• Identify triggers Alcohol, certain foods, weather changes, stress or other factors can all play a part. Avoid or mitigate them by, for example, practicing relaxation techniques.
• Consider the strategic use of estrogen For some women with perimenopausal migraines, “intermittent treatment with estrogen around their periods can be a godsend,” Santoro says. “And in the late transition, estrogen patches can sometimes wipe out headaches altogether.”
SYMPTOMS: WHAT’S NOT NORMAL
It’s important to remember that from your early forties into your early fifties, not everything that makes you feel bad can be blamed on perimenopause. “At times, health care professionals may attribute many symptoms to perimenopause and not investigate other possibilities,” says Shifren.
“The biggest potential for harm is if a doctor minimizes a cardiac symptom like heart palpitations and attributes it to perimenopause without thinking much about it,” notes Santoro. Symptoms to watch for:
• Hot flashes that begin while you’re taking HT or oral contraceptives They’re probably not due to the hormonal changes of perimenopause, Shifren says. They could, in fact, be signs of a thyroid disorder, diabetes or another medical condition, which your doctor can test for.
• Superheavy bleeding If you’re soaking through pads or tampons at a much faster rate than ever before, this could be a sign of endometrial hyperplasia, a condition in which the lining of the uterus becomes too thick, explains Shif-ren. The excess bleeding could also be due to uterine polyps, fibroids, a thyroid disorder or an infection.
Schedule an appointment with your OB-GYN to find out what’s going on.
• Signs of depression or an anxiety disorder Seek medical attention if you regularly have low energy or severe fatigue; worries so severe, you’re having trouble functioning; or other mental issues. Women who have a history of depression are up to five times as likely to be diagnosed with major depression from early perimenopause until postmenopause, says a recent review of the medical literature. If you had postpartum depression or suffer from extreme PMS (premenstrual dysphoric disorder, or PMDD), “you’re also more likely to become clinically depressed at this time,” Landau says.
• Heart palpitations accompanied by other symptoms If you’re simultaneously experiencing weakness, breathing trouble or a squeezing sensation in your chest, heart palpitations may be linked to a thyroid problem, a heart condition or panic disorder. See a cardiologist for a full evaluation, including an ECG, and also have your thyroid-stimulating hormone measured. If you’ve developed an arrhythmia (erratic heartbeat), a variety of medications and procedures can treat it.
• Tenderness in just one breast, not both This, along with a symptom such as a discharge from the nipple or redness or visible swelling in one breast, can be a sign of an infection or another breast problem. Schedule a visit to your doctor.
LIGHT AT THE END OF THE TUNNEL
Happy 366th day of not menstruating! You can now be sure you’ve had your last period and are officially in menopause. At that point you’ll finally be free—of tampons, pads, premenstrual water retention, menstrual cramps and crazy bleeding patterns. Besides being able to wear white any time you like, you’ll experience other benefits in menopause. “There’s less vaginal discharge, the pain from cramping and endometriosis goes away, and fibroids in the uterus stop growing and shrink,” notes Gass. Plus, you no longer need birth control.
Cognitively and emotionally, you’ll reach a more peaceful equilibrium. Brain fog: gone. The mood roller coaster: gone. Mental clarity: It’s back!