Entering your perimenopause years can be daunting, especially when you’re experiencing symptoms you never expected. Forget about hot flashes — why are we getting brain fog or gaining weight despite eating healthy?
You probably weren’t even thinking about this phase in life 10 years ago, but now it’s hard to ignore. If you’re finding yourself dealing with this, you’re not alone, and there are solutions that can help you through the process.
Parenthood Together reached out to registered dietitian and nutritionist Heather Ritter, MS, RDN, LDN, CIEC, to answer all our questions regarding perimenopause and how to navigate it with a better understanding. Because after all, parenting doesn’t get easier as kids get older, so entering your 40s and 50s with more knowledge can feel far less confusing and a lot more manageable.
When to expect the first symptoms of perimenopause
Those in their mid-40s are probably beginning to feel the first symptoms of perimenopause, including a change in their periods. Healthcare expert Heather Ritter exclusively told Parenthood Together, “One of the earliest and most recognizable signs is a change in menstrual cycles. Periods may become heavier, lighter, more frequent, or unpredictable.”
However, she noted that some women can experience hormonal changes as early as their mid-30s and can go on for several years.
Other symptoms include hot flashes, night sweats, trouble sleeping, mood changes, and the aforementioned brain fog. You can also feel a dip in your energy, belly bloating, vaginal dryness, frequent urinary tract infections, and painful intercourse.
“Many women are surprised by how broad the symptom profile can be. Perimenopause affects far more than just reproductive health; it can impact sleep, metabolism, cognition, mood, cardiovascular health, and body composition,” Ritter shared.
Although some symptoms can look like those of PMS, the difference between the two is that perimenopause signs are more unpredictable and can happen at any time.
“Women often tell providers, ‘I don’t feel like myself anymore,’ and that’s because perimenopause is a true physiologic transition, not simply ‘bad PMS,'” Ritter told us.
What is HRT and does it really work?
Hormone replacement therapy (HRT) has been around since the 1930s, but it’s gaining traction among the perimenopause set now. As described by Heather Ritter, “The therapy works by replacing estrogen and, in women who still have a uterus, adding progesterone or another endometrial-protective medication to reduce the risk of uterine cancer.”
According to Ritter, there are various forms of HRT, also called menopausal hormone therapy (MHT). One option is a transdermal patch, which delivers estrogen through the skin. “They are now considered a preferred option by many experts because they bypass the liver and may carry a lower risk of blood clots and stroke compared with oral estrogen. They’re especially helpful for women with migraine history, elevated triglycerides, obesity, or higher cardiovascular risk,” Ritter told Parenthood Together.
Oral tablets are another option, but they do bypass the liver, so there is a risk of clotting and elevated triglycerides. You can also use a gel or other liquid spray, or insert the estrogen vaginally via a cream or tablet.
You may have heard women talk about having a pellet inserted into their skin that lasts for several months, but Ritter warned that they aren’t yet FDA-approved. “Major organizations, including ACOG, recommend caution with compounded pellet therapy due to limited safety data and a lack of standardization,” she stated.
Does HRT have any side effects?
As with any medical treatment, one of the first concerns is the side effects. When on HRT, you may experience breast tenderness, bloating, headaches, nausea, spotting or irregular bleeding, and skin irritation if you’re using patches, Heather Ritter exclusively shared with Parenthood Together.
Other risks include blood clots, stroke, gallbladder disease, and the risk of breast cancer, depending on the type of HRT.
Ritter added, “One important nuance is that risk differs substantially depending on whether estrogen is used alone or combined with a progestogen.”
“Long-term data from the Women’s Health Initiative showed that combined estrogen-progestin therapy was associated with an increased risk of breast cancer, whereas estrogen-only therapy in women with prior hysterectomy did not show the same increase and may even have been associated with lower breast cancer incidence,” she continued.
Additionally, HRT through the skin carries lower risks than oral treatments, but Ritter stressed that risks are low for most healthy women, with the benefits being far greater.
Are you a good candidate for HRT?
If you’re wondering whether to start hormone replacement therapy, Heather Ritter stated, “The ideal candidate is generally a woman younger than 60 or within 10 years of menopause onset who is experiencing bothersome symptoms like hot flashes, night sweats, sleep disruption, or significant quality of life impairment.”
HRT can be especially beneficial to those with hot flashes, changes in ovarian function, sleep disruption, vaginal dryness, and urinary issues.
Folks who should avoid HRT are women with a history of breast cancer, blood clots, stroke, heart attack, and acute liver disease. Unexplained vaginal bleeding and other estrogen-sensitive cancers should also steer clear of HRT, but with all treatments, talk to your healthcare professional before making any decisions.
Managing weight during perimenopause
Many women experiencing perimenopause find themselves gaining weight despite living a relatively healthy lifestyle. This is all due to the changes in your body, including declining estrogen that causes belly bloat, per Heather Ritter.
Muscle mass also declines with age, and symptoms like irregular sleep and elevated cortisol can lead to increased hunger and fat storage.
A change in diet can help, such as upping your protein intake, eating more foods with fiber and omega-3 fats, consistent meals to regulate your blood sugar, drinking more water and less alcohol, and avoiding processed foods, Ritter told us.
You can supplement your diet with magnesium, soy isoflavones, black cohosh, creatine, and vitamin D, but speak to your healthcare provider first to make sure they’re safe for you and won’t interact with any medications.
As for exercise, focus on strength training to build muscle and bone density. Take frequent walks and do some cardio to get your heart pumping. Balance and mobility workouts like yoga and Pilates also do wonders.
“One of the most important things women can understand is that many symptoms of perimenopause are real physiological changes, not personal failings,” Ritter shared.
She continued, “Women are often told they simply need more discipline, fewer calories, or more willpower, when in reality, hormonal shifts affect sleep, appetite regulation, energy, mood, body composition, and recovery.”
So, if you’re 40+ and noticing physical and emotional shifts, rest assured that it’s not all in your head, and relief for you is out there.
Join our Parenthood Together Facebook Group to start a discussion about perimenopause with others in your shoes, and be sure to subscribe to our emails for news about special events!
