By Susan M. Love, M.D.

From hot flashes to fuzzy thinking, as a caregiver who is perimenopausal you’re probably wondering what you did to deserve these added stresses. It’s nothing you did. You were born female and you’re approaching menopause—a natural stage in your life.  The stage before you reach menopause is called perimenopause. The symptoms can range from mildly annoying to debilitating. Here are some common symptoms and options to consider. 

Hot Flashes and Night Sweats

Hot flashes and night sweats can come on every day for up to two weeks or more, and then be gone for a month or two.  Dress in layers to make it easier to lighten up on clothes.  Caffeine, alcohol or spicy foods can trigger hot flashes.  Exercise—some women say that walking through perimenopause can be helpful.  Eat a high-soy diet of at least 60g each day.  Try meditation, breathing exercises or visualizations to relax and reduce stress. Supplements, such as vitamin E, B vitamins or bioflavinoids may help, but there are no conclusive studies.

Consult your healthcare professional or alternative medicine books for advice on herbs such as black cohosh, dong quai, fennel, anise, and other possible remedies.

Non-hormonal drugs have been used with success and are important for women at risk for breast cancer. Hormone Replacement Therapy (HRT) may be right for some women, but be sure to speak with your healthcare professional.

Heavy Bleeding

Heavy bleeding or irregular bleeding during perimenopause is not uncommon.  If it continues for more than a month or two, get checked.  Iron intake is important, as is drinking fluids to replace lost nutrients.  Acupuncture, herbs such as vitex, lady’s mantle, flaxseed, and wild yam root, and homeopathic remedies are commonly recommended, but once again, there are no conclusive supporting studies. Speak with your healthcare professional before trying any of these.

Low-dose oral contraceptives have been shown to decrease blood loss and the progesterone-releasing IUD is an option. Hormones sometimes work, but at other times intensify the problem. Check out all surgical options and get second, even third opinions before proceeding. Hysterectomy isn’t the only possibility and may not be the best one.

Vaginal Dryness

For vaginal dryness, try sexual activity. It actually increases natural lubrication. Drinking lots of water helps your vagina stay hydrated, as do lubricants during intercourse, such as K-Y Jelly.  Herbalists suggest motherwort tincture, dong quai, or ginseng.  Vaginal estrogen creams can be very effective, but only require very low doses as they will be absorbed into your blood.  Be sure to check with your healthcare provider and discuss these and other options.

Insomnia

To help insomnia, try to consume less caffeine and alcohol, avoid eating large meals right before bed, and keep a cool, dark bedroom.  Exercise, relaxation and meditation practiced regularly during the day can help fight insomnia at night.  Herbalists recommend motherwort and chamomile tea among other herbs.   Melatonin, a hormone available as a supplement, can be helpful.  Over-the-counter sleeping pills can be lifesavers at critical times, but never for more than two to three weeks.  Estrogen as well as micronized progesterone have been known to improve insomnia in many cases. Be sure to ask your doctor what he or she recommends.

Mood Swings and Decreased Libido

Mood swings and decreased libido indicate a need for a lifestyle check: your diet, caffeine and alcohol intake, and exercise regimen should be scrutinized.  Stress reduction techniques are crucial.  Support groups and meditation have been shown to reduce anxiety.  Visualization and affirmations can promote calmness within. Yoga is especially good. Herbal and homeopathic remedies are many, so don’t rule them out.  If none of these things help, antidepressants might be required.  Tranquilizers are habit forming, so use only for short times with medical supervision. 

Talk to your doctor if you are on Hormone Replacement Therapy (HRT) as it may make some women feel depressed.

Fuzzy Thinking

Fuzzy thinking requires exercise—physical and mental.  Physical exercise increases reaction time and blood flow to the brain.  Exercise mentally with crosswords, card games and the like.  Ginseng can help sharpen mental abilities, but may have side effects.  Ginkgo biloba has been proven to modestly improve cognitive performance in some people.  Short periods of estrogen therapy may well help your thinking. Again, check with your physician or other healthcare provider before taking any herbal or over the counter medicines.

The menu of options is vast, so research all of them in depth, including lifestyle changes and alternative approaches.  It may be useful to see an herbalist, homeopath, naturopath, or traditional Chinese doctor for recommendations.  Talk to your healthcare professional about drugs or surgery.  Be sure to talk with your doctor about any herbs, medications, and treatments you are considering, to ensure that you aware of any possibly harmful interactions.