Here’s Everything You’ve Ever Wanted To Know About Perimenopause

And what you didn’t want to know.

by Natalia Lusinski
Lindsay Hattrick/TZR; Getty Images
A curly woman in perimenopause holding a flower

A few months ago, a friend of mine in her early 40s said she was having hot flashes, mood swings, and a lower sex drive. She wondered if she could be experiencing symptoms of menopause. You’re too young, I thought. But, as it turns out, she’s not. After speaking to her OB/GYN, my friend realized she is experiencing perimenopause — symptoms of menopause without actual menopause (which is marked by a year without a menstrual cycle). She learned it can start as early as your mid-30s (though mid-40s is more common).

It turned out my friend wasn’t alone in her surprise and lack of knowledge of this hormonal phase. Earlier this year, Bonafide, a wellness company that makes non-prescription products to help alleviate common health issues in women, came out with their Second Annual State of Menopause Survey. The goal was — is — to shed light on the need to destigmatize talking about menopause — and perimenopause for that matter. The company surveyed more than 2,000 women ages 40 to 65 about various menopausal-related things, from their knowledge about the process to their general feelings and sentiments surrounding it.

Twenty-five percent were not aware of when perimenopause typically starts while 31% did not know their treatment options. In addition, just 28% knew how to care for themselves during perimenopause before it started.

Ahead, women’s health experts weigh in and unpack what, exactly, perimenopause is and how you can best be prepared for it.

“Perimenopause begins years before actual menopause,” OB/GYN Kecia Gaither, tells TZR in an email. “It reflects a period of time when the ovaries begin to gradually make less estrogen and when no more eggs are released by the ovaries. Perimenopause ends when women have gone a year without having a menstrual cycle.” She also says it’s important to note that each woman is different — and, as such, perimenopause will occur at different ages. “However, in general, perimenopause typically begins for a woman in her 40s. Again, this transition period varies from woman to woman — from months in some to a decade or so in others.”

Dr. Sherry Ross, women’s sexual health expert, and author of she-ology and she-ology the she-quel, agrees. “This hormonal change typically happens within a couple years of menopause, which usually happens around age 51,” she tells TZR in an email. “But for some, it can happen much earlier. Every decade brings about some emotional and physical change, but for women, the decade of one’s 40s may pack the biggest punches of all.”

Echoing Gaither, Ross says that every woman will experience perimenopause differently, including when “the hormonal storm” begins. “There is also evidence that women who smoke, have a family history of early menopause, undergo treatment for cancer with chemotherapy or radiation, or have a hysterectomy (without removing the ovaries) may experience perimenopause earlier than other women,” she explains.

Common Symptoms Of Perimenopause

Symptoms of perimenopause are similar to menopause, so you may wonder what the difference is. “Perimenopause is a transitional period before and after a woman is still menstruating, but beginning to experience symptoms,” Dr. Tamika K. Cross, OB/GYN and pH-D Feminine Health advisor, tells TZR in an email. “While menopause is defined as 12 months without a menstrual cycle.”

Ross says symptoms may include:

  • Irregular, erratic, and heavy periods
  • Night sweats and hot flashes
  • Mood swings (with depression and anxiety)
  • Short-term memory loss and trouble focusing
  • Low sex drive/low libido and/or vaginal dryness

“And not every woman will have symptoms,” Cross says. “This just varies with genetics, but more often than not, there are at least a few of the symptoms experienced, although the severity may vary.”

How To Manage Symptoms Of Perimenopause

Gaither says diagnosis of perimenopause is made clinically by presenting symptoms and getting your hormonal levels (FSH) checked. Although there is no “treatment,” per se, she says there are many options to help alleviate symptoms.

“It depends on each woman’s specific situation and medical history,” Cross explains. “It’s important to talk with your doctor to see what options are best for you.” Ross also points out that different symptoms will require different treatments.

That said, there are some avenues to explore for specific concerns. For instance, for heavy and irregular periods, “The best treatment for this tends to be with hormones, such as low-dose oral contraception (as a way to control erratic periods),” says Ross. “Experiment with different pills in order to find the one with the least side effects.” Other options include cyclic progesterone, IUDs with progesterone, hormone replacement therapy (HRT), and non-hormonal alternatives, such as acupressure and herbal therapy. Ross says your healthcare provider can explain the ins and outs of these, and what may work best for you.

