Navigating Perimenopause: What Works and What Doesn’t

Christina S. Zhu

Feeling anxious? Struggling to focus at work? Waking up drenched in sweat? Welcome to the often-overlooked world of perimenopause.

Understanding Perimenopause

Perimenopause is the transitional phase leading up to menopause, where individuals experience symptoms but have not yet fully stopped having periods. Once dismissed as merely a hormonal blip, this stage is now recognized as a significant life period lasting up to 10 years, during which both the body and brain undergo profound changes.

Symptoms can range from mood swings and migraines to heart palpitations and urinary tract infections, leading to a sense of losing identity for many women. Fortunately, as knowledge of hormonal changes improves, several therapeutic options are emerging to alleviate these disruptive symptoms.

The Complexity of Symptoms

The way individuals experience perimenopause varies widely due to fluctuating estrogen levels alongside declining progesterone and testosterone. These hormonal changes can impact various aspects of health, including bone density, muscle strength, cognitive function, and cardiovascular health.

Despite this being a common transition for half the population, its effects are often underestimated. Cristina Del Toro Badessa, a physician specializing in hormonal health, emphasizes that menopause marks a critical turning point that affects women physically, emotionally, and socially. Many women, part of the “sandwich generation” caring for both children and aging parents, often neglect their own well-being during this phase.

Societal Impacts of Perimenopause

The consequences of perimenopause extend beyond the personal level; they can significantly influence society as a whole. For example, a survey by the UK charity Wellbeing of Women found that 1 in 4 women have considered leaving their jobs due to unwanted menopausal symptoms. In the U.S., a 2025 study revealed that the economic impact of menopause could reach $1.8 billion annually, driven by decreased work hours or early retirement.

Many women experiencing perimenopause symptoms turn to hormone replacement therapy (HRT)

Treatments and Solutions

Hormone Replacement Therapy (HRT)

When it comes to treatment, hormone replacement therapy (HRT) is the primary recommendation for those over 40, according to the UK’s National Institute of Health and Care Excellence (NICE). However, its uptake has declined, particularly in the U.S., due to historical fears about side effects. Notably, a high-profile study in 2002 was halted after linking HRT to increased risks of breast cancer, heart attack, and stroke.

While these concerns were based on legitimate findings, subsequent studies have demonstrated that context matters — such as starting age and duration of use significantly affect risk profiles. Notably, women who take HRT for less than five years do not show an increased breast cancer risk after stopping.

Several studies led by the British Menopause Society reveal that the risks associated with HRT are relatively small and can be offset by its benefits, such as decreased cardiovascular disease risk and fewer bone fractures. Moreover, emerging research suggests that HRT could potentially play a role in supporting brain health, particularly in managing glucose metabolism, thereby addressing some cognitive symptoms associated with perimenopause.

Alternative Treatment Options

For women not eligible for HRT or who choose not to pursue it, cognitive behavioral therapy (CBT) has shown promise as an effective treatment for perimenopausal symptoms. Clinical trials indicate that CBT can reduce both hot flushes and night sweats.

Recently, non-hormonal options have also surfaced in the market. The FDA approved fezolinetant, a drug that mitigates hot flushes by targeting receptors in the brain. While promising, this medication comes with potential side effects and lacks consistent insurance coverage, making it a costly option.

A similar drug named elinzanetant has garnered attention in the UK, showing efficacy in reducing hot flushes and sleep disturbances without the incidence of liver toxicity seen in some other medications.

Lifestyle Adjustments

Dietary Changes

Integrating more protein into your diet could be beneficial, especially considering that hormonal changes during perimenopause can hinder muscle retention and lead to weight fluctuations. Studies suggest increasing daily protein intake by approximately 0.1 to 0.2 grams per kilogram of body weight can be effective in managing weight and muscle health.

Supplements

While many supplements claim to alleviate perimenopausal symptoms, the evidence supporting them is often mixed. Cimicifuga racemosa (black cohosh), for example, has been shown to potentially reduce various symptoms, but results can vary significantly. Vitamins B6 and D may also help with specific symptoms, although they should not be viewed as replacements for hormone therapy.

Lift weights during perimenopause to enhance bone density, which can diminish due to falling estrogen levels.

Exercise: Weight Lifting vs. Cardio

The best form of exercise during perimenopause remains a topic of inquiry. While strength training has been shown to improve bone density and metabolic health, there is no consensus that it outperforms other exercise types. Balancing various physical activities can yield comprehensive benefits during this transitional stage.

Final Thoughts

Navigating the waters of perimenopause can be daunting, especially with the overwhelming amount of information available online. While many women seek guidance from social media or influencers, it’s essential to proceed with caution. Rigorous ongoing research and increased funding for women’s health are crucial to understanding conditions like perimenopause better.

Ultimately, effective management of perimenopause symptoms may require a multi-faceted approach tailored to individual needs—combining HRT, lifestyle adjustments, cognitive therapies, and possibly new drug treatments as they become available.

As we continue to shed light on this often-misunderstood stage of life, empowering women with knowledge and treatment options should be the goal, paving the way for healthier transitions into menopause and beyond.