Perimenopause and Menopause 101 (How to Deal with Each)

Menopause is a normal stage of every woman’s life, but when it happens and the exact symptomology can be very different for each. Some might be plagued with fierce hot flashes and mood swings, for example, while others might have mild forgetfulness.

How long perimenopause, or the “pre-menopause” phase, may last leading up to actual menopause also differs from woman to woman. It generally occurs in the mid-to-late 40s, with actual menopause occurring around the age of 50, but there is some variation in each phase’s onset based on personal health, environmental conditions, and more. 

Knowing the symptoms of perimenopause and menopause — and the natural steps you can take to alleviate them — can go a long way in keeping women happy and healthy throughout each stage. This guide will provide more information about perimenopause and menopause, as well as how to prepare for (and handle!) the symptoms of each.

The Basics of Perimenopause 

Perimenopause is the reproduction system phase that occurs before menopause, and sees a woman’s body begin to shift toward menopause. In general, the timing occurs similarly down maternal lines from one generation to the next. Other factors, like when menstruation began and whether she had children, also play a role.

  • Women who start menstruating at the age of 11 or younger are 80% more likely to go through perimenopause and menopause earlier than normal. 
  • Women who have never been pregnant may also see up to a 30% chance of early perimenopause and menopause. 

This phase includes physical changes that are easy to both identify and track, including:

Changes in Menstruation

One of the first signs of perimenopause is when a woman’s menstrual cycle becomes irregular. Estrogen levels begin to vary during this stage of life, and those changes create shifts in the duration of each monthly period. The frequency declines, perhaps coming every two months rather than one, as perimenopause continues, and actual menopause begins when a woman goes one full year without having her period. 

Changes in Fertility

A woman’s fertility is on the decline during this time, and the eggs she has left tend to be less viable. Ovulation may not take place with every period, but conception may still be possible for some. It is important to check with a medical professional about fertility if you have questions or concerns about yours during perimenopause. 

negative pregnancy test due to perimenopause.

How long perimenopause lasts can vary from a year or two to several years depending on the woman and her circumstances.

Symptoms of Perimenopause and Menopause 

Each woman experiences different symptoms during perimenopause. Some may have few problems and only realize it is “that time” because of irregularity in their periods. Others may have a whole list of symptoms, most of which come later in the time frame. 

1. Hot Flashes and Night Sweats

Hot flashes come from decreasing estrogen levels, which affect the brain’s control over body temperature and make it more sensitive to even the slightest environmental shifts. 

2. Trouble Sleeping

Most sleeping problems are associated with hot flashes, which often occur at night when the body is already trying to regulate room temperature, the body’s temperature under blankets, the impacts of a partner or pet’s heat radiating, and other factors. 

trouble sleeping due to perimenopause.

3. Worsened PMS/Mood Swings

Even women who did not experience mood swings or grumpiness during their periods may begin to experience both during perimenopause or menopause. They may find themselves upbeat and happy one moment, then depressed in the next — and often for no particular reason. 

4. Vaginal Dryness/Reduced Sex Drive

The drop in estrogen during this stage also causes a thinning of vaginal tissues, which can make them become more easily irritated. Sex can become painful, and the lack of hormones can also result in a general lack of interest in sexual contact. 

5. Forgetfulness

The reduction in estrogen has an effect on brain chemicals, which may affect a woman’s ability to remember mostly small and recent occurrences. 

6. Weight Gain

Many women gain weight beginning with perimenopause and continuing through menopause. The drop in estrogen leads to a higher testosterone-to-estrogen ratio, which impacts where fats are deposited in the body. Many women then develop a larger tummy area or waistline, and poor sleep, less muscle tone, and changes in eating habits only add to the issue. 

NOTE: Having the ovaries removed causes a surgically induced menopause, which forces the body to quickly adjust to a sudden change rather than adapt to a naturally gradual one. This can result in more intense perimenopause or menopause symptoms. 

Dealing with Symptoms of Perimenopause 

There is no specific treatment to address all perimenopause or menopause symptoms, but some physicians prescribe hormone therapy to control them. This can be done with oral medication, intramuscular injection, or applying estrogen to the vaginal area. 

Others focus on natural, holistic remedies to help patients through their bodily changes. Some of these options include:

  • Bioidentical hormone replacement of estrogen and progesterone
  • Black cohosh or deep breathing exercises for hot flashes
  • Vitamin E to reduce inflammation
  • Primrose oil to reduce symptoms
  • Acupuncture for hot flashes and night sweats
  • Magnesium supplements for its anti-stress, anti-anxiety properties 

Women should consult with a naturopathic doctor or other qualified medical professional before beginning any supplement program — including one to combat perimenopause or menopause symptoms — but healthy lifestyle modifications can go a long way in easing the more difficult elements of each stage.

About The Author:

Dr. Karen Threlkel, Naturopathic Physician, Washington DC

Dr. Karen Threlkel, Naturopathic Physician, Washington DC

Dr. Threlkel received her degree of Doctor of Naturopathic Medicine from The National College for Naturopathic Medicine (now called The National University of Natural Medicine) in Portland, Oregon. She also holds a Bachelor Degree in Kinesiology from The University of Maryland. She is licensed in Naturopathic Medicine by the Government of the District of Columbia Department of Health. Dr. Threlkel is a member of the American Association of Naturopathic Physicians, past president & current member of the Washington DC Association of Naturopathic Physicians.

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