Perimenopause Explained: Symptoms, Treatments, and What to Expect 

You Don't Have to "Just Live With" Your Perimenopause Symptoms

As a board-certified OB/GYN at New England Gynecology & Surgical Services in Nashua, NH, I often speak with women who are starting to notice changes in their bodies, signaling the approach of perimenopause. It’s a natural transition, the stage before menopause when your hormones begin to fluctuate. You may experience a range of perimenopausal symptoms, including irregular periods, hot flashes, vaginal dryness, sleep disturbances, mood changes, and more. While perimenopause and menopause are a normal part of life, the symptoms can be anything but comfortable. 

I always tell my patients: you don't need to just "deal with it." There are safe and effective perimenopause treatment options available. With the right guidance, you can navigate this transition with confidence and comfort. 

What is the Difference Between Perimenopause and Menopause?  

You are considered to be in menopause when you have gone 12 consecutive months without a menstrual period and there are no other underlying causes, such as hormone use or medical conditions, affecting your cycle. On average, menopause occurs around age 52, but it can happen earlier or later. About 1% of women may experience menopause as early as age 40, while others may not reach it until around 60.  

The transition period leading up to menopause is called perimenopause, during which hormone levels fluctuate and can cause noticeable physiological changes. It's important to note that not every woman who stops menstruating for 12 months is necessarily in menopause. Factors like thyroid disorders, polycystic ovarian syndrome (PCOS), or the use of hormonal contraception (like birth control pills or the Mirena IUD) can interfere with menstrual cycles and mask true menopausal status.  

Understanding Perimenopause: What I See in My Practice 

Perimenopause typically begins in a woman's mid-to-late 40s and can last for several years. It's a gradual shift, and from my experience, it often unfolds in two phases: 

• Early Transition: This stage typically begins around ages 46 to 47, though it can start earlier for some. During this time, hormone levels behave like a roller coaster, not because of estrogen deficiency, but due to significant fluctuations in your hormones. These ups and downs can worsen existing conditions or symptoms. Many of my patients report experiencing heavier periods, more intense PMS, mood changes, and stronger cramps or headaches—all common effects of these hormonal shifts. 
• Late Transition: As estrogen levels begin to drop more significantly, perimenopause symptoms like hot flashes (daytime), night sweats (nighttime), trouble sleeping, and "brain fog" become more common. We usually see this when women start to skip periods, more than 60 days at a time, usually 1-2 years before the last menstrual period.  

The Menopause Society has some excellent resources that describe perimenopause symptoms. While these symptoms can interrupt daily life, I assure you that you are not alone. You certainly don’t have to “tough it out.” 

My Approach to Perimenopause Treatment  

At New England Gynecology & Surgical Services, we tailor your perimenopause treatment to your specific symptoms and where you are in your journey. I offer my patients a range of solutions: 

Treating Heavy Periods (Early Perimenopause): 

If heavy bleeding is one of your primary perimenopause symptoms, we can explore options like: 

• Hormonal birth control: This can help stabilize your hormones and significantly reduce heavy bleeding. This option can include birth control pills with or without estrogen, patches, rings, or IUDs.  
• Lysteda (tranexamic acid): A non-hormonal pill that many find effective in lightening periods. 
• Endometrial ablation: An in-office procedure that can greatly reduce or even stop heavy bleeding for many women. 
• Hysterectomy: This is a surgical removal of the uterus, in which you can keep the ovaries.  

Treating Hot Flashes, Mood Changes, Insomnia, Joint Pain (Early Perimenopause) 

• Hormonal birth control: These medications can help stabilize the roller coaster of perimenopausal hormonal shifts and sometimes are more helpful than hormone therapy during the early transition.  
• Hormone therapy (HT): For women who have contraindications to hormonal birth control (hypertension, migraines with aura), HT can help alleviate symptoms. Also 10% of women on hormonal birth control may have hot flashes, and changing to HT can be a better option regardless of risk factors.  

Treating Hot Flashes and Night Sweats (Late Perimenopause): 

These are often the most disruptive perimenopause symptoms. We have several effective strategies: 

• Hormone Therapy (HT): For many women, especially if started within 10 years of their last period, HT is incredibly effective. We'll have a detailed discussion about whether it's right for you, reviewing potential risks like blood clots or a slightly increased chance of breast cancer. 
• Non-hormonal options: For those who prefer or cannot use hormones, FDA-approved medications like Brisdelle and Veozah are excellent alternatives for hot flashes. 

Treating Sleep Problems and Brain Fog: 

These perimenopause symptoms are often interconnected. Improving hot flashes and night sweats usually leads to better sleep. Beyond that, I often recommend lifestyle adjustments including: 

• Avoid caffeine and alcohol before bed. 
• Turn off screens at least an hour before you plan to sleep. 
• Engage in relaxing activities like reading or meditation. 

Better sleep usually translates to a clearer mind. If needed, we can discuss short-term medications to help with focus and cognitive clarity. 

Learn more about Dr. Garcia’s treatment recommendations in her podcast episode. 

Yes, You Still Need Birth Control in Perimenopause! 

This is a crucial point I emphasize to all my patients. You can absolutely still get pregnant during perimenopause. If you're still having periods, even if they’re irregular, it's essential to continue using birth control until you’ve gone 12 months without a period. We can discuss whether your current method is still the safest option, especially if you’ve developed any new health conditions. 

Talk to Your OB/GYN and Be Cautious Online 

Perimenopause is a natural process, but again, that doesn’t mean you have to suffer through it. There are many ways we can help you feel better. I strongly encourage you to visit your OB/GYN or a doctor trained in menopause care, which you can find at menopause.org.  

Please avoid getting hormones or other treatments from untrusted sources like med spas or online sellers without direct medical supervision. These can be risky and potentially harmful. It’s always best to work with a licensed provider to ensure your safety and that you get the care that’s truly right for you. 

Final Thoughts  

Perimenopause can feel overwhelming, but it doesn’t have to control your life. With the right support and a personalized perimenopause treatment plan, you can effectively manage your perimenopause symptoms and feel more like yourself again.  

Contact us at New England Gynecology & Surgical Services in Nashua, NH, to schedule your appointment. We’re here to support you every step of the way as you navigate the symptoms and treatment of perimenopause.  

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As a fellowship-trained gynecologic surgeon, Dr. Lydia E. Garcia specializes in minimally invasive surgical techniques for the treatment of various benign gynecologic conditions in women in their reproductive and menopausal years. She believes in a comprehensive approach to women's health care, involving a multidisciplinary approach to treatment along with patient education. 
 
Dr. Garcia continues to be an active participant in AAGL, at which she teaches laparoscopic techniques to physicians, has presented abstracts on abnormal uterine bleeding, endometrial polyps, and adenomyosis, and has been published in publications such as the Journal of Minimally Invasive Gynecology and Nezhat’s Operative Gynecologic Laparoscopy & Hysteroscopic textbook.  
 
She is also a Menopause Society Certified Practitioner and an active participant in the Menopause Society as we as the International  Society for the  Study of Women’s Sexual Health.