February 17, 2020 by Scott Barnacle, MD

Hot flashes, sleep disturbances, night sweats, mood swings, irregular or heavy periods. It’s all part of the menopause transition known as perimenopause. Blame it on the lack of hormones!

Perimenopause begins four years before a woman’s last period when the ovaries begin to produce less estrogen. Menopause is complete when a woman hasn’t had a period for 12 months. Although the median age of menopause is 51, women can experience menopause between age 40 and 60. After menopause, symptoms lessen. All told, women may deal with symptoms for about five years.

If these symptoms are severe or disrupting your life, talk with your gynecologist or primary care provider about treatments that can make this transition go more smoothly. Here are some tips to help you thrive during this time.  

Hormonal Replacement Therapy (HRT)

Hormonal replacement therapy works well for sleep disturbances, hot flashes, night sweats and joint pain. It can be started when women begin to develop symptoms. For women still having regular periods, an oral contraceptive may be used. Another option is Premphase, a medication that combines estrogen and progestin. Progestin is necessary to help reduce the risk of uterine cancer. For women who have had a hysterectomy, estrogen alone may be used. Hormone Replacement Therapy is also available as patches.

Our goal is to keep women on HRT at the lowest dose for the shortest period of time possible.


Antidepressants in the selective serotonin reuptake inhibitors (SSRI) class work very well. Common medications include citalopram and escitalopram. When these drugs are used to treat menopausal symptoms, response is rapid compared to the wait time associated with treating depression.

Physical activity

Estrogen plays a major role in the female body. When the production of estrogen declines women can lose lean muscle mass, gain fat and lose bone density. Estrogen even affects physical balance. Physical activity is more important than ever. To preserve bone mass, regular weight-bearing – walking, running, weight lifting, strength training – is recommended. Shoot for 30 minutes, 5 days a week of moderate exercise such as walking or 75 minutes a week of more intense exercise such as running. In addition, all aerobic activities including walking, swimming and biking help women maintain core strength, improve balance and minimize falls.  

To promote bone health after menopause, increase daily calcium intake to 1200 milligrams per day which can be in vitamins or food rich in calcium. Women should take 800 IU of vitamin D supplements to absorb the calcium.  

Alternative therapies – Use Caution

Black cohosh is an herbal supplement commonly used to treat menopausal symptoms. There is no evidence black cohosh works better than a placebo. Phytoestrogens are plant-based estrogens found in a variety of foods including soy. They are also present in many dietary supplements marketed as a natural alternative to hormone replacement therapy. Phytoestrogens can increase the risk of uterine cancer. In addition, herbal supplements are not regulated by the U.S. Food and Drug Administration. 

You can thrive during perimenopause. Learn more about our OBGYN providers!