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Perimenopause: Everything You Need to Know

Hot flashes and mood swings - learn more about what perimenopause really entails, and how you can prepare for it even in your 30s.
Having a support system while going through perimenopause is invaluable and can help you feel less alone. Image credit: Ron Lach
By Kimberly
July 25, 2023

Learn all about perimenopause and its symptoms, including hot flashes, mood swings and irregular menstrual cycles. Aside from treatment options, learn how to lessen the symptoms and start preparing for this stage of life.

When Should I Expect Perimenopause to Begin?

Perimenopause may start as early as your mid-30s or as late as your mid-50s. This is the period of time when your body begins transitioning to menopause. As a result, your ovaries start producing less oestrogen, and your menstrual cycle may thus become erratic or irregular. Naturally, this also means that your body is moving towards the end of your reproductive years, with a decrease in fertility during perimenopause. However, you may still be able to get pregnant during this time. 

How Long Does Perimenopause Last?

How long you’ll be in perimenopause varies. Some can be in perimenopause for a short time, but for many it lasts between four to eight years. When you’ve gone 12 consecutive months without menstruating, you’ve officially entered menopause. Completing menopause before 40 years old is called premature menopause. This may be caused by medical procedures, or primary ovarian insufficiency. 

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Hormonal Changes and Its Effects

Your hormones – progesterone and oestrogen – levels will fluctuate during perimenopause. These two hormones are responsible for ovulation and menstruation. You’ll notice that your menstrual cycles are no longer as predictable, and you may also experience hot flashes and vaginal dryness. Other symptoms of perimenopause include sleep problems and changes in mood that may include mood swings, irritability or depression. With the decrease of oestrogen, your bones may also thin and your cholesterol levels may change. During perimenopause, if you’re still getting your period, albeit irregular ones, you will still be ovulating. 

Bleeding During Perimenopause - What’s Normal?

Additionally, your periods may also be heavier or lighter than usual, and may need to urinate more frequently. That said, consult a healthcare provider if your periods are very heavy or accompanied by blood clots, or if your periods last several days longer than usual. Moreover, if you spot or bleed after your period, experience spotting after sex, or your periods occur closer together, see a healthcare provider. Some causes of abnormal bleeding might include infection, fibroids, taking blood thinners or cancer. 

Risk Factors for Premature Menopause

Some risk factors can make it more likely that you’ll start perimenopause earlier. For example, smokers usually start menopause 1 to 2 years earlier than non-smokers. Other risk factors include family history, hysterectomy, or cancer treatment, which may cause menopause to occur earlier than normal. 

While it’s usually unnecessary to seek medication for perimenopausal symptoms, sometimes they can be quite bothersome. Treatments may include using hormone therapy, where oestrogen or oestrogen and progestins can help level out hormone levels. Additionally, you may consider antidepressants to help stabilise your moods if necessary. 

Managing Perimenopausal Symptoms

Reduce night sweats by choosing mulberry silk sleepwear, which is temperature regulating and can help with your night sweats. Image credit: SOVA Silk
Hot Flashes

This symptom of menopause can vary from person to person. While some may experience hot flashes for only a little while during menopause, in other instances, they could last for the rest of your life. It usually feels like a brief sensation of heat, where you might become flush and start sweating. After it passes, you might then feel chilled. However, as mentioned earlier, they may differ for each person, and it could feel like intense heat for you instead.

Reduce Your Triggers

If so, be sure to consider triggers for hot flashes like caffeine, smoking, alcohol, or eating spicy foods. In particular, smoking contributes to the increased cardiovascular risks of being postmenopausal, and people who smoke or use tobacco products tend to experience more hot flashes. Other triggers may include wearing tight clothing, stress, heat or hot weather. 

Hot flashes may also disturb your sleep, whether through night sweats or insomnia. To combat this, keep your bedroom cool to prevent night sweats. Consider choosing cooling materials like mulberry silk for your sleepwear and pillows. While it may seem tempting, ironically, long-term use of sleeping pills can interfere with your sleep and have unwanted side effects. Instead, try exercising daily, avoiding caffeine and alcohol at night. Before you sleep, try milk products at bedtime, or take a warm bath or shower. According to Dr James DiNicolantonio, other supplements like inositol, magnesium, glycine and L-Teheanine can be helpful to improve your night sleep. Viewing the sun in the early morning, dimming the lights after 7pm and avoiding caffeine after 12pm can also improve your nightly sleep.

