Are you feeling hot and sweaty? (But you’re not watching “Heated Competition”)? Are you waking up at night for no reason? Are you experiencing unexpected mood changes? If so, you may be experiencing menopause.
And perimenopause can be tricky to figure out because there is no single test, symptoms vary widely, and often overlap with other conditions.
So, here’s what you need to know about menopause symptoms and treatment options.
What is menopause?
Perimenopause is the transition period before menopause. During this period, your ovaries gradually shrink and your body prepares to stop menstruating.
Unlike menopause, which is defined as one year without a period, perimenopause is harder to define and every woman’s experience is different. It’s complicated because periods aren’t a reliable indicator, even if you’ve had a hysterectomy, ablation, or hormonal IUD, says Mary Jane Minkin, MD, clinical professor in the Department of Obstetrics, Gynecology and Reproductive Sciences at Yale University School of Medicine and a member of the HealthyWomen Women’s Health Advisory Board.
How early can menopause begin?
The average age of menopause in the United States is 51, and for most women, perimenopause begins in their 40s and lasts an average of 4 to 7 years, sometimes more than 10 years. “The hormonal process for women (perimenopause) is longer than people think,” explains Nina Ali, M.D., an obstetrician and gynecologist in the general obstetrics and gynecology department at Texas Children’s.
Stress, certain medications, cancer treatment, or ovarian removal can cause early menopause. Genetics can also influence when the brain, pituitary gland, and ovaries begin to change.
What are the symptoms of perimenopause?
A variety of symptoms can occur during perimenopause, and they may vary from person to person. Some days it may feel like there are hundreds of symptoms, but here are some common symptoms of perimenopause:
- irregular menstruation
- Hot flushes and night sweats
- vaginal dryness
- pain during sexual activity
- Burning, itching, or irritation of the vulva
- increased vaginal infections
- weight gain
- Migraine attacks or headaches, especially around certain times of the menstrual cycle
- depression or anxiety
- sleep disorder
- brain fog
- Musculoskeletal Pain and Pain
Is there a diagnostic test for perimenopause?
It may be surprising to hear, but health care providers (HCPs) do not need blood tests to diagnose perimenopause, Ali said. “There are many tests available, but management focuses more on recognizing the overall process as we know it, rather than on specific laboratory values.”
Hormone levels such as estrogen, progesterone, and follicle-stimulating hormone (FSH) fluctuate daily and do not typically change treatment regimens. Instead, your HCP will review your medical history, symptoms, and treatments you have already tried.
Recording your cycles and symptoms in an app or calendar can help you and your healthcare provider track your symptoms.
What is Hormone Therapy?
Hormone therapy (HT) is an FDA-approved prescription medication to treat menopausal symptoms, including vaginal dryness, hot flashes, night sweats, and pain during sex. HT can be systemic. This means it is absorbed into the bloodstream and used to treat conditions such as hot flashes and night sweats. Systemic HT is delivered via pills, patches, sprays, gels, or vaginal rings.
Low-dose HT, also called vaginal estrogen therapy, goes directly into the vagina and very little enters the bloodstream. This treatment is especially used for vaginal and urinary symptoms of menopause.
If you are a HT candidate, timing is important. The best time to start is within 10 years of your last period, during perimenopause or early menopause, when it reduces cardiovascular and other risks and offers the greatest benefits.
According to Minkin, low-dose birth control pills (BCPs) are often used first if you don’t smoke or have risk factors for blood clots. BCP contains estrogen and progestin (man-made progesterone) and completely blocks ovarian function, reducing hormonal fluctuations.
Hot flashes and sleep problems often respond well to HT. But it may help each woman differently. “What we don’t know is whether this will loosen up the joints or give them more energy. Some of these things are harder to measure,” Ali said. Sometimes your health care provider will have you try HT to see if your symptoms improve.
Are there non-hormonal options available to treat hot flashes?
Minkin points out that there are options other than HT that can help manage hot flashes.
Non-hormonal, FDA-approved options include:
- NK receptor antagonist
- One antidepressant, a selective serotonin reuptake inhibitor (SSRI)
Other prescription options that are not FDA approved to treat hot flashes but have shown some benefit include additional antidepressants, anticonvulsants, and antispasmodics commonly used to treat overactive bladder.
If you suspect you may be experiencing menopause, it may be a good idea to see a health care provider with expertise in menopause care. The Menopause Society has a searchable directory of providers who specialize in menopause care, called The Menopause Society Certified Practitioners (MSCP), to help guide you through this transition.
This training material was created with support from Astellas, a member of the HealthyWomen Corporate Advisory Board.
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