Ashlee Williams, MD (Host): We all learn about puberty and hear plenty about menopause, but what about the in-between, perimenopause? The often overlooked bridge between the two rarely gets the spotlight it deserves. Yet, for many women, this transition can last nearly a decade, quietly reshaping everything from mood and memory to daily routines and relationships. And while weight gain, low libido and night sweats are more familiar, symptoms like brain fog, joint pain, and even heart palpitations can take many by surprise.

Welcome to The Healthier You Podcast. I'm Dr. Ashlee Williams. And today, I'm joined by Dr. Marsha Solomon, a board-certified OB-GYN, here at Kaiser Permanente. Together, we'll unravel the complexities of perimenopause, discuss its most common and unexpected symptoms and share tips on managing them, both with lifestyle changes and the latest medical treatments.

Dr. Solomon, thank you so much for being here to discuss this important conversation.

Marsha Solomon, MD: Thanks for having me.

Host: Dr. Solomon, let's start with the basics. What is perimenopause and what makes it so different from menopause?

Marsha Solomon, MD: Great question. Perimenopause is the transition period that occurs before we get into menopause and can last for several years. It is a time when our ovaries start to gradually decrease the amount of estrogen and progesterone that they release, and this can cause differing symptoms. Now, the difference between perimenopause and menopause is that menopause is defined as no period for a continuous 12 months. So, no bleeding or spotting or period for 12 months. That's what makes you officially menopausal.

Host: Yeah, I think a lot of people are like, "Am I perimenopausal? Have I started menopause?" Can you talk about some of the symptoms of perimenopause?

Marsha Solomon, MD: It's actually important to note before I get into symptoms that there are many women who don't actually experience real symptoms of perimenopause, and we just know that they are perimenopausal based on their age. But the majority of women probably experience at least one perimenopausal symptom and the most common one is changes in their menstrual cycle. So, this could be cycle becomes a little bit closer together, or it starts to spread out more people start skipping months of periods. Sometimes the length of flow is longer or it's shorter. Some sort of change in cycle. Also, hot flashes, night sweats. People can start having changes in their sleep patterns or more difficulty falling asleep or insomnia, vaginal dryness or more discomfort with intercourse is possible as well.

Mood changes, people might find that their moods are changing. They feel maybe a little more irritable. Quite often people will describe it as, "I feel like my PMS is worse." So, mood changes like that. Sometimes people also find that they feel they have some difficulty finding words when they're trying to communicate. And so, that's what a lot of people refer to as the brain fog. That's a very common symptom as well.

Host: So, we always like to talk about lifestyle changes. Are there any lifestyle changes that you can make to help with perimenopause symptoms?

Marsha Solomon, MD: Absolutely. The most important lifestyle changes are the ones that make us the healthiest versions of ourself possible. So, healthy diet is number one and probably most important;. So, you want to make sure that you're following a healthy diet with lots of fruits and vegetables and whole grains and lean proteins and healthy fats. And with that comes exercise, regular exercise, exercise at least three times per week and including weight-bearing exercise. Weight-bearing exercise can be very, very healthy to your bones, and also is the best version of exercise that people can do in their middle age. Aside from that, we want to avoid alcohol and caffeine or at least diminish it as much as possible. Smoking, we want to stop smoking. Again, trying to be as healthy as possible.

When it comes to sleep, that's something that when we're younger, we never really focus on, right? Nobody really cares about what they're doing with sleep. We're just able to hang all the time. But this is a time when you probably want to focus on trying to get eight hours of solid sleep if you can. And for people who have difficulty falling asleep, putting away those electronic devices, decreasing the screen time before bed, more relaxing activities can be very helpful. Also, when it comes to mood, trying to work on things like maybe mindfulness. And also, meditation could be very helpful, when trying to stabilize moods a little bit more.

