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Perimenopause is having a millennial moment. Here are 7 ways to cope.

Perimenopausal symptoms can begin as early as the mid-30s for women. Whether women are feeling symptoms, it’s important to establish a menopause plan to get ahead of the curb as the body begins to change.  (Pixabay)
By Emily Laber-Warren Special to the Washington Post

“Welcome to menopause!” proclaims a greeting card created by writer and illustrator Emily McDowell. “On one hand,” the card continues in graphic scrawl, “there’s brain fog, headaches, insomnia, mood swings, and whatever the hell is happening to my knees. On the other hand, there’s the breathtaking power of truly not (caring) what anyone thinks anymore.”

McDowell, founder of the stationery company Em & Friends, was flummoxed when she started having premenopausal symptoms at age 39. “I didn’t know what was happening,” said McDowell, now 48 and a business consultant. When she finally figured it out, she posted about it on Instagram and got more than 10,000 likes. “I felt like, OK, clearly we need to talk about this more,” she said.

These days, menopause is trending. Actress Naomi Watts, 55, recently founded a wellness brand called Stripes that offers “menopause solutions from scalp to vag,” and other big names, including the actress Halle Berry, 57, and former first lady Michelle Obama, 60, are sharing their menopause experiences publicly. Drew Barrymore, 49, interrupted a live TV segment last year to remove her striped suit jacket and fan herself, telling everyone that she was in the middle of a hot flash.

The time is right for these conversations. Millennials, who are known for talking about, well, everything, from periods to postpartum depression, are now talking about perimenopause, which can begin to affect women in their mid-30s and 40s. (The oldest millennials are in their early 40s.)

“Millennials are all about fixing this issue with menopause for their generation, because they don’t want women to be discarded, and not to be supported, and not to have information,” said research psychiatrist Judith Joseph, a clinical assistant professor at NYU Grossman School of Medicine. “So I think that’s what makes them very unique in this menopause activism.”

The science around menopause is also changing. Earlier this month, a 20-year follow-up to the Women’s Health Initiative, a landmark reproductive health study, found that for many younger menopausal women – typically those under 60 – the benefits of hormone drugs probably outweigh the risks for the short-term treatment of menopause symptoms, including hot flashes and night sweats.

Menopause Society guidelines state that for people under 60, taking hormones for a limited period may safely ease hot flashes, night sweats and vaginal dryness, and also protects against osteoporosis. Estrogen creams and inserts are also available to deliver hormones in a more limited way.

For millennials, that’s big news. Scores of baby boomer and Gen X women were forced to navigate the vexing symptoms of menopause without the benefit of highly effective hormone treatments.

“Women have been undertreated. We’ve been misled,” said Donna Klassen, a clinical social worker and co-founder of Let’s Talk Menopause. “And I think women have been suffering in silence.”

Here are seven tips from the experts for coping with perimenopause.

1. Symptoms can begin earlier than you think

Many women and even their doctors believe that menstrual irregularities are the first sign of perimenopause. But changing hormone levels may cause more than 30 wide-ranging symptoms – from irritability and mood changes to sleep issues and joint pain – long before periods are affected.

Gynecologist Robin Noble, who practices in Portland, Maine, has seen patients who went to specialists for eczema, heart palpitations, frozen shoulder, frequent urinary tract infections and other issues without finding relief, but whose problems improved or resolved when they received menopause-specific therapies.

2. Black women may reach perimenopause earlier

For women of color, the transition may begin sooner and symptoms may be more intense and last longer, research shows. But much of the public conversation that’s forming around menopause fails to incorporate these experiences, said Anita Powell, a co-founder of Black Women in Menopause. To fill the gap, she runs the podcast Black Menopause & Beyond. “I’m struggling with menopause. I can’t wave a wand and cure everyone else’s,” she said. “But I think education is very useful.”

3. Find a menopause specialist

In addition to hormone treatments, doctors can prescribe nonhormone drugs for hot flashes or sleep problems or offer complementary therapies, such as pelvic floor treatment for genitourinary symptoms or stress reduction techniques. But it’s important to find a trained provider. Physicians typically receive little to no education in medical school. Klassen, 57, said she had a “gazillion” menopausal symptoms, but her gynecologist’s response was, “Oh, don’t worry about it, everyone has this. You’ll be fine.”

The Menopause Society maintains a list of menopause certified medical professionals.

4. Avoid misinformation and hyped products

The connectivity that millennials have from growing up on social media can help them be more menopause-empowered, said Claire Gill, founder of the National Menopause Foundation. But turning to social media can be problematic, too, because the web roils with misinformation and “meno-profiteers,” Noble said.

Jen Gunter, a gynecologist and best-selling author of “The Menopause Manifesto,” cautions against pricey supplements, such as Goop’s $90-per-month Madame Ovary. “Menopause is becoming a massive business, and everybody is getting in on it,” she said. “There’s no over-the-counter nonprescription product that has any good quality data to support it.”

Consult trusted resources such as the National Menopause Foundation and Let’s Talk Menopause, which offer symptom checklists and evidence-based advice.

5. Even women without symptoms need a menopause plan

If you’re lucky enough to sail through menopause with few symptoms, that doesn’t mean you should ignore it. At menopause, your body stops producing estrogen, and that has ripple effects. Women become more vulnerable to bone loss, heart disease and metabolic issues. Discuss these issues with your medical team. “I look at it as a critical time to really set the stage for better health care in midlife,” Noble said.

6. Exercise and eat a healthy diet

The best nonmedical things you can do to prepare for perimenopause are to eat a heart-healthy diet and exercise, Gunter said. “It’s so boring, right?”

7. Talk to your friends

Advocates encourage women to share information and coping strategies – such as Barrymore’s decision to announce a hot flash instead of trying to hide it.

“I think it’s unusual that there’s this much conversation happening around women’s midlife health right now, so that makes me very optimistic,” Gill said. “But it doesn’t mean that we’ve solved the problem by any means. We have a lot of work to do.”