PAMF Health Blog

Be Well, Be Well Informed

Perimenopause: What’s Normal & Not?

Posted on Oct 6, 2015

You may have heard older female friends and relatives complain about hot flashes, mood swings, bloating and other strange symptoms, and chalk them up to menopause, the “change of life.”  But the real culprit isn’t menopause – it’s perimenopause.

“Perimenopause is the transition to menopause, Sashi Amara, M.D., an internal medicine specialist at the Palo Alto Medical Foundation, says.  “It can start a few years before a woman’s periods end and continue for 12 months after that.”

Hallmark symptoms of perimenopause include hot flashes, night sweats and irregular periods. But other medical problems can also occur around the same age, the mid-40s, Dr. Amara says. So it’s important to know what’s normal, and what’s not.

What’s Normal During Perimenopause

“Your body is changing in the way it’s designed to change” during perimenopause, Dr. Amara says. Experiencing hot flashes or night sweats, irregular periods, vaginal dryness, sleep problems and weight gain may not be pleasant, but it’s all normal.

However, if any of these symptoms are extreme, they could be signs of a medical condition. Sleep disorders such as sleep apnea become more common in a woman’s 40s and 50s. So does hyperthyroidism, which can result in heavy sweating and feeling hot. Tumors that secrete hormones may also cause hot flashes.

And if a woman’s periods stop suddenly, there’s always a chance – a slight chance – that she’s pregnant. “After all, women are still ovulating during perimenopause,” Dr. Amara says. “So it’s important to get checked out by your doctor if you think your symptoms are abnormal.”

What’s Not Normal During Perimenopause

Typically a woman’s periods come further apart and lighter the closer she gets to menopause. Abnormal symptoms include:

  • extremely heavy menstrual bleeding
  • menstrual bleeding with clots
  • periods that last longer than eight days
  • periods that come within a week or two of each other
  • bleeding between periods

Heavy or frequent bleeding could be a sign of uterine fibroids, polyps or endometriosis, Dr. Amara says. In rare cases, heavy menstrual bleeding can even be a sign of cervical, ovarian or uterine cancer.

Embracing and Coping With Change

“This is a natural time of your life. The thing to do is embrace it,” Dr. Amara advises. You have more support than you may realize. “There’s much more acceptance and greater awareness of perimenopause today than there was in the past,” she says. “And I think there’s more empathy from society in general toward women going through this transition.”

She gives her patients in perimenopause a few handy tips to help them cope with hot flashes:

  1. Exercise moderately 30 minutes a day. Limit vigorous exercise because that can raise your core body temperature.
  2. Drink six to eight cups of water a day. Staying hydrated helps keep your core body temperature cool.
  3. Limit caffeine and alcohol, which can raise your body temperature.
  4. Keep your room cool, especially when trying to sleep.
  5. Dress in layers so you can cool down when you’re having hot flashes.

When to Consider a Medical Solution

Some women have light hot flashes for a year or two, and aren’t bothered much by them. But other women suffer severe hot flashes and night sweats for years. “When your symptoms are severe and lifestyle changes don’t help, it’s reasonable to consider a medical solution,” Dr. Amara says.

For some women, the antidepressant Paxil may help ease hot flashes, and a new drug called Osphena may ease vaginal dryness. Still, nothing addresses the symptoms of perimenopause quite as well as the hormone estrogen, which replaces the estrogen your body is no longer making. The problem is that hormone replacement therapy (HRT) is linked to an increased risk of heart disease and cancer.

Is it worth the risk? For a carefully selected subset of women, yes, Dr. Amara says.

“For women who don’t have high blood pressure or blood clots, and who don’t have a family history of heart disease, breast cancer or colon cancer, HRT may make sense for a few years. It’s a reasonable, calculated risk,” she says.

Remember, you won’t stay in perimenopause forever. Eventually, usually by 50 to 52 years of age, your periods will completely stop. When you’ve gone an entire year without menstruating, you’re in menopause at last.

Sashi Amara, M.D.

Sashi Amara, M.D., is an internal medicine specialist at the Palo Alto Medical Foundation and Mills-Peninsula Health Services