Perimenopause Treatment

Understanding Perimenopause

“What is perimenopause?” is a very common question. In essence, perimenopause is the transitional phase leading up to menopause – the point when monthly periods stop for good. After menopause, the ovaries no longer release eggs or produce enough estrogen, but this shift doesn’t happen overnight. Instead, it’s a gradual process.

On average, perimenopause begins about four years before the final period, typically around the mid-40s, though it can start earlier or later. During this time, hormone levels fluctuate significantly. Estrogen levels, in particular, can swing from unusually high to very low, which is what triggers many of the symptoms associated with this stage.

One of the earliest signs of perimenopause is irregular periods, but other symptoms – like hot flashes – can also appear. While this is a natural phase of life, the changes can be challenging. Understanding what’s happening in your body can make it easier to navigate, and treatments are available to help manage symptoms.

How Long Does Perimenopause Last?

Perimenopause isn’t a one-size-fits-all experience – it can last anywhere from a few years to over a decade. On average, the transition spans about four years, but some people move through it faster, while others experience perimenopause symptoms for much longer.

Perimenopause is divided into two stages:

• Early perimenopause
  This is when menstrual cycles start to shift, with intervals between periods becoming noticeably longer (or occasionally shorter). Hormone levels, particularly follicle-stimulating hormone (FSH), start fluctuating, but ovulation still occurs somewhat regularly.

• Late perimenopause
  As hormone fluctuations become more dramatic, menstrual cycles become even more irregular, often with skipped periods and months without ovulation. This stage usually lasts one to three years before the final menstrual period (FMP), which marks the official transition into menopause.

Common Symptoms of Perimenopause

The most characteristic symptom of perimenopause is hot flashes, affecting up to 80% of women. Other symptoms include sleep disturbances, depression, joint pain, and cognitive changes, though their association with perimenopause varies.

• Hot Flashes
  Hot flashes usually start with a sudden warmth in the upper chest and face, quickly spreading throughout the body. They typically last 2–4 minutes, often accompanied by sweating, palpitations, chills, and anxiety. Hot flashes are more frequent at night ("night sweats") and can impact sleep and daily function.
  

• Depression & Anxiety
  Women are 2.5 times more likely to develop depression during perimenopause, especially those with a history of mood disorders.
  

• Sleep Disturbances
  Sleep disturbances are more common in perimenopause, even without hot flashes. According to studies, sleep disturbances affect 32–46% of women during the menopause transition.
  

• Cognitive Changes
  Some women experience forgetfulness, word-finding difficulties, or "brain fog."
  

• Genitourinary Syndrome of Menopause (GSM)
  This was formerly referred to as “vulvovaginal atrophy.” It is caused by estrogen deficiency affecting the vagina, urethra, and bladder, which can lead to vaginal dryness, discomfort, and sexual dysfunction.
  

• Other Symptoms
  Other symptoms include joint pain (affecting 50–60% of women), breast pain, and menstrual migraines.

Wondering if you’re in perimenopause? Mira’s Menopause Transitions Kit helps you track four key hormones – FSH, LH, E3G, and PdG – with ease. It includes the Mira Hormone Monitor, testing wands, and all the essentials to understand your hormonal changes.

Mira users over 35 also get free access to the Menopause Transitions Mode in the Mira app. This feature tracks symptoms like hot flashes and provides a personalized hormone report after two months.

To start, go to your Profile, tap ‘Menopause Transitions’, and follow the steps.

How Perimenopause Differs from Menopause

Perimenopause is the transitional phase when you start experiencing menopause symptoms – like mood swings, hot flashes, and irregular periods – but haven't reached menopause itself. 

This transition only ends once you've gone 12 full months without a period, which is when true menopause begins. While both stages share similar symptoms, menopause marks the permanent end of menstruation. For more insights, check out our How to Transition into Menopause ebook.

Natural Ways to Manage Perimenopause Symptoms

Lifestyle Changes for Symptom Relief

Some lifestyle changes for symptom relief include proper sleep, cessation of smoking and limiting alcohol.

• Proper sleep
  Adopting a consistent sleep routine is crucial during perimenopause. Try maintaining regular bedtimes and wake times, while avoiding late afternoon naps. Create a calming bedtime ritual, whether reading or a warm bath, and minimize exposure to electronic devices in the bedroom. Keep your sleeping environment cool and quiet, exercise regularly but not near bedtime, and be mindful of late meals and caffeine consumption.
  

