While perimenopause is natural, it can cause disruptive physical and mental effects. Menstrual period changes or irregularities are the most common. Other symptoms may include hot flashes, sleep problems, vaginal dryness, painful sex, mood swings, decreased libido (sex drive), and more.
Self-care and nonhormonal approaches can be effective for some, while others may benefit from hormone therapy. This article explores various treatment approaches, including self-care, nonhormonal and hormonal medications, herbs, and supplements.
Table of Contents
Perimenopause Treatment for Physical Effects
During perimenopause, hormonal shifts can cause adverse physical effects, including changes in menstrual cycle length, vasomotor symptoms, sleep problems, and vaginal changes. Discuss one or more of the following treatment options with a healthcare provider if you're experiencing the physical effects of perimenopause.
Age Range for Perimenopause
Perimenopause typically begins in your mid to late 40s, with the average age being 47. For most, it lasts around four years but can continue for a total of eight.
A healthcare provider may suggest a low-dose hormonal birth control or hormone replacement therapy (HRT) to help treat various symptoms. The active ingredients in these medications are estrogen, progesterone, or a combination of both. They might come in pills, sprays, patches, implanted devices, or shots.
Nonhormonal Over-the-Counter (OTC) Medications
Advil, Motrin (ibuprofen), Aleve (naproxen), or Tylenol (acetaminophen) can help relieve menstrual cramps. Antihistamines such as Benadryl (diphenhydramine) or Unisom (doxylamine) have sedating effects that can help with sleep disturbances.
Nonhormonal Prescription Medications
Certain nonhormonal prescription medications can help relieve some of the physical effects of perimenopause, including:
- Neurontin (gabapentin) and Lyrica (pregabalin): Typically treat seizures and nerve pain but can help alleviate hot flashes and improve sleep quality
- Ditropan, Oxytrol (oxybutynin): Can help manage hot flashes, night sweats, and urinary problems
- Effexor (venlafaxine): An antidepressant that helps with hot flashes
- Catapres (clonidine): Typically treats high blood pressure but can help with hot flashes
- Ponstel (mefenamic acid): Originally a treatment for arthritis, but it also helps manage menstrual cramping and back pain
- Veozah (fezolinetant): A newer medication that treats hot flashes by adjusting the brain pathway that regulates temperature
- Ambien (Zolpidem), Zimovane (zopiclone), or Sonata (zaleplon): Treats insomnia
Vaginal Moisturizers and Lubricants
Vaginal moisturizers and lubricants such as Replens, K-Y jelly, or Astroglide temporarily relieve vaginal dryness and pain during intercourse.
Pelvic Floor Physical Therapy
Pelvic floor physical therapy involves pelvic floor exercises (like Kegels) and biofeedback to help with symptoms such as painful sex and urinary incontinence.
Perimenopause Treatment for Mental Health Effects
Perimenopause can also cause mental and emotional changes such as mood changes, anxiety, depression, and reduced mental sharpness (forgetfulness, brain fog).
Therapy, such as cognitive behavioral therapy (CBT) or hypnotherapy, can help you manage mental or emotional changes, develop coping strategies, improve self-care, and address underlying psychological concerns. Self-hypnosis is also a common technique for poor sleep.
Sometimes, a provider will prescribe antidepressants to help you manage mood changes and hot flashes.
Self-Care as Perimenopause Treatment
The following self-care practices are natural ways to ease or manage perimenopause symptoms.
Good sleep hygiene includes a consistent sleep schedule, a relaxing bedtime routine, and a cool, comfortable bedroom. It also helps to avoid caffeine, nicotine, and alcohol close to bedtime (at least four to six hours). Wearing moisture-wicking sleepwear and using breathable bedding can also help you avoid or manage night sweats.
Eat a Healthy Diet
Maintaining a nutrient-dense diet can help you balance hormones, decrease inflammation, manage weight, decrease hot flashes, and maintain bone health. A nutrient-dense diet includes fruits, vegetables, legumes, whole grains, lean proteins, and healthy fats. It also involves portion control and limiting processed foods, salt, spicy foods, sugar, and caffeine.
Dehydration can worsen menstrual cramping. Drink at least 2 liters (67 ounces) of water daily, and avoid alcohol and caffeine. In addition, a glass of cold water can help with hot flashes.
