Menopause Symptoms Can Last for Up to 10 Years – Here’s How to Cope with the Transition

The term perimenopause is not mainstream – but it is a heck of a lot more common than it was 25-30 years ago when your mom went through it. Defined as the lead-up to menopause, perimenopause is the transition during which a woman begins to stop ovulating, fertility declines and periods peter out. It may last, on average, 4 to 8 years, during which time hormone fluctuations can trigger uncomfortable symptoms such as hot flashes, vaginal dryness, and insomnia. 

So that’s the clinical definition.  But do you know what perimenopause will mean for you?

“So often women don’t know that the constellation of symptoms that they may be having relates to menopause,” says Stephanie Faubion, MD, Director of the Center for Women’s Health, Mayo Clinic. “We get the talk before we start our periods. We do not get the talk before we’re going to stop our periods,” she says.

“People don’t know what to expect when they’re heading into this phase of life,” agrees Tamara Duker Freuman RD, a weight-inclusive dietitian.  “A lot of these changes are incredibly common and incredibly expected and when we don’t talk about it, we don’t hear about it. Then we worry about it when it’s happening,” she says.

For many women, the transition is a long goodbye to Tampons. While the process is natural, many experiences that occur with the hormone shift do not feel normal.  During “the change,” the new normal may include unpredictable periods, painful sex, mood swings, joint pain, and insomnia. And the stigma around all of these things can make a perimenopausal person feel even worse. 

There are many permutations (including not having any symptoms) and every woman’s experience in the lead-up to menopause will be different. “The journey can be quite varied,” notes Andrea J. Singer, MD, FACP, CCD, from the Department of Obstetrics and Gynecology at MedStar Georgetown University Hospital.“ That’s why it is important that women are aware of the different symptoms, duration, severity, etc. – and have access to resources and clinicians who can provide needed information,” she says.

And the issues that most distress the patient will vary. “When I see perimenopausal women with multiple symptoms, I wonder, what are the most important symptoms that we need to be treating?” explains Dr. Faubion, who is also medical director of the Menopause Society. “Is it the sleep disturbances and mood disturbance? Or is it mainly hot flashes? And does she still need contraception?” she says.

Here’s the good news: most of these symptoms are very treatable. The not-great news? Many doctors don’t understand perimenopausal symptoms–or the treatments that can ease them.  

However, with a little information, women in their 30s and 40s may be able to get ahead of symptoms, get good treatment, and get on with life. According to Freuman, who is author of Regular: The Ultimate Guide to Taming Unruly Bowels and Achieving Inner Peace, knowing what to expect is powerful for women, “so that they can figure out how to revise their lifestyle strategy to meet this new phase of their lives.”

We talked to experts about the most disruptive signs of perimenopause, and what can be done to manage them.

Irregular, Heavy, Unpredictable Menstrual Periods

Changes in menstrual flow and menstrual frequency are common during the menopausal transition, according to Clair Gill Founder and President of the National Menopause Foundation Irregular periods are experienced by most women as they transition to menopause, she says Often early perimenopause symptoms, unusual periods may be the first things that women notice.  

Faubion says she tends to treat the patient’s most distressing symptoms first. If it is the bleeding that is driving her crazy, she says, “We could use an IUD or we could use a birth control pill, which will cover contraception, it’ll cover bleeding, and it’ll also help with menopause symptoms.”  

For heavy bleeding on its own, your doctor may consider tranexamic acid, a non-hormonal medication that helps improve blood clotting. 

While treatments should be discussed with your doctor, there are non-prescription methods that may help mild symptoms until you consult them. Over-the-counter non-hormonal ibuprofen may help ease cramps and lessen flow. Some research suggests that acupuncture can help with pelvic pain as well as other perimenopausal symptoms such as depression and insomnia.

More lifestyle tweaks many women find helpful:

Hot Flashes and Night Sweats

One of the most disruptive, longest-occurring menopausal symptoms is hot flashes. Described as warm flushes that come on quickly and may trigger heart racing, sweating, chills, and confusion. Hot flash frequency and severity varies; some women have a couple a week, while others have several a day.When they occur at night, these episodes often wake up women, ruining the chance for a good rest. 