• Smoking cessation
  Smoking has been shown to worsen menopausal symptoms, particularly intensifying both the frequency and severity of hot flashes. Additionally, women who smoke are more likely to undergo early menopause compared to those who don’t smoke. Quitting smoking can cause a noticeable reduction in these disruptive symptoms.
  

• Moderate alcohol consumption
  Alcohol consumption has been shown to significantly impact menopausal symptoms, with research indicating that higher alcohol intake increases both the frequency and severity of hot flashes. Try to keep alcohol consumption moderate. The recommended consumption is one glass or less per day.

We'll also explore the importance of balanced nutrition, regular exercise, and stress management in the next sections.

Nutrition and Diet Recommendations

Perimenopause brings significant hormonal changes that affect your nutritional needs. Understanding which nutrients to prioritize can help manage symptoms and support overall health during this transition.

• Protein – Helps maintain muscle strength. Try to include eggs, lentils, fish, lean meats, and dairy in daily meals.
  

• Omega-3s – Support mood and reduce inflammation. Found in salmon, flaxseeds, chia seeds, and walnuts. You can also consider supplements if needed.
  

• Fiber – Aids weight management and stabilizes blood sugar. Try to get 22–25g daily from whole grains, fruits, veggies, and legumes.
  

• Calcium & vitamin D – Essential for bone health. Sources include dairy, leafy greens, fatty fish, and fortified foods. Sunlight helps with vitamin D.

Exercise and Its Role in Symptom Relief

Mind-body exercises have been shown to manage multiple perimenopausal symptoms. Research examining practices like yoga, Pilates, tai chi, qigong, and mindfulness-based stress reduction demonstrates significant benefits for women during this transition. These exercises help maintain bone density, with tai chi and Pilates showing particular promise in reducing bone loss. 

They also improve sleep quality through various mechanisms, including increased melatonin production and better autonomic nervous system regulation. 

Additionally, women who engage in regular mind-body exercise experience reduced anxiety and depression symptoms, with studies showing up to 39% lower risk of developing these conditions compared to inactive women. 

Stress Management Techniques

Managing stress is key during perimenopause, as it can worsen symptoms like hot flashes and sleep issues. Mindfulness – staying present in the moment – helps ease these challenges.

Quick mindfulness tips:

• Start small – Focus on daily sensations (coffee, shower, breeze).

• Create a habit – Use your commute or lunch break for mindfulness.

• Label thoughts – Acknowledge worries ("This is anxiety about hot flashes") instead of engaging with them.

• Change routines – Try a new route or seating arrangement.

• Move mindfully – Practice gentle yoga or mindful walking.

• Breathe intentionally – Spend 5–10 minutes on quiet breathing.

• Observe without judgment – Accept sensations like hot flashes, knowing they will pass.

Remember, mindfulness isn't about making thoughts disappear but rather about observing them with gentle awareness.

Herbal Remedies and Supplements for Perimenopause

While many women seek natural approaches to managing menopausal symptoms, it's important to understand that herbal remedies and supplements aren't regulated as strictly as conventional medicines. These products require careful consideration and consultation with healthcare providers. 

• Always consult your healthcare provider before starting any herbal remedy.

• Natural doesn't automatically mean safe – natural perimenopause supplements can still have side effects.

• Some herbs can interact with prescription medications.

• Quality and purity of supplements can vary between manufacturers.

• Scientific evidence supporting these remedies is often limited or mixed.

With that said, common herbal remedies for perimenopause include:

• Black cohosh - commonly used for hot flashes

• Evening primrose oil - thought to help balance hormone levels

• Red clover - contains plant-based compounds similar to estrogen

• St. John's wort - sometimes used for mood changes

• Ginseng - traditionally used for various perimenopause symptoms

• Angelica - often suggested for hot flashes and mood swings

Medical Treatment Options for Perimenopause

Menopausal Replacement Therapy: Benefits and Risks

Hormone Replacement Therapy (HRT) or Menopausal Replacement Therapy (MRT) can be prescribed during both perimenopause and after menopause to manage symptoms. For many women, the benefits generally outweigh the potential risks when prescribed appropriately.

Key benefits of HRT:

• Effectively relieves common symptoms like hot flashes and night sweats

• Helps prevent osteoporosis by maintaining bone density

• Improves sleep quality and reduces anxiety

• Helps maintain muscle strength

• Addresses vaginal dryness and associated discomfort

Potential risks to consider:

• Slight increase in breast cancer risk with combined HRT (about 5 extra cases per 1,000 women over 5 years)

• Minor increase in blood clot risk with tablet form (not with patches/gels)

• Low risk of stroke, particularly in women under 60

Important considerations for hormone therapy for women include:

• Risk factors vary based on age, symptoms, and personal health history

• Benefits are greatest for women under 60 or within 10 years of menopause

• Patches, gels, and sprays have lower risks than tablets

• Regular medical supervision is essential

• Different types of HRT are available based on individual needs

Non-Hormonal Medications for Symptom Relief

For those looking for alternatives to hormone therapy (HT) during perimenopause, several non-hormonal options may help manage symptoms: 

• Some antidepressants, like paroxetine, have been approved in the U.S. to reduce hot flashes. 

