Your Perimenopause Handbook

Instead of Sneezy, Sleepy and Happy, you’re living with Bloaty, Headachy and Hot Flashy. Our guide explains how to handle what’s going on

by Stacey Colino
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Photograph: Illustrated by Eduardo Recife

Practice slow, deep breathing What’s called “paced respiration” can make a hot flash feel less intense while you’re experiencing it. At the onset of a temperature rise, “don’t fight it—breathe deeply through it, similar to what you might have done during childbirth, and the flash won’t be as bad,” says Carol Landau, PhD, clinical professor of psychiatry and medicine at the Alpert Medical School at Brown University and coauthor of The New Truth About Menopause.“The breathing helps dial down your physiological arousal.” (For a demonstration, go to

If you consistently employ paced respiration, it even has a preventive effect. A 2005 study found that women who practiced breathing that way experienced almost 50 percent fewer episodes. Here’s the best way to practice: Sit in a quiet, comfortable spot. As you breathe, keep your rib cage still and lower and raise your diaphragm to fill and empty your lungs. Inhale for five seconds, pushing your stomach muscles out, then exhale for five seconds, pulling your stomach muscles in and up. Landau suggests following this technique, which is recommended by the North American Menopause Society, 10 to 15 minutes twice a day.

Break a sweat regularly Aerobic exercise reduces hot flashes in many women (though for some, a cardiovascular workout may worsen the symptoms). Women who have a strong physiological reaction to stress (for instance, their blood pressure temporarily rises when they are anxious) are especially prone to experiencing vasomotor symptoms, notes Steriani Elavsky, PhD, assistant professor of kinesiology at Pennsylvania State University. One benefit of regular aerobic exercise is that it can help you become less affected by stress, which in turn can make you less susceptible to hot flashes and night sweats. Although no one has yet determined the optimal exercise prescription, government guidelines recommend getting 150 minutes of moderate intensity or 75 minutes of high-intensity aerobic exercise a week.

Take certain antidepressants While not nearly as effective as hormone therapy, some antidepressants have been shown to reduce the frequency and severity of hot flashes. Among the most widely used are the selective serotonin reuptake inhibitor (SSRI) Paxil and the serotonin-norepinephrine reuptake inhibitor (SNRI) Effexor XR. Used off-label, the antiseizure drug gabapentin, which you take three times a day, can also moderate hot flashes.

Try acupuncture In a recent Turkish study, the severity of hot flashes declined in women who received acupuncture twice a week for 10 weeks—findings that jibe with earlier research. Although it’s not clear why this traditional Chinese medicine technique might cool you off, the study at the Ankara Training and Research Hospital did find heightened levels of estradiol, a form of estrogen, in women who underwent a series of acupuncture sessions. “Typically, patients register a change in severity and frequency after the first few treatments,” says Arya Nielsen, PhD, director of the acupuncture fellowship program for inpatient care at Beth Israel Medical Center’s Department of Integrative Medicine in New York City. “Once hot flashes are gone or manageable, then it is recommended that you have maintenance treatments—for instance, every other week or once a month—until you no longer need them.”

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