Healthy ideas for your inbox
If you pay attention to social media chatter, you’ve probably noticed that people are finally talking more about what women experience as their bodies grow older. Though there’s still much to learn and discuss, it’s refreshing that words like hormone replacement therapy, menopause and perimenopause aren’t taboo. (We can actually talk about things like dry vaginas in the open!)
Many of these conversations also include claims about how to combat perimenopause symptoms without the use of hormones. But how do you sort out what’s real and what’s ... nonsense? We’re here to help.
What is perimenopause?
Perimenopause, in a nutshell, is the life stage that comes before menopause (around four years before your final period) — usually when you’re in your 40s and early 50s. For most people, during perimenopause fertility begins to decline, estrogen and progesterone levels decrease, and certain unwelcome symptoms can kick in.
What kinds of symptoms? Well, just to name a few: irregular periods, vaginal dryness, mood changes, disrupted sleep and hot flashes. Plus, there are a number of psychological issues that often come along, including anger, irritability, anxiety and depression, and even loss of self-esteem and confidence.
So, it makes sense that when perimenopause hits, alleviating those not-so-fun symptoms quickly becomes a priority. To do that, some people will go the hormonal route — either using hormone replacement therapy (HRT) or birth control pills to help them deal with the pitfalls of perimenopause. These treatments have been shown to be both effective and safe for most people.
But what about the folks who can’t or don’t want to use hormones? Luckily, there are some other options.
Why treat perimenopause symptoms sans hormones?
Why might someone choose not to use hormones for treating their perimenopause symptoms?
Angela Petlow, a certified family nurse practitioner specializing in women's health and menopause management, explains that it’s not always safe for people with certain medical conditions to take hormones.
It’s recommended that people who smoke, or those with high blood pressure, heart disease, liver disease or a history of blood clots don’t use oral combined contraceptives or menopausal hormone therapy (which can help with hot flashes and night sweats), because of an increased risk of blood clots, heart attack and stroke.
In the end, it’s best to work with your doctor to determine the most effective way to treat your specific body.
“Some women want perimenopause treatments that they feel are ‘natural,’” says Petlow. "They want to move through their natural menstrual cycles because it can be a key indicator of our health and how we are functioning.”
Simple steps for feeling better without medication
Petlow says the first step to managing your perimenopause symptoms is tracking your menstrual cycle. Once you start keeping track, you’ll begin to notice different symptoms that happen during different times of the month — or you might even see that the number of days you’re in certain phases of your cycle starts to shift (oh, the glory of getting older).
Along with tracking your cycle, it’s also important to take a closer look at your health habits and see if you could make some changes there that could help relieve your symptoms. Some healthy choices that experts agree do seem to help combat the not-so-pleasant effects of perimenopause include:
Lean into healthy food
Eat plenty of fruits, vegetables and whole grains that are high in fiber, as well as calcium-rich foods.
Move your body
Regular aerobic exercise and strength training can help enhance cardiovascular health, prevent weight gain, improve sleep and even elevate your mood.
Keep your stress level in check
Activities like yoga, meditation and stretching may help with mood regulation, plus they promote relaxation and stress-reduction, two things that are essential during life transitions. Therapy (for those who have access) is another option for helping you manage this huge change.
Get those zzzz’s
Did you know your sleep cycle can be affected by your menstrual cycle and your hormones? Plus, things like a snoring partner or dealing with your own sleep issues (like sleep apnea or restless leg syndrome) can really disrupt how rested you feel when you wake up.
Be kind to your vagina
We know that during perimenopause, it can get a little, um, dry down there. Make sure to invest in water-based vaginal lubricants or moisturizers to keep your bits feeling better. Some people also say that sex helps keep things happy down under by bringing more blood flow to the vagina.
Keep caffeine and alcohol to a minimum
As much as you may not want to admit it ... your body is not processing alcohol or caffeine the way it used to (sad). Which means you’ll need to watch how much of each of those you consume, especially considering how much they both can interrupt your ability to get a good night’s sleep.
