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What is perimenopause? Symptoms, onset age, treatment and more

There’s lots of talk about the effects of menopause, but the years leading up to it can make women miserable, too.
/ Source: TODAY

Nina Coslov was in her early 40s when the frustrating symptoms of perimenopause began.

She experienced disrupted sleep that left her wide awake at 2 a.m., and started feeling anxious.

“I went to both my primary care doctor and my OB/GYN, and they both said, ‘Are you still getting regular periods?’ And I said yes. And they said, ‘Nope, you're too young. This is not hormonal,’” Coslov told NBC News special anchor Maria Shriver as part of TODAY’s series “Dismissed.”

“It just didn't feel right to me. I felt like I had to get to the bottom of it.”

After more research, Coslov eventually learned she was in the early stages of perimenopause, a phase many women may not know about.

There’s lots of talk about menopause, which marks the end of a woman’s reproductive years when the ovaries stop making estrogen. The average age of onset is 51.

What is perimenopause?

But perimenopause can start to happen up to seven years before that moment as the amount of estrogen produced begins to fluctuate, according to the American College of Obstetricians and Gynecologists.

Symptoms of perimenopause vary from woman to woman, but can include:

  • Night sweats
  • Hot flashes
  • Disrupted sleep
  • Brain fog
  • Fatigue
  • Irritability
  • Depression
  • Weight gain
  • Changes in menstrual cycle

When Coslov noticed resources and information on the topic were tough to find, she and a friend created Women Living Better, a website to create awareness. Coslov wants women to know perimenopause can start their 40s when they still get a period, and that it's not just their bodies that are changing, but also their brains.

“They have no idea it's coming. We're not educated that it's normal and is going to happen to most women,” she noted.

“I sometimes say, ‘Why don't women know this?’ Like, women's bodies have been working this way forever.”

How to manage perimenopause

Coslov believes many doctors don't know the symptoms are related to hormones. So they may give women medication to sleep better or feel less anxious without treating the root cause.

Lifestyle, diet and exercise have been shown to ease some symptoms. Other women turn to hormone therapy for relief, but that approach is controversial.

On one hand, there’s evidence that starting hormone replacement therapy before menopause is associated with a reduced risk of Alzheimer’s disease for women. Some experts say that’s because the natural drop in estrogen means women lose a “crucially important” layer of protection for their brains, she noted.

On the other hand, there are concerns HRT could raise the risk of cancer.

Doctors say opting for hormone therapy is an individual decision that each woman should make together with her physician.

“There's a problem in mainstream medicine where I think the pendulum swings for and against hormones,” said Dr. Sara Gottfried, author of “The Hormone Cure.”

“We need to find the middle path, the middle ground. And so what I would say for that woman in particular is that we want to figure out how to support you best.”

Women considering HRT should get a thorough medical screening. Those with a family history of certain breast cancer, heart disease, blood clots and strokes would likely not be good candidates.

Coslov just wants women to be aware and consider all of their options. "There's so much to be gained by just talking about it. I feel so much better when I talk about stuff and know it's normal," she said.