Decreasing hormone levels also increase vulnerability to some diseases. Lower estrogen levels make the body start to lose bone faster than it can replace it (the greatest loss in women not on hormone therapy [HT] is in the six years after menopause and then the decrease levels off), which in turn increases the risk of osteoporosis. There may also be changes in blood cholesterol levels, such as a rise in the "bad" LDL cholesterol and a decrease in the "good" HDL, which make us more susceptible to heart disease. They also produce other uncomfortable symptoms -- eyes may get drier, night sweats can cause insomnia, and vaginal tissue can become thinner, with lessened lubrication, which can make sex uncomfortable.
Unpredictable periods and haywire hormones can also inhibit libido, making women less interested in having sex. Recent research indicates that about a third of pre- and postmenopausal women have sexual problems. Yet other studies suggest that our menopausal status isn't the sole culprit: Too much stress and other problems with mental and physical well-being can also be factors.
Are You in Perimenopause?
Unfortunately, symptoms are the only guide. The blood test that looks at follicle stimulating hormone (FSH), a female hormone that identifies fertility, only indicates whether you have passed menopause.
For women who take oral contraceptives, figuring out what's going on can be even more complicated because these drugs smooth out hormonal swings. And though they prevent you from ovulating, most still cause the monthly shedding of the uterine lining that seems like natural menstruation.
Experts recommend that women on the pill periodically take an FSH test at the end of a pill-free week, starting around age 50, to see whether their levels mean they've reached menopause. The reason it's important? Oral contraceptives can be as much as four times stronger than HT; you don't want to take them if you no longer need them. On the flip side, HT doesn't dampen ovarian function: You can still get pregnant taking it.
Bear in mind that you may have to take the FSH test more than once to know for sure that you've passed through menopause. "That's because the ovaries don't die in one fell swoop -- they usually sputter near the end," says Steven Goldstein, MD, a professor of obstetrics and gynecology at New York University School of Medicine and author of Could It Be...Perimenopause?
Natural Relief of Symptoms
So what can you do to get through perimenopause if your symptoms are causing discomfort or distress? Start by identifying and changing behaviors that may provoke or intensify them, says Nancy Fugate Woods, PhD, dean of the School of Nursing at the University of Washington, in Seattle, and a menopause expert.
This is also a good time to take stock of your health habits and make needed lifestyle changes that not only can smooth this transition but also prevent problems later on, says Mary Jane Minkin, MD, a gynecologist at Yale University School of Medicine and author of A Woman's Guide to Menopause and Perimenopause. Eat better, exercise more, drop those excess pounds, and stop smoking, if you haven't already done so.
Here's a rundown of what helps ease the symptoms that bother many women:
Hot flashes. Focus on avoiding known triggers -- anything that elevates core body temperature, including hot weather, hot beverages, and spicy food. Keep your bedroom and workplace cool, drink cold beverages, and dress in loose layers so you can take off clothes if necessary. Cut down on coffee and alcohol; both cause blood vessels to constrict, which can contribute to hot flashes. And take a deep breath: A deep-breathing technique called paced respiration, in which you take slow, deep, full breaths, can avert hot flashes if you feel one coming