Perimenopause Treatment and Self-Care Ideas

Supporting Your Body and Mind During Menopausal Transitions

 

Perimenopause is the time leading up to menopause when a person assigned female at birth stops having a menstrual period for 12 consecutive months.1

While perimenopause is natural, it can cause disruptive physical and mental effects. Menstrual period changes or irregularities are the most common. Other symptoms may include hot flashes, sleep problems, vaginal dryness, painful sex, mood swings, decreased libido (sex drive), and more. 

Self-care and nonhormonal approaches can be effective for some, while others may benefit from hormone therapy. This article explores various treatment approaches, including self-care, nonhormonal and hormonal medications, herbs, and supplements. 

Perimenopause Treatment for Physical Effects 

During perimenopause, hormonal shifts can cause adverse physical effects, including changes in menstrual cycle length, vasomotor symptoms, sleep problems, and vaginal changes.2 Discuss one or more of the following treatment options with a healthcare provider if you're experiencing the physical effects of perimenopause.

Hormone Treatment

A healthcare provider may suggest a low-dose hormonal birth control or hormone replacement therapy (HRT) to help treat various symptoms. The active ingredients in these medications are estrogen, progesterone, or a combination of both. They might come in pills, sprays, patches, implanted devices, or shots.56 

Nonhormonal Over-the-Counter (OTC) Medications

Advil, Motrin (ibuprofen), Aleve (naproxen), or Tylenol (acetaminophen ) can help relieve menstrual cramps.6 Antihistamines such as Benadryl (diphenhydramine ) or Unisom (doxylamine ) have sedating effects that can help with sleep disturbances.7

Nonhormonal Prescription Medications

Certain nonhormonal prescription medications can help relieve some of the physical effects of perimenopause, including:89

• Neurontin (gabapentin) and Lyrica (pregabalin): Typically treat seizures and nerve pain but can help alleviate hot flashes and improve sleep quality
• Ditropan, Oxytrol (oxybutynin): Can help manage hot flashes, night sweats, and urinary problems
• Effexor (venlafaxine): An antidepressant that helps with hot flashes10
• Catapres (clonidine): Typically treats high blood pressure but can help with hot flashes
• Ponstel (mefenamic acid): Originally a treatment for arthritis, but it also helps manage menstrual cramping and back pain11
• Veozah (fezolinetant): A newer medication that treats hot flashes by adjusting the brain pathway that regulates temperature12
• Ambien (Zolpidem), Zimovane (zopiclone), or Sonata (zaleplon): Treats insomnia13

Vaginal Moisturizers and Lubricants

Vaginal moisturizers and lubricants such as Replens, K-Y jelly, or Astroglide temporarily relieve vaginal dryness and pain during intercourse.14 

Pelvic Floor Physical Therapy

Pelvic floor physical therapy involves pelvic floor exercises (like Kegels) and biofeedback to help with symptoms such as painful sex and urinary incontinence.15 

Perimenopause Treatment for Mental Health Effects 

Perimenopause can also cause mental and emotional changes such as mood changes, anxiety, depression, and reduced mental sharpness (forgetfulness, brain fog).

Therapy, such as cognitive behavioral therapy (CBT) or hypnotherapy, can help you manage mental or emotional changes, develop coping strategies, improve self-care, and address underlying psychological concerns. Self-hypnosis is also a common technique for poor sleep.13

Sometimes, a provider will prescribe antidepressants to help you manage mood changes and hot flashes.10

Self-Care as Perimenopause Treatment 

The following self-care practices are natural ways to ease or manage perimenopause symptoms. 

Prioritize Sleep

Good sleep hygiene includes a consistent sleep schedule, a relaxing bedtime routine, and a cool, comfortable bedroom. It also helps to avoid caffeine, nicotine, and alcohol close to bedtime (at least four to six hours). Wearing moisture-wicking sleepwear and using breathable bedding can also help you avoid or manage night sweats.13

Relaxation Techniques

Relaxation techniques such as deep breathing, acupuncture, meditation, or yoga help reduce stress and improve mood. Acupuncture is also helpful for insomnia.4 

Eat a Healthy Diet

Maintaining a nutrient-dense diet can help you balance hormones, decrease inflammation, manage weight, decrease hot flashes, and maintain bone health. A nutrient-dense diet includes fruits, vegetables, legumes, whole grains, lean proteins, and healthy fats. It also involves portion control and limiting processed foods, salt, spicy foods, sugar, and caffeine.16 

Hydration 

Dehydration can worsen menstrual cramping. Drink at least 2 liters (67 ounces) of water daily, and avoid alcohol and caffeine.16 In addition, a glass of cold water can help with hot flashes.

