Most of us think of menopause as something that happens in our 50s. So there is often confusion when symptoms like hot flashes start popping up in our 40s. Yet perimenopause, including symptoms, always precedes menopause and often begins in our 40s. Because so many of us don’t expect to experience menopause symptoms before age 50, we may not recognize them for what they are. This can be confusing and lead to the wrong treatment or no treatment at all.
Here’s a list of perimenopause symptoms published by WebMD. Most women will experience at least some of these as their ovaries produce less and less estrogen.
- Hot flashes
- Breast tenderness
- Worse premenstrual syndrome
- Lower sex drive
- Irregular periods
- Vaginal dryness; discomfort during sex
- Urine leakage when coughing or sneezing
- Urinary urgency
- Mood swings
- Trouble sleeping
And here are some more possibilities from Dr. Joshua Gonzalez (The Sex Ed Blog):
- bloating, weight gain + slowing of metabolism
- thinning hair + drying of skin
- loss of breast fullness
- GI dysfunction
- osteoporosis + muscle aches
- cardiovascular disease
- pain with sex
- irritative urinary symptoms (other than frequency/urgency)
- recurrent vulvovaginal/urinary infections
- increased anxiety
- orgasmic dysfunction
These lists of symptoms are daunting to say the least. But it’s better to be prepared for the possibilities than to be blindsided in the midst of hormone-fueled changes. It’s important to note that the probability of one of us experiencing all of these bullet points – or even most of them – is improbable. Additionally, symptoms come in a wide range of severity. For example, not all women experience hot flashes – probably the most reported menopause-related symptom (behind irregular periods) and some that do experience them find them to be barely noticeable. Still others report hot flashes as debilitating.
Symptoms should trigger a visit to your healthcare professional, certainly if you are younger than 40. But all of us with noticeable symptoms should rule out other causes like thyroid disease, because it can be mistaken for menopause and requires a different type of treatment.
What To Do When the Going Gets Rough
You have choices. And if you’re like most of us, you have some reading to do before you feel tuned in to the facts about menopause. Educating yourself before you meet with a doctor will empower you to ask the right questions and determine whether you’re consulting with the provider who is right for you.
One important choice is all about hormone replacement.
Hormone Replacement Therapy
Menopause symptoms are driven by deficiencies in estrogen, progesterone and testosterone. So it makes sense that treatment with hormone replacement therapy (HRT) would be helpful in reducing symptoms. HRT should be considered individually and always involve a discussion with your doctor. It can be administered as a pill or injection (systemic) or applied topically (local).
Systemic treatment has been shown to improve mood, energy and muscle strength while locally applied hormones can help with vaginal dryness by improving tissue health and restoring the ability to lubricate.
The subject of treating symptoms like hot flashes, irritability and vaginal dryness with hormone replacement has not always been considered safe. In fact, this type of treatment took a big hit in the early 2000s following the results of some major studies. More recent research has shown that HRT is safe for many women. Read more about what the experts at The North American Menopause Society have to say on the subject.
You may also want to read this informative article published by the Mayo Clinic. It talks specifically about treatments, risks and benefits.
Natural & Supplements
There are a variety of over-the-counter remedies that claim to treat menopausal symptoms – not to mention natural supplements like black cohosh, red clover, Dong quai, evening primrose oil, maca, soy, flax seeds, ginseng, valerian, chasteberry – to name a few. If you decide to go this route, be sure to do your own research and discuss with your doctor before starting anything. Unfortunately, we can’t assume that over-the-counter means it's safe. Better to have your doctor weigh in on what is safe for you based on your symptoms, medical history and underlying health.
Yes, that kind of therapy. And it’s not just for depression. It can also be helpful to talk to someone, like a therapist, when you’re dealing with issues around body image, self-esteem and relationships. It’s not uncommon to feel inundated with physical changes that affect our mental health during perimenopause and beyond.
This article from Harvard Health will give you a professional perspective on menopause and mental health.
