Perimenopause – Symptoms and Treatments

What is Perimenopause? Perimenopause is when your body starts transitioning into menopause. But what are the signs that perimenopause is starting? At this time, your ovaries begin producing less estrogen, your menstrual cycle becomes erratic or irregular, and if you’re reading this, you’re probably already experiencing menopause like symptoms, such as hot flashes or irritability. Your body is moving toward the end of your reproductive years. Some begin as early as mid-30s and others in their mid 50s. Overall it can be a very frustrating and confusing time as everything is changing. And YES you can still get pregnant!

During this transitional period of our lives we undergo many changes. Our ovaries begin to produce less estrogen until they stop releasing eggs entirely. Did you know we are born with all our eggs intact? Up to 7 million eggs to be released every menstrual cycle throughout your lifetime. Fascinating when you realize your eggs were inside your mother when you were a fetus in her womb. That means your mother carried the egg cells to her own grandchild! Once your menstrual periods cease for 12 months you’re officially in menopause. Perimenopause is the 8-10 years prior to menopause. During this time you may not always have symptoms. For ladies with PMS it may just feel like more of the same just gradually less often.

Hysterectomies, Cancer treatments and other surgical procedures can cause early menopause. A partial hysterectomy- where they leave your ovaries, can also trigger perimenopause. Your ovaries make the hormone estrogen. As this starts to decline, it throws off the balance with progesterone, another hormone produces by the ovaries. These two hormones together are responsible for ovulation and menstruation. It’s common for hormone levels to fluctuate during perimenopause — to go up and down like a roller coaster.

First Signs of Perimenopause

Irregular periods are usually the first indication. Unpredictable and annoying. Some also experience symptoms like hot flashes and vaginal dryness during Perimenopause. However vaginal dryness can also be from dehydration, stress, and a big culprit allergy medications. You may find during this stage that food allergies and product sensitivities seem to be increasing. So if the irregular periods, super heavy periods, hot-flashes, vaginal dryness, urinary incontinence, weight gain and insomnia aren’t enough…some ladies also struggle with the mood swings- irritability, depression and anger. All considered “normal”. We will discuss ways to ease these issues later in this article.

Go see your doctor if you have the following situations: (They may be “your normal progression” but they may also be a sign of other issues.)

  • Very heavy periods where you need to change your pad or tampon every 1-2 hrs
  • Blood clots in your menstrual discharge
  • Your periods last several days longer than 7 days
  • You spot or bleed between periods
  • Vaginal spotting after sex.
  • Periods occur more frequently than every 21 days
  • Emotional symptoms that interfere with your daily living.

Potential causes of abnormal bleeding include Perimenopause hormonal imbalances, infection, pregnancy-related bleeding, fibroids, blood-clotting problems, endometrial polyps, miscarriage, taking blood thinners or cancer.

There isn’t any treatment to stop Perimenopause, it’s a natural part of life. But there are definitely things you can do, to help with the symptoms. You need to evaluate which treatments are necessary to your sanity, since unfortunately there is no “magic pill” that works for us all. Sometimes the side effects are worse than the symptoms in the first place. Certain lifestyle changes like eating a healthy diet, light exercise and avoiding foods or activities that trigger hot flashes can also help. However, wine and chocolate are sometimes the only thing that keeps the people around us alive.

Traditional Treatments for Perimenopause

  • Antidepressants: These medications help with mood swings or depression.
  • Birth Control Pills: Can stabilize your hormone levels and typically relieve symptoms.
  • Estrogen Therapy: Stabilizes estrogen levels. Comes in a cream, gel, patch or oral pill form.
  • Gabapentin (Neurontin®): A seizure medication that can relieve hot flashes for some women.
  • Vaginal Creams: Available in prescription and over-the-counter options. Treatment can decrease pain related to sex and relieve vaginal dryness.
  • Hormone Therapy: Can help relieve some symptoms of Perimenopause. In general, healthcare providers recommend that people who opt to use hormone therapy start it within 10 years of beginning menopause symptoms and use it for less than five years. Estrogen and hormones have been linked to an increased risk of heart problems and some types of breast cancer.

Treating Perimenopause with hormone therapy can increase your risk for the following conditions: Uterine cancer, Stroke, Heart attack, Blood clots, Gallbladder disease. If you go this route, don’t self medicate, only do hormone therapy under the guidance of a health practitioner that specializes in hormone therapy. It can be highly effective, and you minimize any risks, when you have a program that is customized to work with your individual hormone requirements. It can take a bit of tweaking, and the correct program will monitor you on a monthly basis through the first 6 months of treatment, and yearly afterward. Costs for such programs because of the extensive tests, (tests that are not always available through your regular GP Doctor) require continued monitoring, usually run between $1200-2500 for your first year. Any program that does not include testing should not be considered IMO.

