Perimenopause: Easing the Transition from Menstruation to Menopause

By Sarah Densmore

Menstruation and menopause are well-known biological milestones in a female’s life. Contrary to popular thinking, menopause is not the period of months or years when a woman is “going through the change.” This timeframe is called perimenopause.

Menopause is an actual date in time. Specifically, it’s the 12-month anniversary of a woman’s last menstrual period. When that day arrives, a woman has reached menopause.

During perimenopause, a woman’s ovaries begin to slow down in preparation for the day when there are no more eggs left to release. The process, which can take last anywhere from a year or two to nearly a decade, causes erratic fluctuations in the levels of estrogen and progesterone. This hormonal instability is the cause of many of the physiological changes midlife women experience.

Common perimenopause symptoms include irregular periods, hot flashes, mood swings, insomnia, and vaginal dryness. Some women glide through perimenopause with hardly a symptom. Other women are plagued by a mountain of misery. Most fall somewhere in between. Whether your change of life is great or small, here are some remedies to consider that can help make the transition easier.

Oral contraceptives: Nearly 90 percent of perimenopausal women experience a change in their menstrual cycle. Periods can become heavier or lighter, more or less frequent, and longer or shorter in duration. Oral contraceptives can provide just enough additional hormones to regulate periods. Additionally, the use of oral contraceptives has been shown to reduce hot flashes and lessen vaginal dryness.
Progestin therapy: For women who don’t want to take oral contraceptives but are most concerned with stabilizing their menstrual cycle, progestin is a viable alternative. This synthetic form of progesterone can lighten heavy periods. However, progestin alone won’t relieve hot flashes or vaginal dryness.
Endometrial ablation: Women suffering from very heavy or frequent periods can also consider endometrial ablation. This procedure actually destroys the lining of the uterus so that period flow is either lessened or eliminated.

If you’re periods have become very heavy, last more than a week, or occur more than every three weeks, you can’t assume it’s perimenopause. You need to talk with your doctor to rule out the possibility that your abnormal bleeding is caused by a disease or illness.

Vaginal lubricants: The natural drop in estrogen levels during perimenopause can cause uncomfortable vaginal dryness and interfere with sexual pleasure. Supplementing the body’s waning level of estrogen with oral contraceptives can help, but there are also many vaginal lubricants on the market. These come in water soluble, gel, and even vaginal suppository forms and can be readily purchased at drug, grocery, and discount department store chains.
Diet: If you’re among the 75 percent of perimenopausal women who experience hot flashes, you may want to take note of what you ate or drank before the hot flash occurred. Alcohol and caffeine are known triggers. Hot beverages and spicy foods are also thought to be instigators.

In addition, our metabolism slows as we age, which is why so many women in perimenopause start to put on extra pounds. Middle age women who want to make sure they look and feel their best in spite of their changing hormones, need to eat a healthy diet low in animal fats and high in whole grains, vegetables, and fruits. Poor diet has been linked to many diseases that tend to develop in middle age, including heart disease, high blood pressure, and cancer.
Exercise: Midlife women can’t get enough of this good cardiovascular stuff. Thirty minutes of moderate cardio exercise, such as walking or bicycling, on most days of the week can help ease perimenopausal insomnia and mood swings. Less strenuous activities such as yoga or Tai Chi help relieve the stress that can exacerbate sleep and mood disturbances.
Antidepressants/Therapy: Although midlife hormone changes don’t cause depression, women who have a history of depressive episodes may find their depression returns with perimenopause. If so, it’s important for the woman to talk with her doctor about the possibility of taking antidepressants to relieve her symptoms.

Also, perimenopause can coincide with a lot of changes in a woman’s life that have nothing to do with hormones. Aging parents, children leaving home, later-in-life pregnancy, divorce, remarriage, and career change are some of the many stressors that come with the onset of middle age. A woman may find she needs the help of a therapist to navigate through the many transitions that are a natural part of growing older.
Wardrobe changes: Some women experience hot flashes that come on with such ferocity they find themselves drenched in sweat. Any woman plagued by these soakings should consider switching to breathable, lose fitting, lighter weight clothing that’s made of absorbent fibers like cotton. This can be especially important at bedtime if the woman is prone to hot flashes during sleep (commonly called night sweats).