For the dreaded hot flashes, “Dressing in layers and staying in cool temperatures are the first steps in dealing with hot flashes,” explains Ross. “Air conditioning is your friend! Plan ahead. Bring a cooler with ice for your hands or feet. If you know that hot beverages, spicy foods, red wine, and hot climates bring on hot flashes, avoid them (if possible).” And she says herbal remedies (more on those below) may include black cohosh and other traditional Chinese medicine. “Acupressure may help with mild hot flashes, as well,” she adds.

For mood swings, “Antidepressants are effective in controlling depression, anxiety, and panic attacks, and a therapist may also give added support,” says Ross. “And, of course, exercise, the elixir to all. When you exercise, there’s a natural release of mood-boosting endorphins and serotonin, the ‘feel-good’ hormones that your body can naturally produce.”

For those experiencing low sex drive, low libido, and/or vaginal dryness, “Testosterone therapy may be helpful for a low libido,” says Ross. “For help with vaginal dryness, lubricants (such as KY and extra virgin coconut oil) are a good and affordable investment. Sometimes, once you gain control of the annoying hot flashes, irregular bleeding, and emotional distress of perimenopause, sexual interest is regained and your libido is rescued.” She also points out that there is an FDA-approved medication called Addyi, known as the “pink” pill for women. It works on neurotransmitters in the brain, including serotonin, dopamine, and norepinephrine, all found to be involved with sexual desire.

General Rules Of Thumb As You Enter Perimenopause

When it comes to trying to combat perimenopause — or at least manage its effects better — a great initial plan of attack against symptoms is with a thoughtful and healthy lifestyle. “A well-balanced, and colorful, diet of fruit, vegetables, whole grains, and nuts — and a limited amount of saturated fats, oils, sugar, and dairy — will help,” says Ross. “Drinking water, warm or hot, helps relax the uterine muscles, too. In fact, drink as much water as possible, 2-3 liters a day, to help minimize water retention and bloating.” She adds that you can also try consuming water-based foods, including berries (strawberries, blueberries), celery, cucumber, lettuce, and watermelon. “Adding ginger to hot water is another useful remedy,” she says. “And find an exercise routine that will keep you interested well beyond this perimenopausal period, too.”

If diet and lifestyle changes don’t curb the symptoms of perimenopause, Ross says there are some safe alternatives to help you get through your day. “There are many scientifically studied herbs and vitamins that can help manage the symptoms, so you can avoid prescription medications given to you by your healthcare provider,” she explains. “Passion flower extract, chasteberry, royal jelly, ashwagandha, and maca root are some of the more researched herbs that can actually improve your symptoms and life.” She notes that herbs are not FDA-approved like pharmaceutical medications, but that using a well-regulated manufactured herbal supplement can achieve the same effects as prescription medication. “And they will safely treat hormonal unrest caused by perimenopause,” she adds. Vitamins are important, too. Ross suggests taking calcium, vitamins E and D, thiamine, magnesium, and omega 3-fish oil to help relieve the period bloat and swelling.

Getting a good night’s sleep is imperative, too. “Hot flashes can mess with one’s sleep patterns,” Ross explains. “First and foremost, avoid excessive caffeine and alcohol (if you don’t care to give it up entirely). Seriously, consume your favored vices in moderation. They’re not bad, per se — it’s just better to have less.” She recommends one large cup of coffee in the morning and not more than three to four alcoholic beverages a week (if at all). “Set a regular bedtime, limit your liquids after dinner (so you need not take a midnight bathroom break), and try a warm bath before bed,” she adds. “And is your mattress comfortable and supportive? If not, make it so. Lastly, put your electronic devices (phone included) far from your night table. You don’t need the lure (or the light) of them at bedtime.”

And acupuncture is another way to manage perimenopause’s symptoms. “This ancient Chinese treatment for maintaining health and vitality by balancing energy flow works for many medical conditions,” says Ross. “For women especially, headaches, lower back pain, and menstrual cramps are helped through acupuncture. Even though the studies are not conclusive, hot flashes and heart palpitations may improve with acupuncture treatment, too.”

But in addition to the above, getting psychological support and reassurance from others is also key. “Sometimes, what we need most is a thorough understanding of exactly what is happening physiologically, if only to realize that what we’re going through is completely normal,” says Ross. “Therapy and support groups are often helpful in navigating this hormonal obstacle course.”

Lastly, Ross says that women in their 40s (give or take) who are experiencing unusual hormonal symptoms need to find a healthcare provider to help them navigate the changes caused by perimenopause. “There are simple treatment remedies, along with reassurance, that these are natural symptoms that need to be taken seriously — not just by the patient, but also by the healthcare provider.”