Perimenopause occurs at a time in life when women are already dealing with other challenges, such as raising children, caring for aging or ill parents and juggling career stress. And now instead of a quick end to your menstrual cycle you are facing a decade or more of hot flashes, irregular periods, mood swings, weight gain, hormonal imbalance and night sweats. It can be easy to be overwhelmed, however, now is the time to take control of your symptoms and make lifestyle changes that are mindful of your body’s changing needs. While hormone replacement therapies and prescription medications are available, they aren’t for everyone, and there are many things you can begin doing today, that will help you through this most challenging phase of life.

Determining if you are in perimenopause isn’t an exact science unfortunately, as hormone levels can fluctuate throughout your cycle and even on a daily basis. Often your physician can do tests to rule out other root causes of your symptoms. Physicians often check specific hormones to help determine fertility which can assist you in making decisions if you want to have children. Thyroid disease can often mimic perimenopause and is a test that many physicians will order to help you rule it out, or to address symptoms that you may be experiencing along with perimenopause. Elevated follicle-stimulating hormone (FSH) can be tested to determine when you have reached menopause, as a consistent level of 30 mIU/mL or higher combined with an absence of menstrual cycle generally indicates you’ve reached menopause. But just because there isn’t currently a ‘yes or no I’m in perimenopause’ test, doesn’t mean that you can’t address your symptoms to both survive and thrive during what can be a long phase of life. Today we’re going to look at the main symptoms of perimenopause and how to manage them.

Fluctuating Hormones

Fluctuating hormones are the cornerstone of perimenopause and responsible for most of the symptoms that you’ll experience. So helping your body get your hormones under control will go a long way in reducing all of your symptoms. Hormone therapy can be an option for some women, however new research indicates that improving the health of the gut biome can help your body naturally regulate hormone levels. The gut biome works in three ways to regulate hormones: it metabolizes extra or excess estrogen, it produces estrogens and it tells your body to increase estrogen production. Testing for the gut biome is available, so you don’t have to guess whether or not your gut biome is healthy. Your health care practitioner can recommend the proper way to treat any imbalances based on your test results.

Weight Gain and Bloating

Managing weight gain and bloating during perimenopause can be frustrating. Fluctuating hormones can make weight loss nearly impossible.

Eating eating a whole food diet can reduce bloating and aid in weight loss.

Keep meals small and nutrient dense, avoiding notoriously gassy foods such as beans and broccoli.

Eating a diet high in fiber and staying hydrated by drinking at least half of your body weight in ounces of water every day will help keep your gastrointestinal tract moving smoothly. To be clear you should have a bowel movement daily and your urine should be a very pale yellow.

Hot Flashes

Hot flashes can be one of the hardest symptoms to deal with, an unexpected hot flash can leave you drenched in sweat feeling hopeless and embarrassed. Common triggers for hot flashes include: tight clothing, alcohol, eating a lot of sugar, smoking, caffeine, spicy foods, heat and stress


Exercise helps reduce the frequency and the intensity of hot flashes. But it’s literally not a walk in the park, exercise that reduces hot flashes has to be vigorous, which means you have to exercise for at least 30 consecutive minutes (more is better), you should get your heart rate up and break a sweat. Exercise also releases endorphins, which improve your mood.


Using herbs to alleviate perimenopause symptoms, Black Cohosh, in particular is well researched. Black cohosh helps to alleviate disturbances in mood, hot flashes, night sweats, and vaginal dryness. A 20 to 40 milligram tablet of black cohosh is the recommended daily dose.

Sleep Problems

Sleep problems if not corrected can negatively affect your overall health and mood. When we sleep our bodies detox, repair and rest, without adequate rest none of those things happen and stress increases. The good news is that you can implement some simple strategies to ensure you get a good night’s sleep.

Eliminating caffeine consumption entirely from you diet might not be realistic, but reducing your caffeine intake and not having caffeine for 4-6 hours prior to sleep is an attainable goal.