• Clonidine, a medication usually used for high blood pressure, has also been shown to lessen the frequency and intensity of hot flashes, though it can cause side effects like dry mouth and sleep disturbances.
  

• Herbal treatments, including black cohosh (Cimicifuga racemosa), as mentioned earlier, are available in supplement form in some countries, but their effectiveness remains debated.

Birth Control for Hormonal Regulation

During perimenopause, doctors typically recommend hormonal management strategies through specific birth control methods that can help stabilize the erratic hormone fluctuations of this transition:

• The levonorgestrel intra-uterine device (IUD) is often the first choice, as it provides steady, low-dose hormones directly to the uterus. This helps regulate heavy or irregular bleeding - a common perimenopausal complaint – while having minimal systemic effects.
  

• For women experiencing significant perimenopausal symptoms like irregular periods, low-dose birth control pills (if medically appropriate) can help stabilize hormone levels and provide relief. However, these are typically only recommended up to age 50 and for women without cardiovascular risk factors.

Antidepressants and Other Medications for Mood Changes

The journey through perimenopause can bring emotional challenges, with about 30% of women experiencing new-onset depression during this transition. This number rises to 60% for those who've navigated depression before.

For those looking to manage these mood changes, selective serotonin reuptake inhibitors (SSRIs), a type of antidepressant, often serve as a helpful first approach, especially when depression is the primary concern rather than hot flashes.

Women with milder symptoms may find that natural approaches can provide relief. Regular exercise, mindfulness meditation, and yoga practices can help balance mood while supporting overall wellness during this significant life transition.

Addressing Sleep Issues and Fatigue

Why Sleep Problems Occur During Perimenopause

For those experiencing sleep issues during perimenopause, several biological and lifestyle factors can contribute to disrupted sleep patterns. 

The shifting levels of various hormones, including growth hormone, prolactin, cortisol, and melatonin, can significantly impact sleep quality. Night sweats and hot flashes (vasomotor symptoms), along with mood changes like anxiety and depression, frequently interrupt normal sleep cycles.

Changes to the body's natural circadian rhythm during this transition can further complicate sleep patterns. Many women also find that existing conditions become more pronounced, such as restless legs syndrome, periodic limb movements, sleep apnea, or musculoskeletal pain. Those with a history of insomnia may notice their symptoms worsen during this time.

Daily habits and environmental factors play a crucial role, too. Poor sleep hygiene, irregular sleep schedules, caffeine consumption, alcohol use, and even a snoring partner can compound these biological changes, making quality sleep more difficult to achieve during the perimenopausal transition.

Tips for Improving Sleep Quality

As we mentioned earlier, maintaining good sleep hygiene is essential during perimenopause. Here are the key strategies to remember:

• Keep consistent bedtimes and wake times, avoiding afternoon naps

• Create a relaxing bedtime routine (such as reading or taking a warm bath)

• Limit electronic devices in the bedroom

• Ensure your bedroom is cool and quiet

• Exercise regularly, but not close to bedtime

• Watch your timing of meals and caffeine intake

Natural and Medical Sleep Aids

For those seeking sleep aids during perimenopause, both natural and medical options are available: 

• Melatonin supplements, particularly in rapid-release formulations, can help regulate sleep-wake cycles, while morning light therapy, especially combined with exercise like walking, may improve nighttime sleep quality.
  

• For medical interventions, some antidepressants can help address both sleep issues and hot flashes. However, sleep-inducing medications are generally only used for acute sleep problems due to concerns about side effects and dependency.

Managing Emotional and Cognitive Changes

How Perimenopause Affects Mental Health

Perimenopause is marked by hormonal fluctuations that can impact both physical and mental well-being. 

Changes in estrogen levels contribute to mood swings, anxiety, and an increased risk of depression – especially when combined with stress, sleep disruptions, and life transitions. 

Night sweats and hot flashes can further disrupt sleep, leading to emotional instability. Weight gain, particularly around the midsection, can also affect self-esteem and mental health. At the same time, many women in their 40s and 50s face additional stressors, such as professional transitions, empty nests, or caregiving responsibilities for aging parents. 

