Maybe your periods have become unpredictable. Maybe you wake at 3 a.m. drenched in sweat, or feel more irritable or foggy than you used to. For many women in their forties and fifties, these changes are the first signs of perimenopause. They are a normal part of life, but that does not mean you have to simply put up with them.
What Is the Difference?
Menopause is the point when you have gone 12 months in a row without a period, when that is not caused by pregnancy, illness or medication. In the United States it most often happens in the early fifties, though the timing varies widely.
Perimenopause is the transition leading up to menopause, when hormone levels rise and fall unevenly. It often begins in the forties and can last several years. Many of the symptoms people connect with menopause actually start during this time.
Common Symptoms
- Irregular periods, which may come closer together or farther apart, or be heavier or lighter
- Hot flashes and night sweats
- Trouble sleeping
- Mood changes, irritability, anxiety or low mood
- Vaginal dryness or discomfort with sex
- Changes in bladder habits or more frequent urinary symptoms
- Trouble concentrating or remembering things
- Joint aches and changes in skin and hair
Not everyone has every symptom, and some people have very few. Other conditions can cause similar symptoms. Thyroid problems are a common example, which is one more reason to talk with your provider. Read more about thyroid health.
When to Talk to Your Provider
Make an appointment if:
- Symptoms are affecting your sleep, work, relationships or quality of life
- Your periods are very heavy, last much longer than usual, or come very close together
- You have bleeding between periods or after sex
- You notice ongoing low mood, anxiety or loss of interest in things you used to enjoy
- You want to talk about treatment options, including hormone therapy
Any vaginal bleeding after menopause, meaning after 12 months without a period, should be checked promptly. It is often caused by something minor, but it always needs to be evaluated.
How It Is Diagnosed
Perimenopause is usually recognized from your age, your symptoms and changes in your cycle. Blood tests for hormone levels are often not needed, because those levels can change from day to day during this transition. Your provider may still order blood work, such as a thyroid test, to look for other causes. Labs can be ordered to a lab near you.
Treatment Options to Discuss
There is no single right approach. Options your provider may talk through with you include:
- Everyday adjustments, such as dressing in layers, keeping the bedroom cool, limiting alcohol and caffeine, staying active and protecting your sleep
- Hormone therapy, which for many women is the most effective treatment for hot flashes and night sweats. Whether it is a good fit depends on your age, how long it has been since menopause, and your personal and family history, including heart disease, blood clots and breast cancer.
- Non-hormonal prescription options, which can help with hot flashes for people who cannot or prefer not to use hormones
- Vaginal moisturizers, lubricants or low-dose vaginal estrogen for dryness and discomfort
- Support for mood and sleep, including counseling and, when appropriate, medication
The goal is a plan that fits your symptoms, your health history and your preferences, and that you revisit over time.
Protecting Your Health for the Years Ahead
The drop in estrogen after menopause affects more than symptoms. Bone loss speeds up, and risk factors for heart disease become more important. Weight-bearing exercise, strength training, enough calcium and vitamin D, not smoking, and regular blood pressure and cholesterol checks all help. Bone density testing is generally recommended starting at age 65, or earlier if you have risk factors.
Pregnancy is still possible during perimenopause, so keep using birth control until your provider tells you it is no longer needed.
A Good Fit for Telehealth
Much of menopause care is conversation: describing symptoms, reviewing your history and weighing options. That works well by video. Sagebrooke Family Medicine is starting as a telehealth practice, and if you need a pelvic exam or other in-person care, we will help you arrange it.
This stage of life deserves real attention and real options.
Getting Started
You do not have to wait until symptoms are severe to bring them up. Learn more about women's health at Sagebrooke Family Medicine, read about well-woman care through every stage of life, or contact the practice to ask about getting started.