I’ll let you in on a little secret that most post-menopausal women already know: It’s not the menopause that creates havoc in a woman’s life…it’s the perimenopause, which is the transition to menopause, where the real “change” occurs. If you’ve hit your 40s, you’ve probably already asked yourself, “Is this just PMS or is it the start of menopause?”

For most women, these changes bring a triple whammy at a very busy time of life: the moodiness and irritability of perimenopause in addition to PMS and stress, all at the same time. Experts estimate that 60% to 80% of women experience mild to moderate premenstrual symptoms during perimenopause while up to 20% of women will experience more severe PMS. Stress complicates matters by making symptoms more intense.


So how do you sort the symptoms—and make them go away? The reality is PMS is a highly treatable condition that can be managed largely with lifestyle changes. Since there isn’t a single screening or blood test that will confirm that, “yes, you do have PMS,” a little self-diagnosis is in order. By pinpointing the pattern of symptoms you usually experience, what factors make them worse, and when they’re likely to flare up, you can take charge of them.

What symptoms typically rear up during your monthly cycle? Track them on a calendar or on a free downloadable file at www.takingbackthemonth.com to discover why and when they happen in your particular cycle. The most common PMS symptoms are: irritability (by far the most prevailing), sudden mood swings, weepiness, weight gain and bloating, food cravings (from sweet to salty and crunchy), fatigue, headaches (yes, menstrual migraines!), sleep disturbances, back pain, and breast tenderness. With this list alone, no wonder women will try almost anything to get relief!

While you’re tracking your most irksome symptoms, the next step in the “blast PMS plan” is following the anti-PMS diet and taking recommended nutritional supplements proven to diminish them. Lastly, adopt some simple methods for stress reduction and in no time you may find your cycles are more manageable.

Perimenopause has been described by some women as a “bad case of PMS.” This is because PMS usually intensifies during perimenopause. The first sign that you might be in the perimenopause is a change in your menstrual cycle—the interval between periods may get shorter or longer and menstrual flow may become heavier or lighter. Hot flashes, night sweats, and sleep problems also start. These changes typically happen for four to five years around the most common time of menopause—age 52. However, they can begin as early as your late 30s or as late as your late 50s. As estrogen levels wane, women experience hot flashes, night sweats, and sleep problems. These symptoms increase in frequency and intensity as your ovaries continue to sputter, releasing wildly fluctuating amounts of the hormones estrogen and progesterone


For most women, hot flashes aren’t as distressing as the sleep problems that come from night sweats. There’s nothing worse than being jolted from a deep sleep drenched in sweat. Whether you struggle with falling asleep, staying asleep, or oversleeping, you can regain snooze control with basic strategies. Stick with regular bed and wake times and practice relaxation for 20 minutes before bedtime. Avoid large meals and alcohol late in the evening. If you smoke, stop, as nicotine interferes with sleep cycles. Eat melatonin-rich foods, such as oats, sweet corn, rice, ginger, tomatoes, and bananas, or take melatonin supplements (1 mg to 3 mg, 30 minutes before bedtime). Keep your bedroom cool and dark. Use lamps and nightlights to make your way through the house at night, rather than bright overhead lights. Use mattress toppers and down blankets to create a cozy nest and begin dimming the lights throughout the house at least 30 minutes before bedtime. Don’t let PMS or perimenopause spoil another month. Take it back instead.


If you experience severe symptoms after your PMS plan is in swing, consider adding medications. Natural, micronized progesterone or synthetic progestin can balance the high estrogen levels of perimenopause and ease heavy menstrual flow. Taken at bedtime, progesterone reduces night sweats and enhances sleep. If you have mild premenstrual sleep problems and regular cycles, an OTC progesterone cream may suffice. For vaginal dryness or painful intercourse, a lubricant or a vaginal estrogen (Vagifem) may be appropriate, but discuss these symptoms with your health care provider as not all women are candidates for estrogen therapy.

Temporarily suppressing ovulation with low-dose hormonal contraceptives that contain estrogen and progestin can reduce PMS and perimenopausal symptoms. However, don’t use these contraceptives if you smoke, have high blood pressure, cancer, or a history of liver disease, and take a daily multivitamin to reduce side effects. Complementary therapies proven to help PMS and perimenopausal symptoms include acupuncture, homeopathy, light therapy and herbal therapies (chaste tree berry, black cohosh, and valerian)

• Go grainy: Eat more complex carbohydrates, and eat your meals more frequently.
• Kick caffeine: Increase your water intake.
• Be vigilant with vitamins: Take a daily multivitamin and mineral supplement, 1200 mg calcium with vitamin D daily, and add extra magnesium sulfate (250 mg) and 50 mg B6 and B-vitamins during the weeks leading up to your period.
• Go bland: Avoid hot-flash triggers such as alcohol, spicy foods, and hot baths if you experience hot flashes every menstrual cycle, and if they are uncomfortable.
• Seek supplements: You can supplement declining estrogen by taking in isoflavones, which are typically found in tofu and soy milk, or by taking an isoflavone supplementation (40–80 mg daily); black cohosh is also proven to help with symptoms in some women (40–80 mg daily in divided doses).