Dealing with the Physical and Emotional Symptoms of Perimenopause

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Upset mid-age woman sitting on sofa

Perimenopause is a time when hormones are shifting as the ovaries begin to shut down, with fluctuating and then declining levels of estrogen and progesterone – which can create an array of symptoms, explains Sheryl A. Kingsberg, PhD, a psychologist and chief of the OB/GYN Division of Behavioral Medicine at University Hospitals.

A Flood of Symptoms

There are a number of symptoms that can occur during perimenopause, also known as the later reproductive stage (LRS). Women often complain of sleep disruption, hot flashes and night sweats, and heart palpitations (called vasomotor symptoms), mood changes/irritability, headaches and brain fog. Many women will also notice changes in sexual function including less interest and vaginal dryness and pain with sexual activity.

When you are dealing with these symptoms, you may be quick to anger, feel easily overwhelmed, or weepy. This inability to control your emotions may make you feel guilty or ashamed, which just compounds the emotional toll.

Many women also feel alone or unprepared during the onset of perimenopause, notes Dr. Kingsberg, especially in comparison to other life stages such as pregnancy, in which you have a lot of resources at your disposal.

Tips On Dealing with Your Emotions

Acknowledge and short-circuit your anger. It’s important to recognize your feelings of anger or irritability – then you can do something to defuse the situation, such as walking away for a bit in order to cool off. It also helps to communicate your feelings to others, to encourage understanding and alleviate guilt. It helps to tell others when you’re feeling irritable, says Klassen, as this can foster communication and understanding–and remove some guilt.

Reframe it. Mood changes are common and should be understood as caused by hormonal fluctuations and are temporary. There are ways to manage these symptoms without feeling out of control, weak or “crazy”.

Be kind to yourself. You do not need to apologize for the physiological and biological changes that are happening in your body. Practice self-compassion and know that this is a transitional period that will pass in time.

Support and Treatment Options

If your symptoms are interfering with daily life, there is help available.

“For those struggling with these symptoms, I certainly want to validate that this is not ‘all in your heads,’” says Dr. Kingsberg. “Seek out a health care professional who can help with hot flashes, insomnia, depression, anxiety, or other mood disturbance that may be at work.”

Dr. Kingsberg notes that lifestyle changes – such as a healthier diet, reducing alcohol intake, and exercising – can be helpful, but sometimes more help is needed.

Options include:

  • Cognitive behavior therapy to address depression and anxiety
  • CBTi, or cognitive behavior therapy for insomnia
  • Learning tools to improve impulse control
  • Stress management strategies
  • Hormone therapy
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