Written by Alex Fulton
While the definition of menopause —12 consecutive months without a period — is fairly cut –and-dried, the stretch of time leading up to your last period can be harder to define. Known as perimenopause, this time is often profoundly transitional for many women, whether they’re consciously aware of what’s happening or not.
Lasting from months to years and characterized by a wide array of symptoms, perimenopause isn’t as widely discussed or understood as menopause. For this reason, many women may be caught off guard by the sudden appearance of perimenopause symptoms, and unsure how best to handle them.
“In my experience, women are unfortunately ill-prepared for perimenopause,” says Dr. Brooke M. Faught, DNP. “So many women struggle unnecessarily during this time.”
Learning about perimenopause before it starts, including what symptoms to watch for and how to support your body during this transitional time, can help you feel more prepared when you start to experience the changes that typically precede “the change.”
What to Look for During Perimenopause
“It’s important to note that symptoms experienced during perimenopause will vary per woman,” explains Dr. Faught. However, she continues, there are certain symptoms that are more common among perimenopausal women. These include:1
- Changes to periods
- Sleep disturbances/insomnia
- Mood swings
- Weight changes
- Dry, thinning skin and hair
- Brittle nails
- Joint pain
- Memory problems
According to the North American Menopause Society (NAMS), irregular menstruation is the most prevalent perimenopause symptom, and it may be the only one you experience.2 But even though you may not be ovulating and/or bleeding every month, it’s important to note that you can still get pregnant during perimenopause.
“Many of my patients feel that their age defines potential for pregnancy,” Dr. Faught says. “It is often a surprise that they can still get pregnant, despite decreased fertility with age.”
If you’ve relied on the regularity of your menstrual cycle to assist you in family planning, you may want to pay extra attention to what’s happening with your period during perimenopause — and use birth control until you’ve gone 12 months without a period if you don’t want to conceive.3
“If patients are still menstruating within the past year and are not currently on hormonal contraception, I will often check on a FSH (follicle stimulating hormone) level, which will help to identify menopausal status,” Dr. Faught says. “If above a certain level (based upon individual lab parameters), elevated FSH indicates perimenopause or postmenopause.”
6 Things You Can Do Now to Prepare for Perimenopause
Perimenopause can be highly unpredictable, and there’s no way to know for certain when or how it will affect you as you move toward menopause. But there are steps you can take to help prepare your body and mind for the change’s perimenopause may bring.
1. Start Tracking Your Cycle
Even if your period has come like clockwork every month since it began, you may find yourself experiencing menstrual irregularities related to perimenopause. If you don’t already, as early as your mid-30s, it may be a good idea to start keeping track of your cycle, including symptoms like spotting or heavy bleeding.
“There are many period tracker apps that can be helpful for women experiencing changes to their menstrual cycles and other perimenopausal symptoms,” Dr. Faught says. “I encourage women to research the different options available to determine the app that suits their individual needs. They can also simply track symptoms via their personal calendar.”
If you start tracking in your mid to late 30s, you’ll be more likely to notice changes if and when they begin to occur during perimenopause. You’ll also have a solid base of information to share with your healthcare provider as you discuss the perimenopause transition with them.
2. Establish Better Sleep Habits
Establishing good sleep habits now may give you an advantage when it comes to countering perimenopause symptoms like insomnia and night sweats later. Dr. Faught suggests making these changes to your nighttime routine:
- Limit screen time before bed
- Limit caffeine/alcohol/excessive fluids leading up to bedtime
- Limit distractions in the bedroom (work materials, etc.)
- Try cooling blankets/pillows
- Consider a fan and/or white noise
In severe cases of insomnia and other sleep problems, Dr. Faught recommends consulting with a healthcare provider about medicinal sleep aids.
3. Practice Coping Mechanisms
“I often refer to perimenopause as the mean big sister to PMS,” Dr. Faught says. You may not be able to prevent the mood swings and anxiety that can accompany perimenopause, but you can set up coping mechanisms to help you deal with them. When you find yourself struggling mentally or emotionally, consider:
- Going for a walk, since spending time in nature has been shown to boost mood and self-esteem4
- Texting a friend who can provide a sympathetic ear and/or a distraction from what’s bothering you
- Deep breathing, which can trigger your parasympathetic nervous system and help you calm down when anxious or stressed5. Consider trying formal mindfulness exercises – apps like Headspace or Calm can help you get started.
Another way to better prepare for the emotional ups and downs of perimenopause? Talk to your partner and kids so they, too, know what to expect and can support you with empathy and understanding.
4. Tweak Your Diet and Exercise Routine
“Metabolism declines during perimenopause and postmenopause,” Dr. Faught explains. “Therefore, a woman who eats the exact same way and maintains the same workout routine may notice a change in body physique/weight throughout perimenopause due to this shift in metabolism.” 6
One large study found the average amount of weight women gained during perimenopause was five pounds — but 20% of study participants gained 10 pounds or more.7 To help counteract the changes in metabolism that accompany perimenopause, consider changing up your workout routine and, if possible, making healthy changes to your diet.
This may mean adding foods rich in these nutrients, which can help you regulate your appetite and blood sugar while helping to maintain bone strength:8
- Omega-3 fatty acids
5. Consider Supplements
Dr. Faught advises a measured approach to the use of supplements in preparation for perimenopause. “I don’t generally suggest taking supplements and medications without need, as every woman’s experience with perimenopause is different,” she says. However, she generally recommends a handful of science-backed products she believes can benefit most every woman during her menopause journey.
“First, a high quality, evidence-based probiotic may help to keep the gut healthy and prevent urogenital complications that often arise in this time,” Dr. Faught says.9 “I also frequently suggest vitamin D, B-12, and a high-quality, food-based multivitamin during perimenopause to support bone health, mood, and energy.”10
6. Check Your Family History
Want to know what to expect from perimenopause and menopause? Consider talking to your mom and/or other older women in your family and getting a better understanding of your family’s health history. Since genetics can play a role in the menopausal experience, getting a sense of your family history and experience may help you better prepare.11
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When it Comes to Perimenopause, Knowledge is Power
Perimenopause can be a challenging and confusing time but knowing what to expect can help make things easier. “I encourage women to educate themselves with the help of their health care provider(s) to prepare for possible perimenopausal symptoms,” Dr. Faught says. “Knowledge is power. We fear things less when we are prepared.”