Quit the cigs
Duh. We all know that smoking cigarettes is bad for you. It also can make some perimenopause symptoms worse. So, now’s a good time to quit.
Yes, these suggestions may seem like common sense, but if you’re serious about addressing uncomfortable perimenopause symptoms, making lifestyle changes is the best first move to make — so it’s worth giving these a shot before jumping into other treatments. And it’s OK to take things slow.
“There are just so many demands placed on women, so don’t be too hard on yourself,” says Petlow. “Maybe think of a few small changes to make in the coming months for your health, and then maybe one big one over the next year that can be sustainable.”
Medications can be your friend
So, if you think that all of this is fine and good, but you’d really like to take a more medicine-inclusive route, that’s totally fine. There are plenty of non-hormonal medication options that might ease your perimenopausal symptoms.
Just remember, before trying any of these medications, it’s important to have an open and honest conversation with your doctor about what you’re experiencing so they can help you find the medication that is right for you and your particular situation.
Medications to cool anxiety and hot flashes
These medications can especially be helpful if you're experiencing symptoms of anxiety or depression — which can sometimes increase when you’re going through the myriad of mood fluctuations that can come with perimenopause, or hot flashes.
Petlow says that many women who don’t want to use hormones may benefit from selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), gabapentin, oxybutynin and fezolinetant.
Hot (get it?) tip: though some of these medications may help with hot flashes, fezolinetant is the one that has been approved by the Food and Drug Administration to treat the moderate to severe hot flashes (sweating, flushing and chills) associated with perimenopause and menopause. Fezolinetant is particularly helpful because it targets the special receptors that restore the brain’s regulation of body temperature.
Manage that (heavy) flow
If perimenopause has suddenly made your periods super heavy, nonsteroidal anti-inflammatory drugs (NSAIDs) and tranexamic acid (TXA), a prescription-only medication, are options for some people, but, as mentioned above, make sure you talk to your doctor before taking these, so you’re aware of any negative side effects these drugs might have.
And please, if you’re experiencing super heavy periods or have other alarming symptoms, go see your doctor ... as soon as possible.
When it comes to heavier-than-normal period bleeding, “it’s important for women to be seen right away and to talk with a primary care provider to discern between normal perimenopausal changes or another more serious issue,” says Petlow.
Doctors can also use imaging to help understand why you might be experiencing especially heavy bleeding — so be sure you’re keeping them in the loop.
Other health measures to stay on top of
She also encourages you to make sure your Paps are up-to-date and keep an eye on your thyroid levels, iron levels and cardiovascular health. Osteoporosis (when bones become brittle and weak) is another issue that can flare up during perimenopause and menopause, so it’s important to alert your doctor if you’re experiencing back pain or other concerning symptoms.
These things probably won’t help you
There are some “treatments” that you (if you’re of a certain age) have probably seen plenty of on the internet that don’t necessarily have the backing of strong evidence or scientific research.
According to Petlow, some popular options like certain supplements, herbal remedies, soy foods, soy extracts, soy metabolite equol and cannabinoids just don’t have sufficient evidence to show that they’re truly addressing the negative symptoms of perimenopause.
Also, make sure to chat with your doctor before you start taking any herbal or dietary supplements for your symptoms. Since they don’t need to be regulated by the Food and Drug Administration, you want to make sure you’re not choosing sketchy ones that might interact with other medications you take or do something weird to your body (yikes).
In conclusion
The hard truth? Things are just ... different with your body now. And that’s OK, but it’s important to understand that there likely are changes you can make to feel better.
“I think on a spiritual level, there’s some grief processing as we go into these different places in our life that we don’t necessarily talk about in Western medicine,” says Petlow. “There are so many mixed messages about aging that women get right now with social media.”
And really, you just need to figure out what works best for you when it comes to feeling better. You may find that simply changing your diet, incorporating a little strength training and cutting down on the cocktails is enough to ease your perimenopausal symptoms — or you might want to speak with your doctor about your medication options.
"I wish I had multiple hours with each person to talk about this stuff,” says Petlow. “It's so specific to your lifestyle, what you have access to and what you're experiencing, because not everybody experiences the same things.”
