During perimenopause, hormone tests are generally not helpful because hormone levels change throughout the menstrual cycle. Sometimes testing is done to check specific hormone levels, especially to evaluate fertility problems or when periods stop at an early age. This can help women make decisions about beginning or adjusting treatment. For some women, it may make sense to test for other causes of symptoms that can mimic perimenopause, such as thyroid disease.

Some clinicians recommend testing a woman’s saliva for estrogen or other hormone levels. But salivary hormone levels are expensive, are not accurate, and should not be used to evaluate or treat menopausal symptoms.

Sometimes, elevated follicle-stimulating hormone (FSH) levels are measured to confirm menopause. When a woman’s FSH blood level is consistently elevated to 30 mIU/mL or higher, and she has not had a menstrual period for a year, it is generally accepted that she has reached menopause.

However, a single FSH level can be misleading in perimenopause since estrogen production does not fall at a steady rate from day to day. Instead, both estrogen and FSH levels can vary greatly during perimenopause. One elevated FSH level is not enough to confirm menopause. More importantly, a low FSH level in a woman who is having hot flashes and changing periods does not eliminate the likelihood that she is still in perimenopause. Also, if a woman is using certain hormone therapies (such as birth control pills), an FSH test is not valid. Over-the-counter urine tests for menopause that measure FSH are often advertised, but are expensive and not informative, for the same reasons discussed above.

When a woman suspects she’s in perimenopause, it is an excellent time to have a complete medical examination by a qualified health professional. The diagnosis of perimenopause can usually be made by reviewing a woman’s medical history, her menstrual history, and her signs and symptoms.

The most common symptoms women in their 40s notice are changes in periods and the onset of hot flashes. Menopause is defined as 12 months without a menstrual bleed, in the absence of other conditions. To date, there is no simple test to predict or confirm menopause or perimenopause, but research continues.

SOLUTIONS TO SYMPTOMS OF MENOPAUSE:

Here are five solutions for symptoms common to midlife women. Remember, you should always discuss any concerns you have with your healthcare provider first. There may be other treatments or potentially harmful side effects. Together, you can decide which options are best for you.

• Mood Changes

Some women find that hormone fluctuations in perimenopause create a feeling of being out of control. Reports of increased irritability, anxiety, fatigue, and blue moods are not uncommon. Relaxation and stress-reduction techniques, including deep-breathing exercises and massage, a healthy lifestyle (good nutrition and daily exercise), and enjoyable, self-nurturing activities may all be helpful. Some women try to treat their menopause symptoms with over-the-counter products such as St. John’s wort or vitamin B6.

Discussing mood issues with your healthcare provider can help you identify the cause, assess for severe depression, and decide on the most appropriate intervention. For depression, prescription antidepressant medications may be indicated to correct a chemical imbalance. Although several weeks are usually needed to experience the full effect of one of these drugs, many women show a marked improvement with these medications with relatively few side effects. Some antidepressants have also been found to treat hot flashes. Antidepressant therapy is most effective when combined with counseling or psychotherapy.

• Urinary Incontinence

While it is defined as the persistent, involuntary loss of urine, most women would say urinary incontinence is an unfortunate, unwelcome, unwanted annoyance. Luckily, there are strategies to help improve the various forms of incontinence without medication or surgery. Try drinking adequate water to keep urine diluted (clear and pale yellow), and avoid foods or beverages with a high acid or caffeine content, which may irritate the bladder lining. These include grapefruit, oranges, tomatoes, coffee, and caffeine-containing soft drinks. Also try Kegel exercises to strengthen your pelvic floor muscles and reduce incontinence episodes.

• Night Sweats

To get relief from night sweats (hot flashes that occur during sleep), try different strategies to stay cool while you sleep: The following could help as well:

1. Dress in light nightclothes.

2. Use layered bedding that can easily be removed during the night.

3. Try wicking materials for both.

4. Cool down with an electric fan.

5. Sip cool water throughout the night.

6. Keep a frozen cold pack under your pillow and turn over the pillow often so that your head is always resting on a cool surface, or put a cold pack on your feet.

• Trouble Falling Asleep

Establish a regular sleep schedule and sleep routine such as:

1. Wake up and go to bed at consistent times, even on weekends.

2. Relax and wind down before sleep by reading a book, listening to music, or taking a leisurely bath.

3. Milk and peanuts contain tryptophan, which helps the body relax.

4. A cup of chamomile tea may also do the trick.

5. Keep bedroom light, noise, and temperature at a comfortable level — dark, quiet, and cool are conditions that support sleep.

6. Use the bedroom only for sleep and sex.

7. Avoid caffeine and alcohol late in the day.

• Sexual Discomfort

Menopause contributes to sexual function changes through the decreases in ovarian hormone production and may lead to vaginal dryness and a decline in sexual function. To counteract these changes, try:

1. Vaginal lubricants: Available without a prescription, these products decrease friction and ease intercourse when the vagina is dry. Only water-soluble products should be used because oil-based products such as Vaseline may actually increase irritation. Only products designed for the vagina should be used; avoid hand creams and lotions containing alcohol and perfumes as well as warming/tingling and flavored lubricants which may irritate tender tissue. (Examples of available vaginal lubricants include Astroglide, Moist Again, and Silk-E.)

2. Vaginal moisturizers: Also available without a prescription, these products improve or maintain vaginal moisture in women with mild vaginal atrophy (when tissues of the vulva and the lining of the vagina become thin, dry, less elastic, and less lubricated as a result of estrogen loss). They also help keep vaginal pH low, which ensures a healthy vaginal environment. (Examples include Replens and K-Y Long-lasting Vaginal Moisturizer.) These products can be used on a regular basis and offer a more lasting effect than vaginal lubricants.

3. Regular sexual stimulation: Last but certainly not least, women can maintain vaginal health through regular painless sexual activity, which promotes blood flow to the genital area.