clear or limiting your intake can make a difference. Wearing layers that are easy to remove, keeping your bedroom cool at night, and quitting smoking (if you smoke) can also help keep hot flashes in check.
- Eating more plants. Soy-based foods, chickpeas, lentils, flaxseed, and whole grains contain phytoestrogens — plant estrogens that could potentially help ease symptoms.
- Exercising more. It’ll help you sleep better and boost your mood. Aim for at least 30 minutes of moderate to vigorous movement every day. Yoga can be particularly helpful if you’re dealing with stress or anxiety.
- Losing weight. Having a higher body mass index seems to make women more prone to hot flashes — but losing weight has been shown to help.
One of the most popular supplements for perimenopause symptoms is the herbal extract black cohosh. But experts say there’s not enough quality evidence to recommend it, and it might potentially pose a risk to your liver. It could also be unsafe if you have or are at high risk for breast cancer.
Isoflavone supplements derived from soy or red clover are another possible option, but again, there’s not much proof that they’re useful, and they could potentially raise the risk for breast cancer.
The bottom line? Herbal supplements aren’t an automatic no, but they may not be the best option. If you’re thinking about taking an herbal supplement to wrangle your symptoms, talk with your doctor first.
Perimenopause is a completely normal part of a woman’s life, and if you’re able to handle the symptoms on your own, there’s no need to get medical attention.
But if issues like hot flashes, mood swings, sleep problems, or vaginal dryness are affecting your quality of life, you should absolutely loop your doctor in.
You should also give your OB/GYN a heads up about significant changes to your periods. While some irregularity is normal during perimenopause, you should call the doctor if your periods are extremely heavy or go on for more than 7 days, if you have bleeding in between periods, or if your periods are less than 21 days apart.