These overlapping physical and emotional demands can make perimenopause even more challenging. 

Coping Strategies for Mood Swings and Anxiety

Mood swings and anxiety can feel overwhelming, especially during hormonal transitions in life. While these emotional shifts are natural responses to hormonal fluctuations, their impact can be significant. The good news is that there are practical ways to manage these challenges:

• Practice mindfulness by labeling your emotions without judgment - try saying "This is anxiety I'm feeling" rather than "I'm being too anxious" to create some helpful distance from intense feelings.
  

• Practice cold exposure by splashing your face with cold water or stepping into a cool room – this can help reset your nervous system during intense emotional moments.
  

• Set up a consistent sleep schedule with a calming bedtime routine, as sleep quality directly impacts mood regulation.
  

• Try "opposite action" – when feeling low, deliberately choose an activity that might lift your spirits, like a short walk or calling a friend.

Because hormonal imbalances often play a key role in mood swings and anxiety, understanding these changes can be empowering. Mira’s Hormone Health Clinic provides personalized hormone tracking and expert guidance, helping you recognize patterns in your mood and take proactive steps toward emotional balance. By addressing the root causes of these fluctuations, you can regain a sense of stability and well-being.

Brain Fog and Memory Support Strategies

Brain fog isn’t a medical term, but many use it to describe memory and focus difficulties, especially during perimenopause. Symptoms may include forgetfulness, distraction, and time lapses.

Fortunately, these changes are temporary. To support memory and mental clarity, experts recommend:

• Regular exercise

• Mindfulness and meditation to reduce stress

• Brain-stimulating activities like learning a new skill or solving puzzles

• Avoiding smoking, excessive alcohol, and illicit substances

• Following a Mediterranean diet rich in antioxidants

• Using diaries, lists, and reminders for better organization

When to See a Doctor

Signs That You Need Professional Help

Perimenopause comes with a wide range of symptoms, from irregular periods and hot flashes to mood swings and sleep disturbances. While these changes are a normal part of the transition, they can sometimes become overwhelming. If your symptoms are interfering with your daily life – making it hard to sleep, focus, or maintain your emotional well-being – it may be time to seek professional help.

Severe mood changes, such as persistent anxiety or depression, shouldn’t be ignored either, especially if they start affecting your relationships or overall quality of life.

Likewise, if heavy or prolonged bleeding disrupts your routine, or if hot flashes and night sweats leave you exhausted, talking to a healthcare provider can help you find relief. There are treatment options available, including hormone therapy and lifestyle adjustments, to make this transition more manageable.

Tests and Assessments for Perimenopause Symptoms

There’s no single “perimenopause test,” but healthcare providers often assess symptoms alongside hormone levels to get a clearer picture. 

Blood tests measuring thyroid function can help rule out other conditions that mimic perimenopausal changes. 

Tracking cycle patterns, symptom severity, and overall health history also play a key role in understanding where you are in the transition. 

Creating a Personalized Treatment Plan

Managing perimenopause looks different for everyone. A healthcare provider will consider your symptoms, medical history, and lifestyle to tailor a plan that works for you. 

Treatment may include hormone therapy, non-hormonal medications, or simple lifestyle changes like adjusting diet, exercise, and stress management. The goal is to find the right balance to keep symptoms under control and improve daily well-being.

Conclusion 

While perimenopause represents a significant transition in a woman's life, understanding your symptoms and available treatment options can make this phase more manageable. Whether through lifestyle modifications, natural remedies, or medical interventions, numerous ways exist to address symptoms and maintain quality of life. 

Frequently Asked Questions 

What are the 34 symptoms of perimenopause?

While perimenopause can present with numerous symptoms, the most common ones include irregular periods, hot flashes, sleep disturbances, mood changes like depression and anxiety, joint pain, cognitive changes ("brain fog"), and genitourinary symptoms such as vaginal dryness.

When does perimenopause start?
Perimenopause typically begins in the mid-to-late 40s when menstrual cycles start to change – either becoming longer, shorter, or more unpredictable. 47 is the most common “perimenopause age,” but it’s not uncommon for women to notice early symptoms of perimenopause at 44.

How long does perimenopause last?

Perimenopause typically lasts four to eight years but varies for each person. It ends with menopause, officially marked after 12 consecutive months without a period.

What foods have estrogen?
Certain plant-based foods contain phytoestrogens, which mimic estrogen in the body. These include soy products (tofu, edamame, soy milk), flaxseeds, sesame seeds, chickpeas, lentils, and some fruits like berries and peaches.