Reducing alcohol will allow you to get more REM sleep, so you wake up more rested.

No electronics an hour or more before sleep, the use of electronics is notorious for stimulating the brain and making falling asleep harder.

Go to sleep at the same time and create a night time ritual, that includes lowering the lights.

Sleep in complete darkness, which helps your body reset it’s circadian rhythum.

Mood Changes

Mood changes can be hard to work on, as you may not even realize that your moods are being affected by perimenopause. You might think that everyone and everything on the planet is just set on irritating you and that you have no hope of changing things. But know this, mood and overall mental well-being are affected by perimenopause and you can do something about it.

Stress Management: being overly stressed physically or emotionally will have a negative effect on your mood. Don’t over commit, ask for help, make realistic to-do lists and incorporate more self-care into your daily routine.

Mediate: mediating keeps you in the present moment and teaches you to focus on your breath and notice what is happening. Meditating won’t change your hormone levels but it can help you control your cortisol levels and teach you how to breathe deeply and calmly. Breathing deeply relaxes your body and focuses your mind.

Journaling & Charting: Keeping track of your menstrual cycle and other symptoms, can greatly help you and your physician see the patterns of what is happening to your body. Journaling will allow you to more fully explore daily stresses and your moods.

Talk to other women going through perimenopause. Know that you aren’t alone, share you stories and successes with other women who know what you are going through. Talk to your friends, find a local or online support group.

Bladder Problems

Fluctuating estrogen levels can lead to loss of volume and elasticity in the bladder, which may mean you’ll feel the urge to urinate more frequently. As the vaginal walls also get thinner there can be a higher concentration of bacteria in your genital region and as the urethra may thin, bacteria have easier access to your bladder. This is why urinary tract infections, bladder infections and/or kidney infections are more common as women experience perimenopause. There are however actions you can take to reduce the frequent urge to urinate, incontinence and reduce chance of infections.

Strengthen the pelvic floor: performing Kegel exercises, daily will increase blood flow and strengthen the muscles in the vagina and around the urethra.

Bladder training: By following a timetable for releasing urine, you’ll be able over time to decrease the urge to urinate.

Stay hydrated: drink plenty of water and avoid foods and beverages that make urine control more difficult, such as: alcohol, coffee, carbonated beverages and chocolate.

Vaginal Problems & Changes in Sexual Function

As if all the other symptoms weren’t challenging enough, perimenopause hits hard at the most intimate level. When estrogen levels fall vaginal tissue becomes thinner and drier, the dryness causes irritation and itching. Dryness can make intercourse very painful and often leads to avoidance of sexual intimacy and an overall decline in sexual desire. This is not something that you can simply ignore or wish away, you have to be proactive, and address this uncomfortable but manageable symptom of perimenopause.

Eat a diet high in phytoestrogens: foods and herbs that contain lower-dose estrogens can reduce vaginal dryness. Eat a diet that includes miso, soymilk, tofu, soybeans, flaxseed and flax oil. Don’t expect changes over night. Add these foods to your diet, eat them every day and give them 30 days to take full effect.

Use vaginal lubricants and moisturizers, while these topically applied products don’t address the cause of the problem, they do relieve the dryness and irritation, use them liberally.


Vitamin E, 50–400 IU per day, taken orally have been shown to increase blood supply to the vaginal wall and improve premenopausal symptoms. Take daily for at least 30 days to fee the full effects.

Maca, raises estradiol levels, which alleviates vaginal dryness, and help with concentration, and energy. It comes in powder form and the recommended dose is 2,000 mg per day, you can add it to juices, yogurts or smoothies.

Probiotics can be helpful for tackling vaginal atrophy, specifically Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14, which are noted for thethe restoration of vaginal flora in postmenopausal women.

Vitamin D decreases the pH of the vagina as well as dryness and atrophy.

The bad news of perimenopause is that life that goes on. The good news of perimenopause is that life goes on and you don’t have to settle for every symptom that perimenopause deals you, you have many different ways to deal with the changes you are experiencing.


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