If you choose to manage Perimenopause symptoms at home. There are supplements that you can take. All supplement programs should begin with a good multi-vitamin specific to women (no need to take a million different pills here) and a good probiotic specific to women’s gut & vaginal health. BEFORE YOU START ANY PROGRAM – START A JOURNAL. Like I said there is no “magic pill”, we each have individual needs. For self-diagnosis, I recommend introducing one supplement at a time, for a minimum of 3 months (unless you have an adverse reaction) then stop it immediately. And log your progress. Our hormones fluctuate, week-to-week and month-to-month, and you are in a transition period, things will change. You need to be monitoring over a minimum of 3 monthly cycles before you can deem if something is helping, or not. At this stage of life, each month is a little different. The more you know about your body the better you will be able to gauge your true progress.



My Perimenopause started in my late 30s with super heavy periods, where if I didn’t catch it in time it literally was splashing on the floor right through my clothes in one big gush. It was awful. Luckily, I’m not easily embarrassed and my clientele at the time was all female. Then the break-through bleeding started to happen at the 2-week mark, lasting at least 3 days, and I felt like I was always on my period. Besides being bloated and irritable, this also induced anemia so I was physically exhausted. I started having anxiety & panic attacks and was just overall more miserable than happy. Under the guidance of a Doctor I began my journey trying the following:

1st I tried birth-control pills… No Go… Made it worse – still had breakthrough bleeding and the PMS was insane. CRAZY LAND

2nd I tried anti-depression medications… made me calm (my family begged me to go back on them when I eventually quit) but they made me gain weight and made me numb to the good things in life, just like they made me numb to the stresses of being a single mom and running my own business, which I needed help with at that time. Once I was past all that turmoil, was in a good relationship & place with my career, I found the anti-depression medication really hampered my ability to feel joy. And they were making me fat. Which, was its own misery.

3rd I tried just using pain medications – for when the symptoms got to be too much, and for help with my many migraines. But, they really did nothing except mask the symptoms and they ate my stomach. I now get Botox for migraines and its been a game changer.

4th I decided to give Endometrial Ablation a go. Well disappointment rained down when after 8 weeks of being out of commission, I still got a period. A light one lasting 3 days, but still a period. It did help though, I was able to get the anemia and most of the anxiety that came from being anemic under control and continued on my merry way. But… after 4 years it all started to come back… until over the course of the next 4 years, I was right back where I started.

Endometrial Ablation is a surgical procedure, requiring no incisions that destroys (ablates) the lining of your uterus. Highly effective for many women I know, I’m just the rarity. I do recommend it, even if you just want to take back control of your life and not have to plan it around having a period. There are just women like me where if everything isn’t destroyed, it actually grows back.

5th times the charm. This time I demanded a hysterectomy -and compromised on a partial (where they leave the ovaries) allowing me to maintain some hormones, and continue my visits to “crazy town” where I periodically lose it for 3 days before my phantom period. They also removed my cervix as cancer was a concern. I am happy…ish… the no period is great… not having anemia and all the issues associated with that fantastic…Having no clue when I ovulate so I can’t totally predict my emotions however has been a bit of a battle. So I kept a journal, and my husband also began tracking my ups and downs so he could avoid “breathing in my presence” on those days, in case it ticked-me-off. Joy! “Not funny this week?” Is a legitimate question in our house…lol

6th after surgery I did try hormone therapy -in the form of estrogen pills inserted vaginally for symptoms of dryness and to see if it would balance with my progesterone. Hell no… for me it didn’t help at all! 100x worse! Oh my vagina was wet but I went mentally off the rails with: extreme mood swings, anxiety, flash intense anger and just overall misery. Everything seemed wrong with life. Went off that and decided on a more holistic approach. NOTE: When I went off allergy meds a week later the vaginal dryness problem disappeared. Geeze!

Perimenopause -What Works for Me:


Hydration – I drink one huge glass of water upon waking and any time I pee I go drink at least 4 oz. It’s a habit that works for me as I don’t have time to be sipping on water all day.

Probiotics – I personally take a formula specific to women’s health

Diet – I eliminated all yeast products from my diet… they give me hot flashes, bloating and make me ache. Yep, no bread or beer for me… and red wine has to be for rare occasions. The other items that set me off and aggravate my Perimenopause symptoms are MSG, Aspartame (I swear that stuff is pure poison), Wheat and Milk. For some reason I process cheese, yogurt & sour cream… but not milk. I drink almond milk. In addition, so I don’t become 300 lbs, I also limit my sugar intake. I can’t say Keto completely because I’m a chronic diet cheater. I do eat some fruit, and use honey…but overall I’m on a high protein, low to minimal carbs, full fat and real food diet. I do not do well on processed foods.

Exercise – ummmm do I have to be honest here? Well I stand all day for work and walk to the car. I do occasionally have bouts (before bathing suit season) of working out… but I don’t like to sweat, and it actually aggravates my fibromyalgia symptoms and exhausts me. So I use a vibration platform trainer 3-5 x a week, and honestly it has done more to tone me, keep my posture good, and upped my metabolism than anything else I’ve ever done. I love it… It also helped me recover from the bladder Issues I had post hysterectomy. (See my post on Bladder Incontinence), I fixed that!

My Simplified Supplement Plan for Perimenopause

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Extra Vit C, Extra Vit D – everything else I get in my multi vitamin which I take twice a week. I get most of my daily vitamin & mineral requirement in my smoothies with a scoop of greens thrown in for good measure.

Supplements Specific to my Fibromyalgia

Optimized Folate 1700 mcg – 1 tablet per week. I have the genetic condition MTHFR that causes poor metabolism of Folate (vitamin B9). Between this and allergies to the foods listed above, food and dehydration seem to be responsible for 90% of my fibromyalgia symptoms. This supplement greatly improves my ability to concentrate, and keeps my nerves from fraying to the point that my whole body is vibrating with pain. MSG, Aspartame and Yeast still set it off and trigger all the Perimenopause symptoms, but with the added pain from the fibromyalgia.

Supplements Specific to my Perimenopause

  • Ashwagandha – I take it the 3x week
  • L-Phenylalanine – I take it every other day
  • Kelp -3x a week, as my source of iodine since I use sea salt for cooking.

This is why a journal is so important. You may find that certain supplements are NOT needed every day. It’s important to know at what dose they are helpful and at what dose they are not. Whatever you take, DO tell your doctor about them… Supplements are just as powerful as medication and not all supplements are compatible with medicines needed for medical conditions such as high blood pressure, diabetes etc. Your Doctor should know every supplement you take and why.

The Two Supplements Explained:


Relieves Stress and Anxiety, Reduces Inflammation, Helps Improve Memory and Focus, Can help regulate the Menstrual Cycle, Acts as a Sexual Stimulant, Contributes to Heart Health, Helps to Combat Vaginal Infections. Ashwagandha on Amazon


Is a component in the production of the neurotransmitters’ norepinephrine and dopamine, which are essential for the proper functioning of the brain and nervous system. It’s my version of the happy pill Prozac. L-Phenyalanine on Amazon

Since I have very high progesterone (close to that of a pregnant woman) I do not respond well with anything that simulates or stimulates estrogen. For whatever reason any supplement or medical treatment that increases my estrogen is extremely detrimental to my mental health and the lives of those around me…

We are all different. The following ingredients were in supplements used by ladies in my focus group on Perimenopause, who are not high progesterone (this is by no means and exhaustive list.) Remember if you try these KEEP A JOURNAL, use your journal for at least 3 monthly cycles per supplement change, and log what you are eating and drinking. I guarantee you will start to see a pattern, and many of your symptoms may actually be food allergies.

Ironically – Did you know you can actually crave foods you are allergic too? So don’t let that be your guide. Try the muscle test and see if your body guides you to the dosages and foods that have the components that your body needs.


Rehmannia -used to help relieve menopausal symptoms by clearing heat and cooling the blood, to help relieve irritability, restlessness and feverish sensations at night (hot sweats).

Chaste Tree -used for menstrual irregularities and relief of PMS symptoms such as breast tenderness, headaches, irritability and fluid retention. Used to relieve menopausal symptoms.

Angelica -is an aromatic herb commonly used in Traditional Chinese Medicine (TCM) as a female remedy for gynecological conditions. Also known as Dong Quai.

Chinese Yam (Dioscorea Opposita) -helps relieve night sweats and also supports energy. Often combined with other herbs for maximum effect.

Peony -nourishes the liver blood & softens the liver to help regulate menstruation and alleviate pain. Peony may be used to relieve sweating.

Bupleurum -a traditional herb used in Chinese medicine to help relieve irritability and emotional distress. This herb is extremely calming.

Calcium – to help prevent bone loss and osteoporosis in peri- and post-menopausal women.

Magnesium -helps to maintain proper muscle function, including the heart muscles, as well as energy metabolism, tissue formation and bone development.

Vitamin D -helps with regulating calcium and phosphorus levels in the body, the development & maintenance of bones, healthy skin and muscle strength.

Combination Products with Calcium, Magnesium, Vit D & Zinc

Join the conversation! Share your story, Ask questions, Hear what works for others just like you on our community discussion page Hot Flashes to Menopause


  1. I wish I had read all this information before I started what I now know to be perimenopause then eventually went through the menopause. There is so much that I didn’t know that would have helped me tremendously if I knew several symptoms were normal for perimenopause. Extremely heavy periods for about 3 years were definitely the worst part for me. 

    I have heard so many good uses for Ashwaganda and to see it on this list of natural products that can help, is awesome. I will share this helpful post with all my friends that are approaching menopause. 

  2. I found this article very educational because my wife suffered from endometriosis and has to have a hysterectomy in her 30s which meant we could never have natural-born children. We don’t think she had even entered her menopause phase of life. 

    Your discussion that women are born with all other eggs intact was a revelation to me. I thought that eggs are created over time. I learned something else from this. That the human body is designed to make the odds of getting pregnant in its favor. 

    Once a woman goes past menopause I doubt if childbirth will be possible then. Would you agree?



    1. Hi Edwin Yes you are correct once past menopause it is not possible to get pregnant, however it is possible for some to carry a baby using a donor egg. It is quite an involved process but has been done.


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