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Hot Flashes and Mood Swings? It Might Be Perimenopause

If you’re having hot flashes, trouble sleeping or mood swings, you might think you’re starting menopause. But it’s probably the precursor – perimenopause -- which can last a few months or a few years.

You’re not in menopause until you have not had a menstrual cycle for one year.

During perimenopause, your body is adjusting to a drop in estrogen levels and a decrease in ovary reserve, which is the body’s ability to provide egg cells that produce a healthy, normal pregnancy.

There is no definitive checklist of symptoms, but the most common include:

Hot Flashes

The most well-known symptom of both perimenopause and menopause is hot flashes. A hot flash is the sudden feeling of being uncomfortably hot, sweating and appearing red in the face. It can be very pronounced or leave you feeling slightly flushed when everyone else in the room is not warm at all. For some women, a hot flash can include chills and confusion. Hot flashes can also come on at night, causing you to wake up sweating and turn up the AC — only to have your partner complain that it feels like the Arctic.


Perimenopause means that the body is producing smaller amounts of hormones, including estrogen and progesterone. Estrogen plays a big role in sleep patterns, helping women fall asleep faster and enjoy a higher quality of rest. When its levels are dropping, it’s only natural that sleep becomes more erratic.

Mood Swings

The drop in estrogen also affects mood, leaving you feeling like you are indefinitely experiencing PMS to varying degrees. This can look like increased crying, sadness, irritability, anxiety, fatigue, inattention, lack of motivation and a host of other emotions that leave you feeling not like yourself.

Vaginal Dryness

Decreased estrogen is also responsible for the lining of the vagina becoming thinner, drier and less flexible. This can lead to discomfort with sex, which a partner can mistake for a lack of interest. The good news: this can be treated with everything from vaginal lubricants to prescription or over-the-counter medications.

Weight Gain

Another indicator of perimenopause is weight gain. When women maintain the same lifestyle, diet and exercise patterns, and yet the number on the scale creeps up anyway, this points to perimenopause.

Irregular Menstrual Cycles

Periods can become irregular both in the number of weeks between menstruation as well as the amount of flow. If your period had been regularly appearing every four weeks, it may start showing up every three or six weeks, for example. Along with irregular cycles, fluctuations can also show up in the amount of blood — either a decrease or increase. Increases can be a heavier flow or a greater number of days with bleeding.

Keep in mind that the need for treatment isn’t just a health benefit, but for quality of life. Every woman will go through perimenopause, but she will experience it differently. She will need to make her own choices about if and how to treat it based on the severity of her symptoms. 

A good time to speak to your physician or gynecologist is if the symptoms become increasingly uncomfortable. Together, you and your doctor can determine the best course of action.

There are multiple treatment options:

  • Hormone replacement can address nearly every symptom, from hot flashes to vaginal dryness. But this is not a good fit for everyone.
  • Plant-based estrogens can help with hot flashes, mood swings and night sweats.
  • Nonhormonal medicines can target hot flashes and night sweats.
  • The more natural route can include acupuncture and Eastern medicines, such as black cohosh and other plants. These treatments can help diminish a variety of symptoms.

Your physician or gynecologist will talk to you to determine the best treatment for your symptoms and then explain the various treatment options.

The best course of treatment is the smallest dose for the shortest amount of time. Whichever treatment plan you choose is designed only to help you get through this transition. After all, ask any 80-year-old woman — she is not still dealing with night sweats.

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