Featured Wellness Women's health

What is perimenopause and what can I do about it?

woman awake with cramps

Well, folks, I turned 40 last year and let’s just say, my body has started behaving a bit differently than it did in its 20s and 30s.

My gal pals and I half-joke at each temperature flush or angry outburst: “Is it perimenopause!?” It’s a term we’ve heard bounced around, but know little about. And it’s been hard to find solid research about it, too.

This Baroness von Sketch skit (Warning: Strong Language) really hit home – and made me realize I certainly can’t be the only one confused about this mysterious time in a woman’s life.

So I chatted with Dr. Lisa Del Giudice, family physician, for the lowdown on this often-baffling (and sometimes long) stage of the female reproductive life cycle.


A woman has reached menopause when she has not had a menstrual period in 12 months. This typically happens in a woman’s late 40s to early 50s.

But perimenopause – the time leading up to menopause – can vary greatly from woman to woman, both in length and in how it manifests.

“That’s why this time period can be tricky and challenging to navigate as the body starts to undergo natural changes that lead it to menopause,” Dr. Del Giudice said. “Sometimes Dr. Google can make those common benign perimenopausal symptoms appear as though something more sinister is going. And it’s hard to know what is happening due to perimenopause changes, what’s happening because your room is too hot, and what’s happening due to other issues in the body.”


For some women, hormonal changes start 10 to 12 years before they reach menopause. Therefore, there’s no evidence to check hormone levels (like estrogen, FSH, LH and progesterone). There may be some exceptions such as your periods have stopped completely, you are undergoing fertility treatments or upon investigation your doctor thinks something else might be going on with your hormone levels.

Fluctuating hormones, though, can cause some women to experience mood changes, sleep changes and vasomotor symptoms like hot flashes and night sweats. For some of us, they are mild and barely a blip on the radar.

For others, these symptoms are unbearable and severe, and can affect quality of sleep and life. If this is the case, women should speak to their family doctor about possible treatments.

“We know that many women are afraid of using ‘hormones’ and that there has been bad press about them,” Dr. Del Giudice said. “There are some non-hormonal treatments that can be discussed as well as the pros and cons of hormonal treatments as they apply to you.

“This is 2020; women should not have to suffer.”

Periods in perimenopause

Our periods tend to change in this decade-ish long perimenopause time, Dr. Del Giudice said.

“For some women, periods get lighter and less frequent and for others they can get heavier and more frequent,” said Dr. Del Giudice. Heavier periods and the cramping associated with it can be painful and sometimes cause women to become anemic.

“There are some things we can do about this, so please see your doctor,” she said. “If you are seeing any significant changes from your usual periods, your doctor may also want to look for other underlying causes that can be addressed to better manage these symptoms.”

Some of these underlying common causes include sexually transmitted diseases, fibroids, adenomyosis, and endometriosis, and also less common causes like cancers such as cervical and endometrial cancer. That’s why it is important to keep up with your Pap tests (More on that below.).

So, in a nutshell, if you experience changes to your period including heavier (in flow and/or with increased amount of large clots), more painful or coming when it is completely unexpected, it’d be a good idea to check in with your doctor.

And, if you stop getting your period before age 40, talk to your doctor.

Dryness and painful intercourse

Vaginal dryness and painful intercourse are common for women as they pass age 40. This is often due to what we call vaginal atrophy and can sometimes also lead to more frequent urinary tract infections.

“Sometimes we can treat this with simple topical water-based products or non-hormonal products. For others topical estrogens may need to be brought on board to provide relief, ” said Dr. Del Giudice.

If you are experiencing painful intercourse or dryness, talk to your doctor about this.

“It’s quite common, so most family doctors are well versed on how to manage it and would be happy to discuss options with you. Your comfort and quality of life is important to us so we are happy to help in any way. We also know that some people are cautious about taking hormones so we are happy to weigh out the benefits and risks of the topical options.”

What can we do about all this?

Make sure you keep up with all the usual things that we know are good for your overall health: try to eat well, exercise and stop smoking.

There is good evidence that shows smoking makes hot flashes and night sweats worse. This would be a very good reason to consider quitting. (sunnybrook.ca/quitsmoking) Other factors like alcohol consumption and body weight might too play a role in vasomotor symptoms.

Keep up with your Pap test (women aged 21 to 69 should have a Pap test every three years if they are or have ever been sexually active. Is it time for your Pap?) and when you do turn 50, don’t forget about getting a mammogram and colorectal cancer screening as well.

“The research literature has also gone back and forth regarding the association of menopause with heart disease, so for this reason, I also recommend getting your blood pressure checked, along with checking your cholesterol levels and screening for diabetes,” Dr. Del Giudice added.

For women who take thyroid medication, changes in hormone levels can affect your thyroid pill needs, so this should be checked too.

“Many women remember their mother taking hormones or having hysterectomies,” Dr. Del Giudice said. “This is not as common these days.

“The Women’s Health Initiative study in 2002 along with the The Heart and Estrogen/Progestin Replacement Study (HERS) study made women and doctors more hesitant to use hormone replacement therapy. An increased incidence of bowel obstructions many years after hysterectomies have made these less common as well.”

That said, if your life is being affected by hormonal or other changes linked to perimenopause, please speak to your doctor to determine if there’s a treatment option that could be right for you.

About the author

Alexis Dobranowski

Alexis Dobranowski is a Communications Advisor at Sunnybrook.