A pause & a transition

Perimenopause is a natural phase of life — not an illness. This climacteric and transitional phase includes navigating peri-menopause and a few years of postmenopause, writes Dr Manjula Anagani

For many women, the 40s and early 50s bring about significant physical and emotional changes. This transitional period before menopause, known as perimenopause, is marked by hormonal fluctuations that cause various symptoms. Understanding this phase and learning to manage its effects can empower women to embrace this stage with confidence.

What is perimenopause?

Perimenopause, also known as the climacteric, refers to the phase leading up to menopause when estrogen levels begin to decline. It typically starts in a woman’s 40s, though it can begin earlier. Menopause is officially defined as 12 consecutive months without a menstrual period, but perimenopause can last for several years. During this phase, hormonal changes lead to irregular ovulation, which results in both physical and emotional symptoms.

Physical signs of perimenopause

• Irregular periods: Menstrual cycles may become unpredictable, heavier, or lighter.
• Hot flashes and night sweats: Sudden feelings of heat, often accompanied by sweating.
• Sleep disturbances: Hormonal changes or night sweats can lead to insomnia or disrupted sleep.
• Weight gain: A slower metabolism may cause weight gain, particularly around the abdomen.
• Vaginal dryness: Lower estrogen levels can result in vaginal discomfort.
• Joint pain and fatigue: The decline in estrogen can lead to aches, stiffness, and increased fatigue.
• Urinary issues: Increased frequency and urinary incontinence can occur due to weakening pelvic muscles and hormonal changes.

Mental & emotional impact 

While physical symptoms are common, perimenopause can also significantly affect emotional well-being:

• Mood swings: Hormonal fluctuations often lead to irritability, anxiety, or feelings of sadness, which can be intense and unpredictable.

• Brain fog: Many women report memory lapses, difficulty concentrating, or feeling mentally “cloudy,” making it harder to focus or remember details.

• Increased stress: The combination of physical symptoms with everyday personal and professional responsibilities can create a sense of being overwhelmed, leading to heightened stress levels.

• Changes in self-identity: Perimenopause marks a major life transition, and many women experience feelings of loss or uncertainty, questioning their identity as they navigate these changes. These emotional shifts can sometimes lead to a sense of disconnect or confusion about future goals and desires. Together, these emotional symptoms can be as disruptive as the physical ones, affecting overall quality of life.

Medical support

If symptoms become unmanageable, consult a healthcare professional for the following options:

• Hormone Replacement Therapy (HRT): HRT can relieve severe symptoms like hot flashes and dryness. It’s essential to discuss the risks and benefits with your doctor.

• Non-hormonal therapies: Medications, including antidepressants, can help manage mood swings and sleep disturbances.

• Vaginal treatments: Non-surgical pelvic floor therapy can help manage symptoms like urinary incontinence and vaginal dryness associated with hormonal changes. Localised estrogen therapy can address vaginal discomfort.

• Supplements: Vitamin D, calcium, and omega-3 fatty acids can support bone health, heart health, and reduce inflammation.

Prioritise mental well-being

• Stress management: Practices like meditation, deep breathing, and mindfulness can improve emotional balance. Engage in hobbies or creative activities that bring joy and relaxation.

• Seek support: Joining a support group or consulting a counsellor can help women process their experiences and feel less isolated. Sharing stories and tips with others going through similar changes can be incredibly empowering.

• Cognitive stimulation: Activities like puzzles, reading, or learning a new skill can combat brain fog and improve focus and memory.

• Therapeutic practices: Incorporate therapies such as acupuncture or aromatherapy, which may provide relief for symptoms like stress and insomnia.

Enhancing quality of life

• Build a strong support system: Lean on family, friends, or community groups for emotional and practical support.

• Regular health check-ups: Regular screenings are essential to monitor overall health and catch any potential issues early.

• Celebrate milestones: Shift the narrative around perimenopause to one of empowerment. This phase can be an opportunity for self-discovery and personal growth.

• Cultivate mind-body harmony: Practices such as tai chi, Pilates, or dance can integrate mental focus with physical health, improving overall well-being.

When to seek help

If symptoms interfere with daily life, such as severe mood swings, persistent insomnia, or unexplained physical discomfort, it is essential to consult a doctor.

Embracing the transition

Perimenopause is a natural phase of life — not an illness. With the right support, self-care, and awareness, women can navigate this period confidently.

By understanding the changes in their bodies and seeking timely care, women can focus on health and well-being as they transition into a new chapter of life.

Navigating perimenopause
Successfully managing perimenopause requires a holistic approach to address both physical and emotional health. Here are some comprehensive strategies to navigate this phase.
Some healthy lifestyle choices:
 Balanced nutrition: Incorporate foods rich in calcium, vitamin D, and phytoestrogens (like soy and flaxseeds) to support hormone balance. Lean proteins and whole grains help maintain energy levels and manage weight.
 Regular exercise: Yoga, walking, or strength training can help manage weight, improve sleep, and boost mood. Exercise also strengthens bones and improves cardiovascular health, which are crucial during this phase.
 Sleep hygiene: Establish a consistent sleep routine, limit screen time before bed, and create a relaxing sleep environment. Avoiding caffeine and alcohol in the evening can also improve sleep quality.
 Stay hydrated: Drinking adequate water helps with skin hydration, reduces bloating, and alleviates vaginal dryness.
 Avoid triggers for hot flashes: Identify and avoid triggers such as spicy foods, caffeine, or stress, which may intensify hot flashes.

(Dr Manjula Anagani is a Padmashree Awardee and a leading robotic gynaecologist  based in Hyderabad.)