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Tips to manage perimenopause
From lifestyle and dietary changes to hormonal and non-hormonal options, here are some tips from our experts
Top things to know about managing perimenopausal symptoms
Everyone is unique, and no two people will have the same perimenopause experience.
There are several options to support you in managing perimenopause, including hormonal and non-hormonal options.
Adapting your daily habits can help manage uncomfortable perimenopause symptoms like hot flashes and mood changes.
Some people will have a lot of perimenopause-related experiences, and some may have little to none.
For some women and people with cycles, the changes they experience during perimenopause can be stressful and worrying. Learning about common perimenopause experiences and tips to manage them can help you regain the feeling of control.
There are numerous options available to support you, including alternative treatments, hormonal treatments, and non-hormonal treatments. It’s worth knowing that even simple changes to your daily habits can help manage certain perimenopause experiences, like hot flashes and mood changes.
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Perimenopause is a transition
During perimenopause, reproductive hormones like estrogen and progesterone fluctuate significantly and then decline gradually, giving rise to new sensations and changes in your body (1,2). Perimenopause experiences vary widely across people and cultures.
Perimenopause is the body’s transition towards menopause (the point at which someone hasn’t had a menstrual period for a full year) (2). This transition can be as short as a few months or last for more than 10 years (3). On average, it lasts around four to five years (4).
Common perimenopause experiences
Perimenopause can be associated with physical, emotional, and hormonal changes (5). Although some people will not experience any noticeable changes, at least half of all women and people with cycles will have perimenopausal symptoms during this time (3). Tracking and sharing your experiences during this time can help you identify any possible triggers and anything that might help you manage them.
Tracking any changes to your cycle and any experiences you notice throughout your cycle can also be helpful to understand when you might be entering perimenopause. With Clue Plus, you can track perimenopause experiences, such as hot flashes or mood swings, in Clue and use the custom tags to note further changes and details.
Typical experiences associated with perimenopause may include (1,4):
Hot flashes
Night sweats
Disturbed sleep
Changes in menstrual cycle length or period flow
Mood changes like low mood and irritability (4)
Cognitive changes such as brain fog and forgetfulness
Changes in libido
Everyone is unique, and no two people will have the same perimenopause experience. Some people will have a lot of perimenopause-specific experiences, and some may have little to none. There are many tips and treatments available to help support you through this time.
Tips for managing perimenopause
There are a number of simple tips you can work into your routine to help support your journey in perimenopause, including (1):
Regular exercise, particularly strength training and weight-bearing exercise can help maintain bone health and lead to improved balance.
Stress management techniques and exercises that help you relax, like yoga and meditation, may be helpful in tackling any mood changes (6). If you’ve never tried yoga or meditation before, start with a gentle yoga class or short meditation.
Use of a vaginal lubricant or moisturizer can help you feel more comfortable if you’re struggling with vaginal dryness.
Smoking has been linked to increased hot flashes and night sweats (7). Although it may be difficult, stopping smoking may be a good way to help ease perimenopause experiences. Speak to your healthcare provider for further information and support.
Prepare for hot flashes by dressing in layers and having cool drinks with you (3).
Limit your intake of alcohol and caffeine to reduce the severity of hot flashes (3).
Hormone replacement therapy (HRT) for perimenopause
What is hormone replacement therapy (HRT)?
Hormone replacement therapy (HRT), also called hormone therapy, is sometimes prescribed during perimenopause to help relieve experiences associated with this time (3). If you notice vulvar and vaginal changes such as dryness, you might choose to use hormones inside the vagina in the form of a cream, ring, or tablet (3). But if you’re experiencing more whole-body changes, such as hot flashes, you might choose hormonal therapies that will act throughout the body (aka systemic HRT). Systemic HRT can be taken in several forms, like pills, patches, gels, creams, and sprays (3,8).
What are the risks and benefits of HRT?
