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Could This Be Perimenopause?

A generation ago, hot flashes, irregular periods, and mood swings would have been labeled menopause or “the change of life.” Today, your doctor is more likely to call this perimenopause, a new term for the transitional years leading up to the end of menstruation.

Perimenopause often begins around age 47 and lasts for about five years. During this time, the ovaries gradually become smaller and fertility declines. At the same time, the levels of the hormones estrogen and progesterone become unstable, rising and falling randomly. This triggers hot flashes, changes in menstrual flow, and other symptoms as periods taper off.

When a woman’s periods have stopped completely for a full year, she has officially reached the stage of menopause. Generally, this happens around age 51.

Telltale signs

Like puberty, perimenopause is a life stage with no exact beginning or end. Some doctors use blood tests to help assess whether a woman is in perimenopause. But one of the most reliable ways to detect perimenopause may be to look at a woman’s symptoms.

Many women develop one or more classic symptoms of perimenopause between ages 45 and 55. If these are mild, lifestyle changes or simple drug remedies can bring relief. Here’s what to expect during this life change and some tips for coping:

Hot flashes

These are sudden surges in body heat, causing flushing and sweating. Hot flashes that disrupt nighttime sleep are called night sweats.

Try this: Keep your cool by dressing in easy-to-shed layers, keeping the room temperature cool, drinking cold water, avoiding spicy foods, and keeping a small fan handy. Logging hot flashes in a journal may help you identify things that trigger them.

Irregular menstrual cycles

Your period may change in frequency and flow, either heavier or lighter. You may have spotting between periods.

Try this: Your doctor may recommend low-dose birth control pills. These can regulate periods, decrease any heavy bleeding, and help minimize hot flashes.

Vaginal problems

These include dryness, itching, or irritation of the vagina and genitals, which can make sex uncomfortable.

Try this: Water-based over-the-counter vaginal lubricants and moisturizers can help. Talk with your doctor about using prescription estrogen products, such as suppositories, creams, or vaginal rings.

Urinary issues

You may have sudden or frequent urination or leakage. You also may have more frequent urinary tract infections (UTIs).

Try this: Daily Kegel exercises can help strengthen pelvic muscles and increase bladder control. Wiping from front to back, urinating within an hour of feeling the urge, and wearing cotton underwear can all help prevent UTIs.

Hormonal or stressed out?

About the time of perimenopause, many women report feeling more tearful, sad, or angry. Some say they have difficulty concentrating and their moods swing from one extreme to another. The issue is often more complicated than changing hormones.

Typically, these hormonal changes hit when a woman already has other stress in her life, says JoAnn Pinkerton, M.D., an obstetrician/gynecologist.

You may have teenagers to parent, aging parents to care for, and new stresses in your marriage. If you are having hot flashes at night, you may be sleep-deprived. All this can create a cycle of fatigue and irritability.

Lee Shulman, M.D., professor of obstetrics and gynecology at Northwestern University, agrees. “To dismiss emotional changes as ‘just hormonal’ is a disservice to women. Your doctor should help you evaluate your stress levels and assess whether there is an underlying emotional disease.”

He adds, “This is a great opportunity to become more self-aware and focus on taking good care of yourself emotionally and physically.” Exercising, eating right, and getting enough sleep are all healthy steps in the right direction.

Treatment options

If your emotions still seem out of control, ask your health care provider about treatment options. “Estrogen has a well-being effect, so taking a hormone can be helpful,” notes Dr. Pinkerton. “But if you’re dealing with clinical depression, you may need an antidepressant and counseling.”

For some women, the beginning of perimenopause represents the end of youth. There are more positive ways to view this phase of life, though.

“It’s time to start giving mature women their due respect,” says Dr. Shulman. Especially at this age, “women need to become more aware of their value and the vital role they play in their family, at work, and in their community.”

Adds Dr. Pinkerton, “Once you get through perimenopause, things calm down again. You are older and wiser, and you have more energy. I call this postmenopausal zest—and it’s something to look forward to."