Treatment Options

Should the hot flashes be unbearable, you may consider medications like hormone replacement therapy, or non-hormonal medications like selective serotonin reuptake inhibitors, to reduce the severity and frequency of hot flashes However, these may have other side effects like nausea, elevated blood pressure and changes in bowel habits. 

Another way to treat your menopausal symptoms include TCM treatment for kidney yin or yang deficiency. TCM physicians might prescribe herbal medication, acupuncture and moxibustion to treat the symptoms. 

Mood Swings, Fears and Depression
Beginning a meditation practice can help reduce negative emotions and increase patience and tolerance. Image credit: Marcus Aurelius

Other than hot flashes, you may also experience mood swings, depression, or have more anxiety and fears. If these are particularly overwhelming, you might want to check with your healthcare provider. Good self-care habits to implement include yoga, meditation or slow, deep breathing exercises. Try to engage in creative outlets or hobbies to help you foster a sense of achievement, and remember to stay connected with your family, friends and community. 

Painful Intercourse

Sex may become uncomfortable or painful, so try using a vaginal water-based moisturising lotion or lubricant during intercourse.

Start Preparing in Advance

To preserve your muscle mass and prevent osteoporosis and frailty, start strength training with weights or resistance bands, Image credit: Andrea Piacquadio
Include Strength Based Exercises

While perimenopause might be one or two decades away at least, starting to prepare for it (and maintaining good health) can help alleviate the symptoms and their long-term effects. For example, incorporating strength training at least twice a week can help build muscle mass and bone density, and prevent low hormone-related diseases and their symptoms.  After the age of 30, muscle mass decreases about 3 to 8 per cent, with an increased rate after 60 years old. Decreased muscle mass, strength and function may lead to disability in older people. You can start working out at home with YouTube videos, dumbbells and resistance bands. Some exercises include squats, planks and shoulder presses.

Dietary Guidelines

In terms of diet, incorporate more fish, nuts, veggies, dairy and fruit into your meals, while reducing the amount of sugar, alcohol or coffee that you consume as these can elevate your hormones. A balanced diet can help with all the changes that will take place. You’ll also need to get around 1,000  to 1,200mg of calcium in your diet or supplements to prevent osteoporosis. As a guide, a 250ml glass of milk usually contains around 300mg of calcium. 

Importance of Protein in Your Diet
Getting sufficient protein - at least 1 to 2g per kg of bodyweight - can help preserve muscle mass. Image credit: Malidate Van

Another essential aspect is getting enough protein, about 1 to 2g of protein per kilogram of bodyweight depending on your activity levels. During menopause, your diet should be rich in protein to maintain muscle mass and strength. According to a 2021 study, late perimenopausal women had 9 per cent lower muscle mass, and postmenopausal women have 10 per cent less as compared to early perimenopausal women. When older adults increase their protein intake by 20 per cent, they have a 32 per cent lower risk of frailty. Other benefits of protein include energy production, sleep and mood, helps curb cravings, while regulating blood sugar levels.At each meal, try to incorporate a palm-sized portion, such as a chicken breast, mackerel fillet, half a block of tofu or three eggs.  

Isoflavones to Help Reduce Hot Flashes

It may also be beneficial to include isoflavones in your diet to benefit your overall health, and reduce your hot flashes. According to the research by Li-Ru Chen, Nai-Yu Ko and Kuo-Hu Chen, they found that isoflavones help reduce hot flashes and benefit the systolic blood pressure during early menopause. Additionally, isoflavones also help improve glycemic control in vitro. Some foods containing isoflavones include lentils, chickpeas, soybeans, grains and beans, fruits and vegetables. Of these, soybeans, chickpeas and lentils are considered to contain the most powerful plant oestrogens. As for flaxseed, choose crushed or ground forms rather than the whole seed or seed oil forms.

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