How to cope with this midlife milestone
Some women consider menopause a health problem to bring to the doctor. Others view it as a natural part of life to be managed, not treated. Either way, this time of life can be a bit like traveling in a new city without a map—or even a clear destination. In fact, you may not even realize you’re there until you’ve passed it.
The average age for menopause is 52, but some women reach it in their 40s or later in their 50s. Menopause isn’t official until a woman has gone a full year without a menstrual period. Then she becomes post-menopausal. During the transitional years leading up to the end of menstruation, a woman is in perimenopause. This transition may last several years.
Many of the telltale symptoms of perimenopause are caused by hormonal shifts. During perimenopause, a woman’s ovaries make different amounts of hormones than usual, causing estrogen and progesterone production to vary greatly. Sometimes symptoms go away by themselves, and often lifestyle changes can help. Here are some common issues and ways to cope with them.
Often the first sign of perimenopause, menstrual irregularity is common as women enter their mid- to late 40s. Periods may come more or less often, last shorter or longer, or be lighter or heavier.
If you’re experiencing heavy periods, talk with your doctor about various treatment options. There are different types of medications and hormonal contraceptives that may reduce the bleeding and related problems.
The Heat Is On
As many as 75 percent of perimenopausal women experience sudden surges of heat, known as hot flashes or flushes. They’re considered night sweats if they occur with perspiration during sleep. Usually, the upper body starts to feel hot and then waves of heat spread throughout your whole body. Hot flashes can make your skin look blotchy and red as blood vessels in the skin surface expand.
To beat the heat, try these tactics:
Dress in easy-to-shed layers.
Drink cold water when you feel a hot flash coming on.
Avoid triggers like spicy foods, alcohol, and caffeine.
Keep rooms cool.
Losing weight, if you’re overweight, may also help improve hot flashes. And if you feel one starting, try relaxation breathing—slow, relaxed, deep breathing at an even pace.
Some women may get relief from eating soy foods or taking supplements. Potentially helpful herbs include black cohash and red clover. Talk with your doctor about any herbs or supplements you’re considering, since they may not mix well with other medications.
Vaginal and Urinary Problems
Hormonal changes can cause vaginal tissue to become drier and thinner. This can lead to vaginal infections, itching, burning, and uncomfortable sex. Lower hormones may also contribute to a lower libido. Use water-based, over-the-counter (OTC) vaginal lubricants to make sexual intercourse more comfortable.
Urinary problems may also develop as hormone levels fall—lower estrogen levels sometimes weaken the urethra. As a result, women may have a hard time holding their urine long enough to get to the bathroom (urinary urge incontinence) or leak urine when they sneeze, cough, or laugh (urinary stress incontinence). If you’re dealing with either of these issues, try to limit or avoid caffeine. Toning exercises for the pelvic floor, called Kegel exercises, can help with urinary problems, too.
Mind, Memory, and Mood
Perimenopause can carry a host of psychological effects. You may experience premenstrual symptoms such as irritability, mood swings, and crying spells.
Poor sleep can lead to mood changes, difficulty thinking clearly, and memory problems. If hot flashes are disturbing your slumber, getting those under control should help. Otherwise, you may need to change some habits to achieve your nightly z’s:
Don’t work out, smoke, exercise, or eat a large meal right before bed.
Stay away from caffeine—especially after noon.
Keep your bedroom dark, quiet, and cool.
Go to bed and get up at the same time every day.
If you’re feeling stressed, it can be difficult to manage perimenopause symptoms. Divorce, a parent’s illness, children leaving home—they’re all common midlife challenges. Finding healthy ways to deal with stress can smooth out mood swings and may help you sleep.
What About Medication?
Prescription hormone therapy can treat many of the symptoms of perimenopause. It can reduce hot flashes, alleviate night sweats, and relieve vaginal symptoms. But it may raise your risk for blood clots, heart attack, stroke, breast cancer, and gall bladder disease. Because of this, the U.S. Food and Drug Administration advises using hormone therapy at the lowest dose that relieves symptoms for the least time needed.
Low-dose birth control pills may also help women manage perimenopausal symptoms, including irregular periods. And there are some nonhormonal drugs prescribed to reduce hot flashes, such as a group of antidepressants called selective serotonin reuptake inhibitors (SSRIs).
If vaginal dryness and discomfort aren’t relieved by OTC care, prescription medicines are available. Doctors can also prescribe vaginal estrogen, which doesn’t carry the same risks as taking hormone pills.
Finally, if your emotions feel out of control, consider seeing a therapist or joining a support group. Or talk with your doctor about whether you may have an underlying condition such as depression.