Like with all things, good health and lifestyle choices can play a role in laying the right foundation for perimenopause, menopause and post-menopause. That’s not to say that healthy people won’t experience symptoms, but overall health and lifestyle have been known to mitigate some of the troublesome aspects of this time of life.
Diet & Nutrition
There is a lot of consensus when it comes to recommendations for what to eat during perimenopause and menopause. The experts agree that more plant-based foods and less meat is the way to go. The Medierranean Diet is often recommended, because it is rich in plant-based foods, fish and healthy fats and discourages eating processed foods. According to the Harvard T.H. Chan School of Public Health, the Mediterranean diet is “excellent for heart health, blood pressure, brain health and weight loss.”
I’m not advocating for the Mediterranean Diet – that’s your decision, hopefully based on your own research and maybe a discussion with your doctor or nutrition expert. But it’s a good example of the type of eating that works well during perimenopause and menopause. Whether you decide on a formal diet, like the Mediterranean, or you come up with a plan of your own, the goal should be to eat foods that are anti-inflammatory with the right nutrients to support your body during this time of change. Most experts agree that incorporating dairy products, healthy fats, whole grains, fruits, vegetables, foods high in phytoestrogens and quality sources of protein into your diet is your best bet when it comes to staying healthy and relieving menopause symptoms.
Here’s where you can read more about the kinds of foods to eat (and not to eat) from the experts at WebMD. But don’t stop there! Resources abound when it comes to proper diet and nutrition from perimenopause through post-menopause.
It’s best to keep it moving for as long as we can. Make it something you enjoy and you're more likely to do just that. The CDC recommends 150 minutes of moderate aerobic activity or 75 minutes of vigorous aerobic activity per week for most healthy women. And don’t forget to add some weight resistance to your routine. Exercise not only helps with weight management and muscle loss, but it’s good for mental health, overall health and your sense of wellbeing.
Do not underestimate the power of sleep or the potential danger when your ability to sleep is compromised. Whether it’s falling asleep or staying asleep, disturbances are common during perimenopause and menopause. Unfortunately, symptoms of chronic insomnia can be mistaken for other disorders and prescribed the wrong or ineffective treatment which can, in turn, lead to serious health issues.
Always consult with a medical professional when you’re having chronic sleep problems. And make sure that whoever it is understands how to treat women transitioning through perimenopause and menopause.
For more information about sleep and menopause, read this article from the Sleep Foundation.
Deep-breathing exercises, massage, meditation and mindfulness are excellent stress-reduction techniques that can be helpful in managing mood and anxiety fluctuations that can occur during perimenopause. These techniques can also be helpful with sleep issues. Movement that focuses on breathing like yoga and tai chi have also been known to help.
The connection between mindfulness and wellbeing is a real thing. NAMS (The North American Menopause Society) has a great article on mindfulness during menopause – Make Your Menopause a Positive Experience. Definitely worth the read.
A Word To the Wise
Menopause and the years that lead up to it is the time to become in tune with yourself: mind, body, spirit. Educate yourself on the ins and outs of the process by reading, talk to women in your life who have been through it and, of course, establish an ongoing dialogue with your doctor about what works best for you.
“We don’t receive wisdom; we must discover it for ourselves after a journey that no one can take for us or spare us.” – Marcel Proust
I could not have said it better myself.
WebMD, Perimenopause, reviewed by Traci C. Johnson, M.D., June 14, 2020
The Sex Ed Blog, Perimenopause & Menopause, Dr. Joshua Gonzalez
healthline, 10 Herbs and Supplements for Menopause, Ansley Hill, R.D., L.D., medically reviewed by Jillian Kubala, M.S., R.D., September 30, 2020
Harvard Health Publishing, Menopause and Mental Health, March 1, 2020
Mayo Clinic Blog, Hormone Therapy: Is It Right For You?, Mayo Clinic Staff, June 9, 2020
North American Menopause Society, The Experts Do Agree About Hormone Therapy, NAMS Staff, no date
The Checkup by SingleCare, The Best Diet to Reduce Menopause Symptoms, Jennifer Nelson, medically reviewed by Leslie Greenberg, M.D., May 12, 2021