Are you getting hot and sweating (but you’re not watching Heated Rivalry)? Waking up at night for no reason? Do you experience unexpected mood swings? If so, it could be perimenopause.
And it can be difficult to figure out perimenopause because there is no single test and the symptoms vary widely and often overlap with other conditions.
Here’s what you need to know about perimenopause symptoms and treatment options.
What is Perimenopause?
Perimenopause is the transition period before menopause. During this time, your ovaries gradually relax and your body prepares to stop having periods.
Unlike menopause, which is defined by a year without a period, perimenopause is more difficult to define and every woman’s experience is different. It’s also complicated if you’ve had a hysterectomy, ablation or hormonal IUD because your period isn’t a reliable marker, said Mary Jane Minkin, MD, clinical professor in the department of obstetrics, gynecology and reproductive sciences at Yale University School of Medicine and a member of the HealthyWomen Women’s Health Advisory Council.
How early can perimenopause start?
The average age of menopause in the United States is 51, and for most women, perimenopause begins at age 40 and lasts an average of four to seven years, sometimes over a decade. “[Perimenopause] is a longer hormonal process for women than people may have realized,” explained Nina Ali, MD, a board-certified obstetrician/gynecologist in the department of general obstetrics and gynecology at Texas Children’s.
Stress, certain medications, cancer treatments, or removal of the ovaries can trigger earlier perimenopause. Genetics can also influence when the brain, pituitary gland, and ovaries change.
What are the symptoms of perimenopause?
Perimenopause can have a variety of symptoms that vary from person to person. Some days it can seem like there are hundreds of symptoms, but here are some common perimenopause symptoms:
- Irregular periods
- Hot flashes and night sweats
- vaginal dryness
- Pain during sexual activity
- Burning, itching or irritation in the vulva
- Increased vaginal infections
- Weight gain
- Migraine attacks or headaches, especially at certain times in your menstrual cycle
- Depression or anxiety
- Sleep disorders
- Brain fog
- Pain and discomfort of the musculoskeletal system
Is there a diagnostic test for perimenopause?
It may be surprising to hear this, but health care providers don’t need blood tests to diagnose perimenopause, Ali said. “Many tests are possible, but management is less about specific laboratory values and more about recognizing the overall process that we know is taking place.”
Hormone levels such as estrogen, progesterone and follicle stimulating hormone (FSH) fluctuate daily and treatment usually does not change. Instead, your doctor will review your medical history, your symptoms, and any treatments you have already tried.
Noting your cycles and symptoms on an app or calendar can help you and your HCP track your symptoms.
What is hormone therapy?
Hormone therapy (HT) is a prescription medication approved by the FDA to treat menopausal symptoms such as vaginal dryness, hot flashes, night sweats, and pain during sex. HT can be systemic, meaning it is absorbed into the bloodstream and used to treat symptoms such as hot flashes and night sweats. Systemic HT is administered via pills, patches, sprays, gels, or a vaginal ring.
Low-dose HT, also called vaginal estrogen therapy, goes directly into the vagina and very little enters the bloodstream. This treatment is specifically used for vaginal and urinary symptoms of menopause.
If you are a candidate for HT, timing is important. The best time to start is within 10 years of your last period, during perimenopause or early menopause, when this will reduce cardiovascular and other risks and provide the greatest benefit.
Minkin says low-dose birth control pills (BCPs) are often used first if you don’t smoke or have risk factors for blood clots. BCPs contain estrogen and progestin (a man-made version of progesterone) and completely suppress ovarian function, reducing these hormonal fluctuations.
Hot flashes and sleep problems often respond well to HT. But it can help every woman differently. “What we don’t know is whether it loosens the joints or gives you more energy – some of those things are harder to measure,” Ali said. Sometimes doctors will ask you to try HT to see if your symptoms improve.
Are there non-hormonal options for treating hot flashes?
Minkin pointed out that there are other options besides HT that can help manage hot flashes.
Non-hormonal, FDA-approved options include:
- NK receptor antagonists
- An antidepressant, a selective serotonin reuptake inhibitor (SSRI)
Other prescription options that are not FDA-approved for the treatment of hot flashes – but have shown some benefits – include additional antidepressants, an anti-seizure medication, and an antiseizure medication typically used to treat overactive bladder.
If you suspect you may be in perimenopause, it’s a good idea to look for a provider who has experience managing menopause. The Menopause Society has a searchable directory of providers who specialize in menopause care, called The Menopause Society Certified Practitioners (MSCPs), to assist you in this transition.
This educational resource was created with support from Astellas, a member of the HealthyWomen Corporate Advisory Council.
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