Exercise

Regular physical activity increases oxygenation and circulation, reduces inflammation, and boosts serotonin and endorphin levels (natural mood-elevating chemicals and pain relievers). This helps:61617

• Boost your mood10
• Improve sleep quality13 
• Maintain muscle mass and bone strength
• Improve heart health 
• Decrease hot flashes
• Maintain a healthy weight

Cool Packs and Fans

A portable or handheld fan can help cool you off during hot flashes. You can also use cool packs to keep you cool outdoors in warm weather. 

Avoid Smoking Cigarettes

Cigarettes cause blood vessel constriction, reducing blood flow to the uterus and worsening cramps. Smoking also increases the risk of side effects from hormone therapy.5

Heat

Heat relaxes tissues and stimulates blood flow. Placing a disposable heat patch, heating pad, or hot water bottle on the lower abdomen (belly) can help cramping.6 A warm bath is also a great choice as it relaxes the whole body and relieves stress. 

Topical Creams and Ointments

Topical medications are gels, creams, ointments, or patches you use if you have back pain along with menstrual cramping. Icy Hot (methyl salicylate-menthol) and Aspercreme (trolamine salicylate) are common examples.18

Aromatherapy

Diffusing essential oils such as lavender, cedarwood, and bergamot can help you sleep better. Lavender may also help soothe anxiety.192021

Herbal Remedies and Supplements

While homeopathy is not the first line of treatment for perimenopause, some studies show that herbs may help with specific symptoms.22 

However, it’s important to use caution and discuss supplements, vitamins, and herbs with your healthcare provider. While natural, they can:23 

• Interact with medications
• Produce side effects
• Negatively affect those with certain health conditions
• Lack the same regulation as pharmaceutical drugs
• Vary in quality, purity, and safety between brands
• Lack the scientific evidence to support their effectiveness and recommended doses

Factors to Consider With Perimenopause Hormonal Treatment 

Hormone replacement therapy is effective in treating perimenopause symptoms. However, when discussing the benefits and risks with a healthcare provider, consider the following:51924

• Symptoms and severity: Talk with your healthcare provider about whether your symptom severity warrants hormone therapy or if you may benefit more from nonhormonal treatments.10 
• Overall health: Some health conditions, such as hormone-dependent breast cancer, ovarian cancer, liver disease, diabetes, migraines, and blood-clotting disorders, may impact the suitability for hormone treatment.
• Individual risk factors: Those who have obesity, smoke cigarettes, have high blood pressure, or have cardiovascular (heart or blood vessels) disease are at higher risk for harmful side effects, such as blood clots, from hormone therapy. 
• Hormone therapy types: Birth control and HRT involves estrogen, estrogen-progesterone combinations, or progesterone only. Each option has potential risks and benefits. 
• Route of hormone therapy: Hormones come in various forms, such as pills, patches, creams, implantable devices, shots, or vaginal rings. Some people prefer specific routes due to convenience, follow-up care, or ease of use. 

• Pregnancy concerns: While the chance of getting pregnant decreases with age, those in perimenopause can still get pregnant. However, pregnancy in your late 40s carries a higher risk for you and the baby. If contraception is also a concern, multiple nonhormonal and hormonal options exist. 

Ongoing Care and Perimenopause Treatment Into Menopause 

Perimenopause can last for several years before transitioning into menopause. While you won’t have menstrual periods with menopause, some people continue to experience symptoms such as vaginal dryness and hot flashes. Self-care measures remain the same as perimenopause (outside of those that help you cope with painful periods).

As you move into menopause, a healthcare provider may recommend switching from hormonal birth control to hormone replacement therapy or additional treatments and therapies to manage ongoing symptoms.3

Lower estrogen levels can cause your bones to be more brittle. If you are not already taking calcium and vitamin D supplements for bone health, a provider may suggest this if you do not get enough of these vitamins through diet and sunshine.26

Summary 

Perimenopause is a natural process. However, it can cause disruptive physical and mental effects such as menstrual period changes, hot flashes, mood swings, insomnia, and more. Prioritising self-care and considering various nonhormonal and hormonal treatment options can help you minimize or manage these symptoms as you navigate this transition.

 

Very Well Health