Host: I think a lot of these tips are important for overall health. Good sleep hygiene, I think we start to prioritize sleep as we age. And I think it's really important what you mentioned about strength training. We focus a lot on cardiovascular health and like running and biking, but building our strength is also very, very important as we age, especially for bone health, to prevent osteoporosis, which is common in aging women. Okay, so we talked about sleep, and we talked about avoiding alcohol, including smoking and exercise. Are there any herbal supplements that can help with perimenopause?

Marsha Solomon, MD: That's actually a very good question. So, there are a lot of people that will try supplements or herbal remedies to try to help to manage their perimenopausal symptoms. And the truth is it does work for some people. Some people do have relief of their symptoms with these supplements. But studies actually have not really given us definite answers. There's sort of mixed reviews with respect to how effective and how safe these herbal remedies or supplements can be.

I think for anyone who is considering trying to start a supplement or herbal remedy, it's really important to have a discussion with their healthcare provider first, because we have to remember that these are not regulated substances and we're not really sure of how these things will interact with current medications or current treatment plans. So, always make sure you speak to a healthcare provider before starting a herbal remedy or a supplement.

Host: Yeah, and I think that's a good tip with any health condition. If you're going to start something over-the-counter, it's always good to check with your primary care doctor to make sure that it's good for you and it doesn't interact with any of the current medications that you take.

Marsha Solomon, MD: Absolutely.

Host: Dr. Solomon, what about hormone replacement therapy or HRT? Is that helpful for perimenopausal symptoms?

Marsha Solomon, MD: It can be. Hormonal treatment can be very helpful to people who are having significant hormonal side effects from their perimenopause. And so, what HRT does is it helps to give back some of that estrogen that may be starting to become deficient and progesterone as well. Birth control can also work the same way, so sometimes when somebody is not menopausal yet, we might give them back a little bit of estrogen and progesterone in the form of birth control to help regulate their cycles and to help with the hot flashes and vaginal dryness, night sweats that they might be experiencing. Both HRT and birth control are very reasonable options to help manage symptoms, but certainly options that do carry potential risk depending on somebody's medical history should be definitely discussed with a healthcare provider before starting to try something.

Host: I think that is an excellent point, Dr. Solomon. I think some people do get concerned about the side effects of hormonal replacement therapies such as blood clots, stroke, certain cancers. Are there other treatment options that are non-hormonal for perimenopause symptoms?

Marsha Solomon, MD: Yes, absolutely. There are definitely some other classes of medications that can be helpful. One of these is an antidepressant or an SSI. SSRIs can be really helpful in managing the hot flashes and the night sweats that people may experience and also benefit you in managing some of the mood changes that people experience, such as increasing depression and anxiety.

There's also another medication called gabapentin that can help with some of the hot flash and night sweat type experiences that people are having. There are vaginal lubricants, vaginal moisturizers that can be recommended or even prescribed to help with some of the vaginal dryness and discomfort with intercourse that women may experience. So, lots of other non-hormonal medications that we can help with.

Host: Thank you so much for this valuable insight, Dr. Solomon. Here are some key takeaways from today's episode. One, perimenopause is the natural transition before menopause defined by irregular periods in hormonal changes. Two, common symptoms include hot flashes, night sweats, irregular bleeding, mood changes, sleep disturbances, and vaginal dryness. But some people have additional symptoms like joint pain and brain fog, and some may not have symptoms altogether. Three, healthy lifestyle changes like maintaining a balanced diet, getting regular exercise, managing stress, and good sleep hygiene can help manage symptoms. Four, hormone replacement therapy is highly effective for many symptoms, but has potential risk. The decision should always be personalized with your healthcare provider. Five, there are also non-hormonal treatments available, such as some antidepressants, other medications, and vaginal moisturizers, which can help relieve specific symptoms.

For more expert advice, visit kp.org/doctor and listen to more episodes of Healthier You wherever you get your podcasts. If you found this episode helpful, don't forget to subscribe and share it with others. Thank you. And from all of us at Kaiser Permanente, be well.