Years before menopause, your body begins the natural process of change. Sometime during your 30s and 40s, the amount of estrogen and progesterone produced by the ovaries begins to fluctuate. A common sign of perimenopause is a change in your menstrual cycle:

• Cycles may become longer or shorter
• Cramping may increase or decrease (from uterine muscles contracting and blood vessels constricting)
• Low back discomfort may increase or decrease
• Flow may become lighter or heavier
• You may begin to miss periods. Some women may get a period every 2-3 weeks, others will not menstruate for months at a time, yet others may actually find that their menstrual cycle continues as normal and then suddenly stops. In the later stages, you may start missing at least two menstrual cycles in a row.

It is common for women to experience symptoms for between 4 – 8 years. Although changes in menstrual bleeding are normal during perimenopause, you should still report them to your OB/GYN. Abnormal bleeding may be a sign of a problem (fibroids, endometriosis, pelvic inflammatory disease).

While perimenopause and menopause are not diseases or disorders, they do trigger some profound changes in your body. 

• Hot flashes – a sudden feeling of heat rushing to the upper body and face may last from a few seconds to several minutes or longer. It may start in the face, neck, or chest, and progress upward or downward. Some women have hot flashes a few times a month or several times a day. They can start in the perimenopause period, and continue for several years into menopause. Hot flashes that happen at night (night sweats) may wake you up and cause you to feel tired and sluggish during the day. Putting a towel underneath your body helps keep your sheets drier!!
• Sleep problems – you may have insomnia (trouble falling asleep), or you may wake up long before your usual time. Night sweats may also disrupt your sleep.
• Vaginal changes – as estrogen levels decrease, the lining of the vagina may become thinner, dryer and less elastic. Vaginal dryness may cause pain or discomfort during sex (water-based lubricants can be used each time you have sexual intercourse). Vaginal infections also may occur more often.
• Urinary tract changes – the urethra can become dry, inflamed or irritated. This can cause more frequent urination and increase the risk of urinary tract infections. You may need to visit the toilet more often! Some women may experience urinary incontinence, involuntary urination after coughing, sneezing, laughing, or lifting – kegel exercises to strengthen pelvic floor muscles can be useful to regain/maintain urinary control.
• Breast tenderness (perimenopause) or breast shrinkage (menopause)
• Decreased fertility
• Headaches
• Unexplained exhaustion
• How mood changes and depression are related to hormones is still unclear. Women who perceive high amounts of stress, are in poor health, or have a history of depression may be more likely to experience depression symptoms during perimenopause and menopause.
• Increased or decreased sex drive
• Cognitive functions – some women may experience short-term memory problems and difficulty focusing for long periods.
• Some women may experience an increase in abdominal fat
• Some women may experience hair loss or thinning of hair

Most women do not seek medical advice during this time, and many women require no treatment. Here are several things for you to try and experiment with to help make you more comfortable and stay healthy during this significant and natural time of your life:

• Nutrition – eating a balanced diet will help you stay healthy before, during and after menopause. Be sure to include enough calcium, magnesium and vitamin D to help maintain strong bones. Remember, supplements cannot correct a poor, unbalanced diet.
• Stay hydrated – especially if you are experiencing hot flashes and sweating! Urine should generally be light lemon yellow to clear in color.
• Regular activity/exercise – a mix slows down bone loss, helps keep blood vessels more youthful and elastic, boosts general mood, may help improve sleep (each person needs to experiment to figure out what time of day is best for her to perform exercise), decreases risk of breast and certain other cancers, keeps connective tissues more resilient, improves your overall health
  • Aerobic activity – that makes you sweat for 20 minutes or more
  • strength training – by resisting against weight such as your own body, an exercise band, handheld weights, etc. It should be heavier than what you encounter in your normal, daily routine to have a protective effect.
  • Balance training – like yoga, tai chi, 1-leg balance exercises, pilates, etc. may help you avoid falls, which could lead to broken bones
  • Flexibility/stretching – helps you feel less stiff
• Deep breathing techniques, guided meditation, and/or progressive relaxation can help limit sleep disturbance. Stress can aggravate hot flashes and night sweats, so avoiding or learning how to deal with known stressors and practicing relaxation techniques can help these symptoms.
• Avoid tight clothing
• Limit consumption of spicy food, caffeine and alcohol
• Stay sexually active to reduce vaginal dryness
• Maintain a cool, comfortable temperature in the bedroom at night, or use a ceiling or floor fan to minimize the discomfort of night sweats
• Wake up and go to sleep at the same times to help regulate your sleep cycle
• Smoking can exacerbate symptoms
• Using at-home remedies and over-the-counter (OTC) medication
• Routine health care – visit your OB/GYN once a year to have regular exams and tests. Dental checkups and eye exams are important, too. Routine health care visits, even if you are not sick, can help detect problems early.