Regular physical activity increases oxygenation and circulation, reduces inflammation, and boosts serotonin and endorphin levels (natural mood-elevating chemicals and pain relievers). This helps:
- Boost your mood
- Improve sleep quality
- Maintain muscle mass and bone strength
- Improve heart health
- Decrease hot flashes
- Maintain a healthy weight
Cool Packs and Fans
A portable or handheld fan can help cool you off during hot flashes. You can also use cool packs to keep you cool outdoors in warm weather.
Avoid Smoking Cigarettes
Cigarettes cause blood vessel constriction, reducing blood flow to the uterus and worsening cramps. Smoking also increases the risk of side effects from hormone therapy.
Heat relaxes tissues and stimulates blood flow. Placing a disposable heat patch, heating pad, or hot water bottle on the lower abdomen (belly) can help cramping. A warm bath is also a great choice as it relaxes the whole body and relieves stress.
Topical Creams and Ointments
Topical medications are gels, creams, ointments, or patches you use if you have back pain along with menstrual cramping. Icy Hot (methyl salicylate-menthol) and Aspercreme (trolamine salicylate) are common examples.
Herbal Remedies and Supplements
However, it’s important to use caution and discuss supplements, vitamins, and herbs with your healthcare provider. While natural, they can:
- Interact with medications
- Produce side effects
- Negatively affect those with certain health conditions
- Lack the same regulation as pharmaceutical drugs
- Vary in quality, purity, and safety between brands
- Lack the scientific evidence to support their effectiveness and recommended doses
Factors to Consider With Perimenopause Hormonal Treatment
Hormone replacement therapy is effective in treating perimenopause symptoms. However, when discussing the benefits and risks with a healthcare provider, consider the following:
- Symptoms and severity: Talk with your healthcare provider about whether your symptom severity warrants hormone therapy or if you may benefit more from nonhormonal treatments.
- Overall health: Some health conditions, such as hormone-dependent breast cancer, ovarian cancer, liver disease, diabetes, migraines, and blood-clotting disorders, may impact the suitability for hormone treatment.
- Individual risk factors: Those who have obesity, smoke cigarettes, have high blood pressure, or have cardiovascular (heart or blood vessels) disease are at higher risk for harmful side effects, such as blood clots, from hormone therapy.
- Hormone therapy types: Birth control and HRT involves estrogen, estrogen-progesterone combinations, or progesterone only. Each option has potential risks and benefits.
- Route of hormone therapy: Hormones come in various forms, such as pills, patches, creams, implantable devices, shots, or vaginal rings. Some people prefer specific routes due to convenience, follow-up care, or ease of use.
- Pregnancy concerns: While the chance of getting pregnant decreases with age, those in perimenopause can still get pregnant. However, pregnancy in your late 40s carries a higher risk for you and the baby. If contraception is also a concern, multiple nonhormonal and hormonal options exist.
Endometrial Ablation During Perimenopause
If you experience severe, extended menstrual bleeding during perimenopause and other treatments are not working, a healthcare provider may suggest endometrial ablation. This surgical procedure removes the uterine lining, which can reduce menstrual bleeding.
While ablation can be very effective, it is only an option for those who do not wish to get pregnant in the future. Risks include a chance of uterine scarring, postsurgical complications, and a need for repeat or alternate procedures.
Ongoing Care and Perimenopause Treatment Into Menopause
Perimenopause can last for several years before transitioning into menopause. While you won’t have menstrual periods with menopause, some people continue to experience symptoms such as vaginal dryness and hot flashes. Self-care measures remain the same as perimenopause (outside of those that help you cope with painful periods).
As you move into menopause, a healthcare provider may recommend switching from hormonal birth control to hormone replacement therapy or additional treatments and therapies to manage ongoing symptoms.
Lower estrogen levels can cause your bones to be more brittle. If you are not already taking calcium and vitamin D supplements for bone health, a provider may suggest this if you do not get enough of these vitamins through diet and sunshine.
Perimenopause is a natural process. However, it can cause disruptive physical and mental effects such as menstrual period changes, hot flashes, mood swings, insomnia, and more. Prioritizing self-care and considering various nonhormonal and hormonal treatment options can help you minimize or manage these symptoms as you navigate this transition.