Many of the patients Dr. Wendy Wolfman sees as director of Mount Sinai’s Mature Women’s Health Clinic in Toronto are surprised—and less than thrilled—by the sudden onset of perimenopause symptoms. “They often feel that they haven’t been told enough about what’s happening to their bodies,” she says. “And many women put up with symptoms unnecessarily.”
Perimenopause means “around menopause” and usually kicks in during your 40s (or even in your mid-to-late 30s) as your ovaries start producing less estrogen and your reproductive system starts winding down. It can last anywhere from five to 10 years—until your periods stop altogether (once you hit 12 months period-free, you’re officially in menopause).
The symptoms, Dr. Wolfman says, can be troublesome and disruptive. One of the first signs of perimenopause is shorter menstrual cycles and heavier, more irregular periods. You may also experience hot flashes, headaches, vaginal dryness and mood swings. “It’s important to recognize the symptoms and know that you can do something about them,” she says. Here are five of her top perimenopause survival tips.
How to banish bloating and cramping
As your hormones start to fluctuate, your periods can become heavier and more erratic, bringing with them the bonus side effects of cramping and bloating. Non-steroidal anti-inflammatory drugs (ibuprofen, naproxen) can help take the edge off and reduce menstrual bleeding. (If your periods become particularly heavy or painful, see a doctor to rule out fibroids and endometriosis, both of which can be triggered during perimenopause.)
For more severe bleeding, your doctor may prescribe hormonal therapy, such as straight progestin, or combined oral contraceptives that contain both progestin and estrogen. “If you’re not a smoker, the birth control pill can be used to manage menstruation and heavy bleeding until you reach menopause,” Dr. Wolfman says.
How to deal with headaches
Research shows that if you have a history of migraines, they may become more frequent or intense during perimenopause. Even women who never experienced migraines in the past can begin being afflicted by them, says Dr. Wolfman. Hormone Replacement Therapy (HRT) is the treatment most often prescribed, usually in the form of a patch that provides a low, steady supply of estrogen. If a headache does hit, over-the-counter pain relievers and applying a cold cloth to your head and neck can help relieve the pain.
How to improve your mood
“Increased irritability and mood swings are common during perimenopause,” Dr. Wolfman says. “It’s important to get help because not only do these symptoms affect you, they also affect the people around you.” In some cases, your doctor may prescribe an anti-depressant, but often you can manage symptoms yourself with relaxation techniques like yoga and meditation. Studies show that exercise also helps — the Mayo Clinic recommends 30 minutes or more of activity for perimenopausal women on most days of the week, just not right before bedtime.
What to do about a lagging libido
As estrogen levels decrease, the lining of your vagina gradually gets thinner, dryer and less elastic, all of which (no surprise) can lead to a lagging libido. Your doctor may recommend low-dose contraceptives or vaginal estrogen (which comes in cream, tablet or ring form), but you may also find relief with over-the-counter vaginal moisturizers and water-based lubricants. On the plus side, staying sexually active helps by increasing blood flow to the vagina.
How to get a full night’s rest
Hot flashes and night sweats are two of the biggest sleep disruptors during perimenopause. The first step toward better sleep is to avoid potential triggers (like spicy food for dinner or a hot cup of tea before bed). Low-dose estrogen is the most common medical treatment, but not all women can—or wish to—take hormones. Other options include antidepressants, such as selective serotonin reuptake inhibitors (SSRIs), andNeurontin, which is an epilepsy drug.
Perimenopause is a natural part of aging, Dr. Wolfman says, and it doesn’t have to get in the way of your life—especially if you take steps to manage your symptoms.
Published May 2019. Updated June 2020.