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

Experiment with eating soy Soy contains phytoestrogens—plant compounds that are chemically similar to estrogen—and for that reason, many researchers have hypothesized that consuming these foods or their extracts (isoflavones) reduces hot flashes. While studies have been inconsistent, one large, recent analysis in Menopausefound that in women who took soy isoflavones, the frequency of hot flashes was reduced by 21 percent more than in those taking a placebo; the severity of the hot flashes was reduced by 26 percent more than in the placebo group. If you want to try the soy approach, eat two servings of soy products a day, which translates into seven ounces of tofu, a half cup of edamame or two cups of soy milk. “Three months on soy should be enough to see a substantial effect,” says Melissa Melby, PhD, biological-medical anthropologist at the University of Delaware in Newark and a coauthor of the Menopausestudy.

SYMPTOM: Irregular Periods
It’s common for your periods to come erratically during perimenopause.

How to Handle

Rule out pregnancy If there’s any possibility that you have conceived, take an over-the-counter pregnancy test to find out. If you miss two periods in a row, take a second test, even if the first one came out negative, says Goldstein (you may have tried it too early).

Try low-dose contraceptives if  erratic bleeding patterns are driving you crazy But be warned: Doctors will typically steer you away from taking oral contraceptives if you have a history of blood clots, heart disease, breast cancer or endometrial cancer or if you smoke and are over 35. In those cases, your physician may recommend a 14-day course of progestin (synthetic progesterone). Another option, the Mirena IUD—a soft, flexible IUD that releases small amounts of progestin into your uterus—can end heavy periods as well as provide contraception for up to five years, after which point it loses its effectiveness.

SYMPTOM: Mood Changes
Moodiness, edginess or irritability (à la PMS) is common among perimenopausal women. “It’s not about feeling sad as much as it’s about having changeable moods,” says Landau. In addition, there’s something of a domino effect: Hot flashes can trigger sleep disturbances, which can leave you feeling moody or irritable during the day.

How to Handle

Get enough vitamin D The “sunshine vitamin” is increasingly linked to improved mood, Landau says. New research from the University of Minnesota found that women who consumed less than 400 IU of vitamin D daily (that’s the government’s daily requirement) had significantly lower scores on mental-health quality-of-life measures than those who consumed more than 400 IU per day. If you suspect you’re running low, talk to your doctor about taking daily D supplements.

Try cognitive behavioral therapy (CBT) This type of short-term treatment can change the way you respond to events. For example, if you’re having a night sweat, a CBT technique could help you avoid having the kind of anxious reaction (“I’ll never get back to sleep!”) that makes the situation worse. A new CBT protocol, done both in group therapy and as an individual self-help practice, was recently shown to be effective at reducing the negative impact of hot flashes and night sweats (while not necessarily reducing the symptoms themselves). That specific program is currently available only in the U.K., but for those who live on this side of the pond, “a clinical psychologist who works with physical health problems could provide treatment to reduce stress and help women manage symptoms,” says clinical psychologist Myra Hunter, PhD, a professor at King’s College London who helped develop the protocol.

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