Perimenopause: What’s Happening?


Most women know hot flashes and mood swings can signal the start of menopause. But when hormonal changes happen to you, the experience can be confusing. Find out what’s happening and what you can do to relieve the symptoms.

Dr. Margit Lister, with Wasatch OBGYN, says most women don’t need to seek treatment for perimenopause.


Let’s start with definition of menopause. Menopause is defined as “no menses for 12 months’. This is when your ovaries stop ovulating and you stop having the hormonal shifts that produce a menstrual cycle. The average age of menopause is 51 years old, but can happen at ages 45-55 yrs


Prior to the end of your menstrual cycle, changes in your hormone levels can lead some symptoms of menopause. Menstrual irregularity is usually the first sign that things are beginning to change. Then you may notice a hot flash or two, night sweats and then after awhile vaginal dryness. The transition period before no longer having cycles but still having menstrual irregularity is called perimenopause.


Let s look at hot flashes. Hot flashes are a feeling of heat that starts in your neck or upper chest that radiates out to the rest of your body. It usually last for 2-4 minutes. Some women will have several hot flashes in an hour, while others will only have a few, a week. Some women sweat with the hot flash and then will feel chilled once it ends. Others will feel their heart race and may become anxious. Hot flashes usually last for about 4 years but have been documented in women as long as 22 yrs.

Night sweats is a hot flash while you sleep. This may cause you to wake up because you are dripping wet and you have sweat thru your clothes. You may also wake because of feelings of being too hot or too cold. This can be very disruptive to your nights rest. The inability to get adequate sleep night after night, makes other problems such as fatigue, irritability, trouble concentrating and mood swings much more frequent.


Sleep disruptions and natural aging sleep problems can make sleeping thru the night a difficult task. Some women will have difficulty falling asleep, while others will not be able to go back to sleep once they awaken in the night. This inadequate sleep and the transition of menopause can lead to the development of depression. If you have a previous history of depression, you are at a much higher risk of depression.


First you don’t need labs to diagnose menopause. If you haven’t had a menses in 12 months, you are menopausal. Save your money. If you have had a hysterectomy and you still have your ovaries, it is very difficult to tell when you make that transition. Labs will tell you what your ovaries are doing THAT day. Labs do not tell you ANYTHING about tomorrow or yesterday. So, if you are menopausal by labs, this WILL NOT PREDICT if you are going to stay menopausal. But the exact date isn’t as important as how you’re doing with the transition.

Do you need treatment?

Some women don’t need any treatment for menopause and they sail on thru it without a single symptom. If you are one of these women, don’t speak up in large crowds as you may be mobbed with jealousy. About 15% of women will not have symptoms. Most of us with experience something, some worse than others. The women who need treatment are the ones who are having major disruptions in their life and are unable to be the mom, wife, woman they life to be.


Dress in layers. This way you can add or subtract clothing as needed per flash.

Keep cool. Keep the house cool, by opening a window, lowering the thermostat.

Avoid triggers: avoid hot drinks, changing from a cool to hot place (inside in the summer then going to your car)

Stop the flash: sometimes putting a cool rag on your neck will stop the flash

Quit smoking! no explanation needed except it’s good for you and makes the flashes better if you stop!


Get a routine: go to bed and get up at the same time every day.

Quiet activities: take a bath, read or meditate prior to going to bed.

Stop it: don’t nap, avoid alcohol, avoid caffeine in the afternoon, don’t exercise at night

Journal: make a list for the next day

Staying asleep

Dress in layers:

Keep cool

White noise: Water fountain, white noise machine, fan, anything that makes boring monotonous noise.


(iritability, depression)

GET sleep! Make it a priority to get solid sleep each night

Stay active: exercise (not at night), this is the great stress release your body is looking for

Social support: Talk with other women about how you feel and what you are going thru, you realize that you are not alone and this is a natural (albeit difficult) transition.

Dr. Margit Lister is an OBGYN with Intermountain Health Care. If you would like to schedule an appointment, visit:

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