We've all heard of menopause, particularly the hot flashes it can bring. But what else do you know about it?

For instance, did you know that the symptoms we often attribute to menopause actually begin earlier during what's called perimenopause, the transitional stage that occurs before menopause officially begins?

"Once you go 12 consecutive months without experiencing a period, menopause begins — marking the end of your reproductive years. But, prior to this is a stage called perimenopause," says Dr. Latricia Thompson, OB-GYN at Houston Methodist. "This is when your ovaries start producing less estrogen, resulting in a range of physical and emotional symptoms. It occurs approximately four years before menopause, usually around 47 to 48 years of age."

Dr. Thompson is here to explain how perimenopause affects your body and what you can do about it.

What are the symptoms of perimenopause?

Dr. Thompson: The most common and well-known symptom of perimenopause is, of course, the hot flashes we've all heard about and often attribute to menopause.

But there are other perimenopause symptoms to be on the lookout for, including:

• Irregular menstrual cycles, with lengthening intervals or prolonged heavy bleeding
• Sleep disturbances
• Mood changes, including depression, anxiety and mood swings
• Vaginal dryness
• Sexual dysfunction
• Cognitive changes, such as memory loss or "foggy brain"
• Changes in body composition, such as increased abdominal weight gain (also called central obesity)
• Skin changes
• Long-term health consequences, such as cardiovascular disease and bone loss
  
  

Because symptoms can be mild and appear gradually, it may be hard to put everything together and realize your symptoms are related to the same cause.

What causes the symptoms experienced during perimenopause?

Dr. Thompson: As far as why perimenopause symptoms even occur in the first place, the lack of estrogen is the primary culprit.

For example, lack of estrogen leads to hot flashes, which then can lead to interrupted sleep due to night sweats. It can also cause thinning of the vaginal tissue, which can lead to vaginal atrophy causing vaginal dryness, itching and pain with intercourse. In turn, this can cause sexual dysfunction. Women having vaginal dryness may also experience dry skin in general.

There are also many studies showing the importance of estrogen on cognitive function. So, lower levels of estrogen may be what cause many women to complain of feeling "foggy brain." But, it's also important to note that these sorts of cognitive changes can also be caused by depression, which could be an entirely separate issue.

As for the emotional symptoms of perimenopause, it's thought that estrogen deficiency plays a role — although the connection isn't yet fully understood.

How can perimenopause symptoms be managed at home?

Dr. Thompson: Treatment depends on the exact symptoms a woman is experiencing. However, the first measure is to adopt and/or maintain a healthy diet and exercise regimen.

Simple diet changes that can help relieve symptoms include decreasing spicy and fatty foods. Some women report relief with soy products or natural supplements like black cohosh, as these are home remedies for hot flashes.

Exercise releases endorphins, which can help with depression, anxiety and mood swings. It's the natural happy pill.

For general skin dryness, almond oil can be helpful. Try applying it before you towel off after a shower, since it helps to lock in moisture. You can also try lubricants such as coconut oil for vaginal dryness.

Decreased libido is another common symptom of perimenopause that many women are looking to address. Women are mental creatures, and the more sophisticated we become, the more mental we become. This means we find other things that may be more stimulating than physical sex. Perimenopause is a perfect time to explore with your partner to figure out new ways to connect and communicate. Another option is to consider taking a vacation. Have you ever noticed that the libido improves when you aren't worried about the laundry, cooking dinner or paying bills? Vacations give us time to be worry-free. You can even try a staycation to mimic that feeling on a smaller budget.

When should you see a doctor about perimenopause symptoms?

Dr. Thompson: The home remedies mentioned above work for many women, but not all. If your symptoms are starting to affect your overall well-being or quality of life, it's time to talk to your doctor.

The most common reasons women see their doctor about perimenopause symptoms are hot flashes, mood swings and decreased libido, but your doctor can help with any of the symptoms above.

For instance, if vaginal dryness continues despite using a natural lubricant, consult with your doctor about your prescription options. Some women may also wish to seek help from a counselor to address decreased libido and sexual dysfunction. A counselor can help you and your partner adjust to a new norm.

Another important reason to see your doctor about symptoms that are impacting your well-being is that they could be caused by something other than perimenopause.

Other conditions that have overlapping symptoms with perimenopause that may need to be ruled out include thyroid disease, hyperprolactinemia and, yes, pregnancy. Additionally, some sleep disturbances are the result of anxiety or depression, and it's also important to rule out other concerns like sleep apnea and restless leg syndrome.

Lastly, some long-term consequences of estrogen deficiency are cardiovascular disease and bone loss. This is why it's important to make certain that you work with your doctor to monitor your cholesterol levels to help protect your heart during and beyond this transitional stage.