Understanding Perimenopause: Expert Insights from Jila MD
As a board-certified OB-GYN with over 20 years of experience in women’s health and a specialist in menopause and hormone therapy, I’ve dedicated my career to empowering women through every stage of life. At my Miami-based practice, I focus on personalized care, including comprehensive personalized hormone replacement therapy (PHRT) and guidance for navigating hormonal changes. Perimenopause, the transitional phase leading to menopause, can be a challenging time filled with physical and emotional shifts. In this blog post, I’ll share expert insights on what perimenopause is, its symptoms, causes, stages, and effective management strategies to help you feel informed and supported
What is Perimenopause?
Perimenopause, often called the “menopause transition,” is the natural phase when a woman’s ovaries gradually produce less estrogen and progesterone, leading up to menopause, the point when periods stop entirely. This transition typically begins in a woman’s 40s but can start as early as the mid-30s or as late as the early 50s. Unlike menopause, which is defined retrospectively after 12 months without a period, perimenopause can last anywhere from a few months to 10 years. During this time, hormonal fluctuations can cause irregular menstrual cycles and a variety of symptoms, but it’s important to remember that this is a normal part of aging, not a disease. In my practice, I often explain to patients that perimenopause is like a “rocky road” to menopause, where hormone levels rise and fall unpredictably. Understanding this phase empowers women to seek timely care and make lifestyle adjustments for a smoother journey.
Common Symptoms of Perimenopause
The symptoms of perimenopause vary widely among women, but many experience a combination of physical and emotional changes due to declining hormone levels. Some of the most common include:
Hot flashes and night sweats: Sudden waves of heat that can disrupt sleep and daily life, affecting 35-50% of women
Irregular periods: Cycles may become shorter, longer, heavier, or lighter as ovulation becomes less predictable.
Mood changes: Irritability, anxiety, depression, or mood swings, which can feel similar to PMS and affect about 4 in 10 women
Sleep disturbances: Insomnia or poor sleep quality, often linked to night sweats
Vaginal and sexual changes: Dryness, discomfort during intercourse, and decreased libido due to lower estrogen
Weight gain and metabolic changes: Slower metabolism and fat redistribution, particularly around the abdomen
Other issues: Fatigue, memory lapses (“brain fog”), joint pain, and headaches
Causes and Stages of Perimenopause
The primary cause of perimenopause is the natural aging of the ovaries, which leads to a decline in estrogen production and fewer viable eggs. Factors like genetics, smoking, certain medical treatments (e.g., chemotherapy), or early hysterectomy can accelerate this process. There’s no single trigger, but lifestyle and environmental influences play a role.
Perimenopause is often divided into two stages:
Early perimenopause: Periods are still somewhat regular, but symptoms like hot flashes and mood swings may begin. Hormone levels start fluctuating.
Late perimenopause: Cycles become highly irregular (skipping months), and symptoms often intensify as estrogen drops more significantly.
Treatment Options for Perimenopause
While perimenopause can’t be “cured,” its symptoms can be managed effectively to improve your well-being. Treatment should be personalized, and options include:
Personalized Hormone Replacement Therapy (PHRT): I call it “personalized” because it is very important this is tailored to each individual by an experienced provider. The most effective way to alleviate hot flashes, night sweats, mood swings, and vaginal dryness is by replenishing estrogen and progesterone. As a menopause specialist, I guide patients through options for long-term health benefits, ensuring it’s customized and started at the right time for safety.
Lifestyle Changes — Supporting bone density & muscle strength: In my experience, a combination of HRT and lifestyle adjustments, such as exercise and nutrition, yields the best results for most women. Exercise during perimenopause is a key component of health and wellness during this transition. It isn’t just about burning calories or shedding weight; it’s about strengthening your body from within. As estrogen levels decline, women experience a rapid loss in bone density and muscle mass. Resistance and strength training should take center stage
Diet Tips: A balanced diet following a Mediterranean-style approach, rich in phytoestrogens (e.g., soy, flaxseeds, legumes), omega fatty acids (e.g., salmon, sardines, walnuts), fiber from whole
grains, fruits, and vegetables, lean proteins, healthy fats, calcium-rich foods (e.g., dairy, leafy greens, fortified plant milks), and vitamin D sources (e.g., eggs, fortified cereals, or supplements if needed) to support bone health, reduce inflammation, balance blood sugar, and alleviate hot flashes and mood swings. Limit processed sugars and refined carbohydrates to prevent energy crashes. Stress management through mindfulness or meditation, maintaining a healthy weight, and staying hydrated with water, herbal teas, and water-rich foods (e.g., cucumbers, watermelon)
Expert Tips from JilaMD: Drawing from over two decades in obstetrics, gynecology, and menopause care, here are my top tips for thriving during perimenopause.
Prioritize self-care: Incorporate daily movement (e.g., brisk walking, yoga, strength training, or even dancing) and mindfulness practices like breathing exercises to combat mood swings, fatigue, and stress.
Monitor your health: Keep a symptom journal and get regular check-ups, including bone density scans if you’re at risk for osteoporosis, to support long-term bone, heart, and cognitive health.
Embrace personalization: What works for one woman may not for another; HRT, for instance, can be customized to your needs for optimal safety and efficacy
Focus on long-term wellness: Perimenopause is a gateway to menopause, so building healthy habits now—like a nutrient-rich diet emphasizing plant-based foods, omega-3s, and limiting sugars, along with consistent movement supports overall thriving
As highlighted in my recent discussions on thriving through menopause, empowerment comes from knowledge and proactive care
Conclusion
Perimenopause is a significant life transition, but with the right knowledge and support, it can be navigated with confidence and grace. As your trusted partner in women’s health, I’m committed to providing compassionate, expert care. If you’re experiencing perimenopausal symptoms or want to discuss options, join the Waitlist today via www.jilamd.com . Remember, you’re not alone. Let’s work together for your best health.
Stay tuned for more blog posts on women’s wellness topics. For personalized advice, reach out—your journey to hormonal balance starts here!
