The Perimenopause Prescription

woman with hands to the sky( — Sleep deprivation. Night sweats. Periods that defy any consistent calendar…welcome to the wonderful world of perimenopause. No, you’re not losing your mind (though it may definitely feel like it).

What Is It?

Perimenopause is a physiological stage when your body begins its transition into menopause. During this time, estrogen levels fluctuate, causing irregular menstrual cycles, as well as a wide assortment of other symptoms.

Here’s what to expect…and what to do:

1. Unique Symptoms

You and your sister and your friend likely will probably all experience perimenopause differently, from when symptoms start to their frequency or severity. Most women enter perimenopause between ages 45 and 55, but for some it starts as early as the 30s. Not even experts can’t predict your symptoms or when they’ll end—perimenopause can last anywhere from two to ten years. You’re officially in menopause when you’ve gone 12 months without a period. A clear sign that menopause is fast approaching is when you miss your period for more than 3 months. Symptoms, such as hot flashes and insomnia also get more intense a year or two before and after menopause due to the rapid decline of estrogen. With time, most women adapt to lower levels of the hormones, and symptoms finally calm down.

Prescription: There’s no way to postpone menopause, but studies suggest certain factors, such as smoking, may bring it on earlier. Also, ask your mom when she started going through “the change.” There’s a genetic link, so yours will likely begin around the same time.

2. Hot Flashes & Chills

About 80% of women in perimenopause experience hot flashes, often followed by a chill. Though researchers don’t know the exact cause, they suspect fluctuating hormone levels may send mixed signals to the hypothalamus, the part of the brain that regulates body temperature, and that creates a hot flash. It can last from a few seconds to 10 minutes, causing a flushed face, intense sweating, or even heart palpitations. Those that occur in your sleep, typically accompanied by heavy perspiration, are called night sweats.

Prescription: Studies show that deep breathing for 15 minutes twice a day can reduce the frequency of hot flashes by 39%. Herbal remedies such as black cohosh may also help—if only because you think they will. Also, adding isoflavones, which are estrogen-like compounds found in soy foods, to your diet can reduce hot flashes, according to some research, and help you feel cool and comfortable. Lastly, medication prescribed by your doctor (specifically, low-dose or very low-dose hormone therapy) is the most effective way to treat severe hot flashes, as well as some antidepressants and certain blood pressure and antiseizure meds. Ask your doctor to help you decide what is right for you.

4. Irregular Cycles

Remember when you knew exactly what time your monthly visitor would arrive? Well, about 90% of women experience 4 to 8 years of irregular periods before menopause. As ovulation becomes more erratic, the time between each cycle may shorten by a day or two at first, and then by several days, meaning you get your period more often. Blood flow can go from light to crazy-heavy and clumpy, with severe cramping. Later in perimenopause, you might skip periods, and then resume a normal cycle for a while.

Prescription: Low-dose birth control pills with a combo of estrogen and progestin may help regulate your cycle (for smokers and women at high risk for blood clots, progestin-only pills may be safer). Taking birth control, however, means you may not notice when menopause starts. Your doctor may suggest a good time to stop taking the pill for a few months to see if your period resumes.

5. Weight Gain

While perimenopause is not totally at fault for an expanding waistline, it certainly contributes to the cause. Before menopause, many women store fat in the hips and thighs (better for pregnancy); when estrogen levels dip, however, testosterone increases, causing extra weight to settle in your midsection. Plus, the stress of hormonal fluctuations can cause an increase in cortisol, which helps stimulate the storage of fat around the belly. Hormones aside, metabolism slows about 5% per decade, which means that at age 45, you need 75 less calories per day than you did at age 35 to stay the same weight.

Prescription: Amp up your workout routine—add two or three strength training. Adding sessions to your weekly regimen help fight age-related muscle loss, which slows down metabolism – even including fast-paced intervals to your daily walk to burn more calories. Your goal: Keep your waist size under 35 inches; more than that is linked to an increased risk of heart disease and diabetes.

6. Loss of Sexual Interest

Studies show that for many women, a good sex drive before perimenopause will return after you hit menopause. During, however, is a different story: Even if you can get over the less-than-sexy night sweats, crampy periods, and perpetual crankiness, hormonal shifts may lower your sex drive and can cause vaginal dryness (which tends to make intercourse hurt).

Prescription: Over-the-counter lubricants or topical estrogen can help with dryness and may help boost your libido in the process.

7. Forgetfullness

You try and try and try, but you still can’t remember what you ran back in the house to get, or what that thing is you use to write with. This sudden forgetfulness can be frightening, but it’s also quite common: One study showed that 60% of perimenopausal women experience short-term memory loss and have a hard time concentrating. The effect seems to be temporary, however—after menopause you’ll return to your usual sharp self, say researchers.

Prescription: While your brain’s on the blip, make an effort to concentrate and be more mindful of your actions. When you walk into your house and put your cell phone down, for example, say out loud, “I’m putting my phone on the kitchen table.” Avoid multitasking—don’t talk on the phone while you scan e-mails because trying to do too much at once can lead to forgetfulness. And feel free to rely more heavily on Post-its and to-do lists to keep important tasks top of mind.

8. Insomnia

Estrogen and progesterone help regulate sleep. When they’re out of whack, so is your slumber. Hot flashes and night sweats don’t help matters any, nor do bouts of depression. Couple that with the pressures and stresses of everyday life and you’ve got a perfect recipe for insomnia.

Prescription: Exercise regularly (but not within 3 hours of bedtime), and sip calming chamomile tea instead of caffeine or alcohol in the evening. Keep your bedroom cool, dark, and quiet. To ease night sweats, try lightweight, wicking pajamas that absorb moisture, and sleep with a fan. The same relaxation methods that help quell hot flashes may also bring on sounder sleep.

9. Increased Hair Growth

How many times have you plucked a couple of disturbing thick black hairs from your chin and wondered, “What?!” Once again, hormones are to blame—during perimenopause, female estrogen declines while male androgen while, which shifts the balance. The result: surprise hair growth in follicles that are particularly androgen-sensitive, such as on your chin and upper lip. This hormone shift can also have the opposite effect—hair loss in places you don’t want to lose it!

Prescription: For unwanted hairs, plucking, waxing, and lasers work; you may also consider birth control pills or anti-androgen drugs. To prevent hair loss on your head, talk to your doctor about medication (prescription and/or over the counter) that you can take. New hair may be thinner and shorter than the locks still on your head and can take 12 weeks to start growing.

Birth Control Pill – The Ultimate Prescription?

During perimenopause, birth control pills can help ease severe symptoms—the combined estrogen and progestin regulate unpredictable periods and take the edge off hot flashes or mood swings. As you approach and after you reach menopause, you may consider switching to hormone therapy to alleviate persistent symptoms—these medications contain much lower doses of hormones and are used to replace the ones the body no longer makes after menopause. Short-term use of hormone therapy is safe for most women; it’s using it long-term (more than a few years) that can increase the risk of breast cancer, according to Women’s Health Initiative research. It’s not recommended for women at high risk of breast cancer or blood clots.

The best step you can take is to talk with your doctor to determine your best course of hormone treatment.

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