HRT can help with managing any uncomfortable perimenopause experiences, including hot flashes and night sweats (1). Also, data suggests systemic HRT lowers the risk of osteoporosis (a condition characterized by weakened bones due to decreased bone density), and heart disease and may help people live longer if taken during perimenopause (3,8). However, systemic HRT also carries risks, including an increased chance of developing breast cancer, stroke, and blood clots (8). The U.S. Federal Drug Administration (FDA) currently recommends that people who choose HRT take it at the lowest dose that helps and for the shortest possible time (9).
Risks vary by whether your form of HRT contains a progestin (a form of the reproductive hormone, progesterone) or not (3,8). During perimenopause, many women opt for long-term options, like the IUD, to help manage unpredictable bleeding and some other changes (10). Hormonal contraceptives can also help prevent unintended pregnancies, which are still possible during perimenopause (10).
Non-hormonal options for perimenopause experiences
What’s available?
If you’re looking for treatments for perimenopausal experiences but you don’t want to—or you can’t—take hormones, it might be a relief to know there are non-hormonal options out there. Interestingly, medications that you may know have different uses have also been found to be helpful in perimenopause. For example, medications that are primarily used to treat depression, high blood pressure, and seizures have been found to also be effective in reducing hot flashes (3). One example is antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs), which are helpful for mood changes and can also help manage hot flashes (3).
Selective Estrogen Receptor Modulators (SERMs)
Another medication is called selective estrogen receptor modulators (SERMs), which are non-hormonal and have effects similar to estrogen on certain parts of the body (1). One SERM named Ospemifene is approved to be prescribed by healthcare providers to treat painful sex caused by vaginal dryness (11). Similarly, a combination medication containing estrogen and a SERM, called Duavee, can be used to treat hot flashes and prevent osteoporosis (12).
These medications may have unwanted side effects, so it's important to have a discussion with your healthcare provider about the benefits and risks before you begin taking them. Tracking your experiences after starting any new course of medication can help you identify any side effects and let you know if it’s working for you.
Alternative and “natural” treatments and supplements for perimenopause experiences
Eating a balanced diet is important to keep your energy levels up. Getting enough calcium and vitamin D in your diet can help keep your bones strong (1). Although other alternative treatments such as acupuncture, mindfulness, reflexology, vitamins, and herbal supplements are available, there is no strong scientific evidence of their benefits for perimenopausal experiences (3).
Plant and dietary supplements, such as Black cohosh (a well-known supplement taken in perimenopause) have mixed and unclear results (3,8). Several herbal remedies aren’t well regulated, and they haven’t been tested enough to be sure of their safety. This means there’s no guarantee that they’re at an effective dose to help ease symptoms, or that they’re safe to take (1).
Taking new dietary supplements can cause side effects, and some supplements may interact with other medications you might already take, so it’s recommended to speak to your healthcare provider before starting any new supplements.
When to seek medical advice
Perimenopausal experiences can have a significant impact on someone’s quality of life. It may be a good time to check in with your healthcare provider if you have any concerns about your experiences, or if they’re affecting your daily life or your well-being.
FAQs
What does hormone replacement therapy do?
Hormone replacement therapy (HRT) is a treatment in which a person takes synthetic estrogen and/or progestin, the synthetic form of the hormone progesterone. HRT replaces the naturally declining levels of estrogen and progesterone that occur during perimenopause and menopause (1,13,14). This replacement may relieve symptoms of hormonal changes (15) such as irregular menstrual cycles (16), hot flashes (17), vaginal dryness (16), mood changes (18), and sleep disturbances (16).
How can I manage perimenopause naturally?
There are a number of lifestyle changes you can make to manage perimenopause, like regular exercise to improve balance and stress management techniques to help with mood swings (1,6). Vaginal lubricants can help with vaginal dryness, and limiting your alcohol and caffeine intake can reduce the severity of hot flashes (3). Additionally, eating a balanced diet with enough calcium and vitamin D can help keep your bones strong (1). Although other alternative treatments such as acupuncture, mindfulness, reflexology, vitamins, and herbal supplements are available, there is no strong scientific evidence of their benefits for perimenopausal experiences (3).
How can I relieve vaginal dryness during perimenopause?
There are several methods for relieving vaginal dryness, including using vaginal lubricant, taking medication like selective estrogen receptor modulators (SERMs) (11), or HRT (3).
