How to Recognize and Treat Perimenopause and Menopause Symptoms
April 29, 2021
Many women don’t know what to expect during perimenopause, which is the time period — often marked by distressing changes in the body — that leads up to menopause, or the end of a woman’s menstrual cycle and childbearing years. Those changes can come as a shock, so we broke down the signs, causes and treatment options for five common symptoms.
Hot Flashes
What they feel like:
“Most women will report a heat sensation that starts in their head and moves down their body,” said Dr. Nanette Santoro, a professor in obstetrics and gynecology at the University of Colorado who researches symptoms of perimenopause and menopause. That’s often followed by a cold sensation, she said, as the blood vessels in the body dilate and then rapidly lose heat. Hot flashes typically last between one and five minutes and can come on in both perimenopause and menopause.
There are a variety of symptoms associated with hot flashes, said Dr. Holly Thacker, a women’s health specialist at Cleveland Clinic. Some women experience tactile hallucinations and feel like their skin is crawling; some have heart palpitations. Hot flashes are also linked to insomnia and disrupted sleep.
What causes them:
It’s not entirely clear what brings on a hot flash, Dr. Santoro said, but the fluctuations in estrogen levels that occur during perimenopause may lead to temperature changes. While the menopause transition is marked by lowering estrogen levels over time, those levels fluctuate substantially until the final menstrual period. “The hormones don’t just slowly trickle down to nothing,” she said. “They’re on a bit of a rollercoaster.”
How to treat them:
Hormone therapy, which involves taking supplemental estrogen or progesterone alongside estrogen, is thought to be the most effective available treatment for hot flashes after menopause. The F.D.A. has also approved paroxetine, an antidepressant most commonly known as Paxil, to treat moderate to severe hot flashes.
Some doctors do not recommend hormone therapy during perimenopause and instead prescribe a low-dose hormonal birth control method. Hormone therapy regimens typically contain one-fourth of the amount of hormone in the lowest-dose birth control pill, Dr. Adams said, but it is not enough to provide contraception and to control irregular bleeding.
Depression and Anxiety
What they feel like:
“Depression and anxiety really become a thing in perimenopause,” said Dr. Karen Adams, a professor of obstetrics and gynecology at Oregon Health and Science University. It can feel like a constant case of premenstrual syndrome, or PMS. “You’re not imagining things,” Dr. Adams said.
Women who experience anxiety will feel irritable and on edge, and may have heart palpitations. Depression is typically marked by a low mood, a lack of motivation, sleeping and eating more or less than usual, and not enjoying activities that are typically a source of comfort.
What causes them:
“When we lose estrogen, we’re more vulnerable in terms of mood,” said Dr. Stephanie Faubion, medical director of the North American Menopause Society and director of the Mayo Clinic Center for Women’s Health.
Women who have experienced perinatal depression or premenstrual dysphoric disorder, a severe form of PMS, are at a higher risk for developing depression around menopause. Hot flashes are also associated with anxiety.
How to treat them:
Depression that occurs around the menopause transition responds well to estrogen, Dr. Faubion said.
If a woman isn’t responding to hormones, antidepressants can be helpful, Dr. Adams said. Mindfulness, cognitive behavioral therapy, relaxation techniques and yoga can also improve mood.
Genital and Urinary Symptoms
What they feel like:
Women may experience intermittent vaginal dryness, urinary leakage and an overactive bladder during and after perimenopause. They sometimes report an itching or burning sensation in the vagina or during urination: “Some describe it as razor blades or shards of glass,” said Dr. Faubion. Sex can be painful; so can wiping with toilet paper or wearing jeans.
What causes them:
Low estrogen levels can lead to genital symptoms. “Estrogen helps maintain the health of those tissues with elasticity and blood flow and moisture,” Dr. Faubion said. “You lose all of that when you lose estrogen.”
How to treat them:
Unlike hot flashes, genital symptoms do not go away without treatment, Dr. Santoro said. The No. 1 prescription treatment is vaginal or local estrogen, which is available in vaginal rings, creams and inserts. Many women may also alleviate symptoms by using over-the-counter vaginal moisturizers and lubricants.
Brain Fog
What it feels like:
Women may feel like their thoughts aren’t as clear as they once were, and may have trouble remembering words.
What causes it:
There could be a number of causes, Dr. Faubion said. “It could be basically withdrawal from a steroid, estrogen,” she said. But hot flashes, night sweats and other symptoms of menopause can interrupt sleep, and decreased and fragmented rest can take a toll. Depression and other mood disorders also impact cognition.
How to treat it:
Brain fog tends to be more of an issue in perimenopause, Dr. Adams said, and levels out after menopause. “Just knowing that can be a relief,” she said.
Identifying and addressing sleep issues can also mitigate brain fog. Night sweats and hot flashes can be alleviated with supplemental estrogen. Avoiding caffeine, alcohol and nicotine before bed can help improve sleep. Eating earlier may also be beneficial: Make sure your last meal is at least two hours before bed.
Skin and Hair Issues
What they feel like:
Women report losing hair, growing new facial hair and thinner or dryer skin.
What causes them:
Women lose about one-third of the collagen in their skin around the menopause transition, Dr. Faubion said.
Hair thickness has a hormonal component, Dr. Adams said; some women notice changes in their hair during pregnancy and postpartum as well. Hair loss may also be related to thyroid abnormalities and vitamin deficiencies, which are not necessarily related to menopause but can crop up with age.
How to treat them:
Taking a daily women’s formula multivitamin, as well as taking estrogen, can support preventing hair loss. Rogaine, a hair-thickening product that comes in a topical foam, has also been shown to work for women. Taking estrogen can increase skin thickness, moisture and flexibility, too.
Have a physician check your thyroid hormone levels, because hair loss can be related to thyroid abnormalities. And consult your doctor about any new health issues that you think may be related to perimenopause or menopause.
While these symptoms can be irritating and disruptive, “all these things can be treated,” Dr. Adams said. Perimenopause and menopause symptoms will not last forever. “It’s not your new normal,” she said.
