The Change Before ‘the Change’: 5 Facts to Help You Prepare for Menopause Symptoms

Understanding what perimenopause is (and isn't!)

If your vision of menopause looks extreme — like hot flashes that have you sweating through a tank top in February — take heart. The transition to menopause is often a lot less dramatic than your mom or even your BFFs would have you believe.

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The lead-up to menopause, called perimenopause, is something you might dread. But you don’t have to. These five facts can help you feel calm and prepared for this next part of life. You’ve got this.

1. Perimenopause: It’s a process

Officially, menopause occurs when you haven’t had a period for 12 months. Alas, it’s not quite as simple as, “Now it’s here, now it’s gone.” 

Perimenopause, the stage before the main event, can take a few months or even up to a decade. On average, perimenopause starts in your 40s and lasts about four years.

During this phase, the ovaries gradually pump out less estrogen. “Your reproductive system starts to run out of gas,” explains Ob/Gyn Judith Evans, MD.

This means your menstrual cycles change thanks to your hormones fluctuating. Periods may get closer together or farther apart. Bleeding may be heavy one month and lighter the next. Eventually, periods will stop completely. (A definite upside to this stage!)

2. Know your perimenopause symptoms: Help is available

The first signs of perimenopause can make you feel like a teenager again (and not in a fun “eat nothing but pizza and sleep till noon” kind of way). In addition to those irregular periods, you may have tender breasts and bad PMS. Find yourself crying one minute, irritable the next? You’re not imagining it!

As you approach menopause, symptoms may increase, including insomnia, vaginal dryness, low libido (sex drive) and the infamous hot flashes, where you suddenly feel warm or flushed for no reason.

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Shifts in estrogen production trigger hot flashes. For people sensitive to those shifts, it can be like riding a roller coaster.

But don’t despair. “There are plenty of people who cruise through this transition with no problems whatsoever,” Dr. Evans says.

Talk to your doctor if you feel like help is needed for your symptoms. Hormone replacement treatments and lifestyle changes (like tweaking your diet and managing stress) can turn the roller coaster into more of a carousel.

3. Menopause might not be the cause

Here’s a curveball: Your symptoms may not be due to menopause at all. (Being a woman is fun, right?!) Dr. Evans says, “Just like Freud blamed mothers for everything, we tend to blame our ovaries and uterus for everything. But menopause isn’t always to blame.”

Many symptoms mimic the signs of menopause but there might be other causes. In midlife, there are plenty of factors affecting women’s physical and mental health. Some of those can mimic the signs of menopause.

For example, juggling work, kids and aging parents can contribute to anxiety and depression. Weight gain, which is often blamed on menopause, has more to do with an aging metabolism. Thyroid disorders can mimic menopause as well. And though it’s not the norm, pseudo-hot flashes have even been caused by chronic sinus infections, Dr. Evans says.

Bottom line: Don’t write off discomfort as, “Well, I guess this is my life now.” You don’t need to live with uncomfortable symptoms, whatever the cause. See your doctor to figure out what’s going on and how best to manage it.

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4. Lifestyle choices: You can make menopause easier

“When the hormone system works together, it’s a beautiful dance,” Dr. Evans says. To help keep you waltzing through menopause, consider these lifestyle choices that go a long way to keeping perimenopause symptoms in check:

  • Eat a balanced diet with plenty of calcium.
  • Exercise regularly.
  • Embrace stress management techniques.
  • Limit caffeine and alcohol.
  • Get enough sleep.
  • Clue into personal triggers (such as spicy food or hot showers) that might make hot flashes flare.

5. Hormone replacement therapy: It can bring relief

If menopause symptoms are getting you down, medications can help. Talk to your doctor about low-dose birth control pills, which can regulate heavy or irregular periods during early perimenopause. Closer to menopause, hormone therapy can improve symptoms such as hot flashes.

Treatment is especially helpful if hot flashes are interfering with a good night’s sleep, Dr. Evans adds. Often, women find that anxiety and depression ease once hot flashes and night sweats are no longer making them toss and turn all night.

At the end of the day, just remember: Menopause is a stage of life, not a disease in need of a cure. And you can continue to live your best life during these years.

“If you’re feeling some distress, touch base with a healthcare provider,” Dr. Evans reassures. “No matter what you are going through, we can help.”

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