Hormone therapy, HRT or HT, is the best treatment for moderate to severe hot flashes and night sweats, says Dr Faubion. Birth control pills or rings are a good option for perimenopausal women who can still become pregnant until they reach menopause, she notes.

Several mind-body approaches have also been studied for reducing the frequencyand severity of hot flashes. Hypnosis can be effective. Some relaxation techniques such as foot massage and reflexology have been shown to help ease vasomotor symptoms as well as perimenopausal sleep problems. 

Other drug-free treatments can help reduce how much the symptoms bother you including, cognitive behavioral therapy (CBT) and mindfulness meditation. 

More recommended DIY remedies:

Mood Problems, Including Depression and Anxiety

For many women, some parts of mid-life feel like a hot mess. In addition to hormone flux, they face caring for aging parents, career challenges and changes, relationship issues, raising young children, older children leaving home, and generally more overall stress.

It is not surprising that studies have found that women are especially vulnerable to depression during perimenopause. Women with a history of depression have an even higher risk.

In 2019, the North American Menopause Society and the Women and the National Network of Depression Centers released the first-ever guidelines for the evaluation and treatment of perimenopausal depression It encourages clinicians to consider menopausal status during their work-up of female patients and notes that symptoms such as hot flashes can complicate, co-occur, and overlap with depression.

Among the proven therapies for perimenopausal depression, including antidepressants and psychotherapy, the guidelines say that estrogen therapy can be effective, especially when a person has multiple perimenopausal symptoms. Data on mindfulness-based stress reduction programs suggest the approach can help improve symptoms of both depression and anxiety.

While there is less research on anxiety in perimenopause, research has established a link between anxiety, stress, and another symptom: sleep deprivation. Some research suggests that acupuncture shows promise for treating depression and co-occurring insomnia.  

Complementary therapies, which may help when used alongside other treatments, may include:

Vaginal Dryness and Painful Sex

Decreasing estrogen levels can cause drying and thinning of the vaginal tissues. This may lead to itching and discomfort, urinary problems as well as pain and burning during sex, a condition known as vaginal atrophy or  Genitourinary Syndrome of Menopause (GSM).  Unlike some perimenopausal problems, this one won’t resolve eventually on its own – in fact, GSM will worsen.  “Vaginal dryness symptoms don’t get better with time, they just get worse without treatments,” according to Faubion.

Symptoms may call for a hormonal option, such as a vaginal estrogen cream, ring insert, or tablet.  Both dehydroepiandrosterone (DHEA), and osoemifene, a selective estrogen modulator (SERM) act like estrogen in your body and help ease pain associated with GSM. For milder symptoms, OTC lubricants and vaginal moisturizers may help maintain moisture. Vaginal moisturizers are used on a regular basis. “Like a face cream for the vagina,” Faubion says. Lubricants are used just before sexual intercourse.

Insomnia and Other Sleep Problems

It feels like poor sleep can ruin everything. Difficulty falling asleep, sleep disturbances, difficulty staying asleep and early morning awakenings are linked to the shifting hormones of perimenopause. And some women may also have a co-occurring condition. This is the time when women face an increased risk for health issues such as sleep apnea, thyroid disorders, and restless leg syndrome.

And, as mentioned, sleep trouble goes hand in hand with other perimenopausal symptoms such as hot flashes and depression. Depending on the severity of the sleep issues, you may benefit from an antidepressant. Sometimes hormone therapy makes sense, according to The Menopause Society, especially if hot flashes are involved. 

Cognitive behavior therapy for insomnia (CBTi), is an effective method for improving sleep. Yet your most powerful weapon may be exercise. When researchers reviewed 17 clinical trials, they found that physical activity such as yoga, aerobic exercise, and walking, reduces insomnia and other sleep issues in older women, according to research published in 2023. Per another study, when perimenopausal women with anxiety, depression, or insomnia, did two 60-minute-long aerobic exercise sessions each week for 8 weeks, they experienced improvements in symptoms of all three disorders.

Other drug-free tips include: