No, you're not going crazy. The Tasmanian-devil rage, sleep-depriving night sweats, unpredictable periods, and whatchamacallit forgetfulness—it's real, it's normal, and it's called perimenopause, 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 flurry of other more surprising symptoms. Here, the truth about what to expect—and simple steps you can take to feel like your self again.
It's pretty much unpredictable
You and your BFF likely won't experience it the exact same way, 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. Experts can't predict how bad your symptoms will be or when they'll end—perimenopause can last anywhere from a lucky 2 to an exhausting 10 years. You're officially in menopause when you've gone 12 months without a period. One sign menopause is close: You miss your period for more than 3 months—that indicates you'll likely stop menstruation altogether within a year. 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 hormone, and symptoms ease up.
Feel-better fix: 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.
It's like PMS—on steroids
You accidentally burned the pizza in the oven: The pre-perimenopausal you may have muttered a curse and tossed it in the trash. You-in-the-throes-of-perimenopause, however, assault the oven door, burst into tears, and blame your husband, kids, and cocker spaniel for distracting you. One minute later, you're totally fine. Okay, maybe you don't actually attack your stove, but the rest pretty accurately exemplifies the toll raging hormones take on your emotional state. Research shows that nearly 40% of women experience mood swings associated with hormonal dips—from sudden anger to intense moodiness, anxiety, or despair.
Feel-better fix: It's hard to avoid mood swings entirely, but there are ways to alleviate them. Studies suggest too little vitamin B12 may be linked to mood swings and depression, so up your intake of B12-rich foods, including shellfish (clams, mussels, and crab), salmon, lean beef, low-fat or fat-free milk, and eggs. (A daily multivitamin also provides the recommended amount.) Some OTC products, such as Pamprin, may help ease irritability, as can yoga and--it goes without saying--getting enough sleep. For severe mood swings, your doctor may recommend hormone therapy—the medication may ease emotions by boosting neurotransmitters that help regulate moods.
You're sweating, then you're freezing.
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.
Feel-better fix: If you suspect your spicy Mexican lunch brought on a flash, take note, and avoid that trigger next time. (Coffee and wine are other common culprits.) Studies show that deep breathing for 15 minutes twice a day can reduce the frequency of hot flashes by 39%. Herbal supplements such as black cohosh may also help—if only because you think they will. Several studies show that it's no better than a placebo in reducing hot flashes, but the effect is still significant.
The same is true for soy: Adding isoflavones—estrogen-like compounds found in soy foods—to your diet reduces hot flashes, according to some research; other studies show no change at all. Whether it's the placebo effect at work or not, that edamame appetizer (always get your soy from food, not supplements) may still help you feel cool and comfortable.
Prescriptions meds—specifically, low-dose or very low-dose hormone therapy—are the most effective way to treat severe hot flashes. When hormones aren't an option, antidepressants and certain blood pressureand antiseizure meds may work as well. Your MD can help you decide whether one of these routes is right for you.
Stock up on supersize tampons.
Gone are the days when you knew exactly what time your monthly visitor would arrive. 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.
Feel-better fix: 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.
You can so still get pregnant.
Sure, irregular ovulation means less chances to conceive, and true, fertility steadily decreases as you get older. But as long as you are having periods—no matter how erratic—you can still get pregnant. In fact, while birth rates for teens and women in their 20s and 30s decreased in the past few years, those in the 40-plus bracket increased, according to the CDC. About half of pregnancies among women 40 and older are unintended, found a study from the National Center for Health Statistics. So unless a baby is on your agenda, use birth control.
You may go up a jeans size (sorry!).
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 your body to secrete more cortisol—and high levels 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.
Feel-better fix: Amp up your workout routine—add two or three strength-training to your weekly regimen to help fight age-related muscle loss, which slows down metabolism, and include fast-paced intervals (try this routine) to your daily walk to burn more calories. Your goal: Keep your waist size to under 35 inches; more than that is linked to an increased risk of heart disease and diabetes.
You're never in the mood for sex.
First, the good stuff: Studies show that for many women, a good sex drive before perimenopause will return after you hit menopause. During, however, poses more of a challenge: 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, frankly, makes intercourse hurt).
Feel-better fix: Over-the-counter lubricants or topical estrogen can help with dryness and may help boost your libido in the process. Sometimes emotional factors can play a role too—maybe you and your husband are adjusting to an empty nest or new roles as caregivers of your parents, which can strain your marriage and sex routine. For ideas to reconnect and rekindle the passion, visit our 14-Day Sex Jumpstart here.
"Thingy" is a permanent part of your vocab.
You try, you really do—but for the life of you, you can't remember the word for that thing you write with, the name of your best friend's kid, or what you ran back in the house to get. 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.
Feel-better fix: 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.
You forget what a good night's sleep is like.
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.
Feel-better fix: 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.
Hormone therapy may be right for you.
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.
On the other hand, the safety and efficacy of some bioidentical hormones—the so-called natural hormones popularized some celebrities—is still debatable. Biodenticals claim to be better than standard hormones because they are derived from plant chemicals (instead of made in a lab) and can be customized in compounding pharmacies for each patient's specific needs. The issue with compounded hormones is that they are not FDA-tested or approved for purity and efficacy—plus, there there's no science to support they are any safer than standard hormone therapy. Talk with your doctor to determine your best course of hormone treatment.
Hair will boldly grow where it never did
How many times have you plucked a couple of disturbing thick black hairs from your chin and wondered, Where the heck did that come from? Again, hormones are to blame—during perimenopause, female estrogen declines and male androgen stays put, 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!
Feel-better fix: For unwanted hairs, plucking, waxing, and lasers work; you may also consider birth control pills or anti-androgen drugs, such as Aldactone, to help prevent errant hairs from growing. To prevent hair loss on your head, prescription minoxidil (Rogaine for women) is FDA-approved for growth and to prevent further loss. New hair may be thinner and shorter than the locks still on your head and can take 12 weeks to start growing.