You used to sleep through the night. Now you wake up at 3 a.m. hot and restless. Your periods are heavier, or they show up whenever they want. You feel foggy, short-tempered or just not like yourself.

If this sounds familiar, you may be noticing perimenopause symptoms. Perimenopause is the transition leading up to menopause, and it can start years before your last period. The good news is you don’t have to push through it alone. There are real, effective ways to feel better.

What is perimenopause?

Perimenopause is the time when your body begins to make less estrogen and progesterone. It often starts in your 40s, but some women notice changes in their late 30s. It can last anywhere from a few years to a decade.

Menopause itself is one point in time: 12 months in a row without a period. Everything before that point is perimenopause. Because hormone levels rise and fall unevenly during this stage, symptoms can come and go.

Common perimenopause symptoms

Every woman’s experience is different. Some of the most common signs include:

• Irregular periods, including periods that come closer together or further apart
• Heavy or long periods that make it hard to plan your day
• Hot flashes and night sweats
• Trouble falling or staying asleep
• Mood changes, anxiety or irritability
• Brain fog or trouble focusing
• Lower sex drive or vaginal dryness
• Weight changes, especially around the middle
• Low energy

You may have one or two of these, or many. None of them are “just in your head.”

When heavy periods get in the way

Are your periods interfering with your lifestyle? Heavy bleeding is one of the most common reasons women in their 40s see a gynecologist. Soaking through pads or tampons every hour or two, passing large clots, or planning your week around your cycle are all worth a conversation.

Heavy bleeding can have several causes, including hormone changes, fibroids or polyps. Your provider can help find the cause and talk through options. These may include medication, hormone therapy or a minimally invasive procedure. At Rhett Women’s Center, many procedures can be done in our on-site surgical suite, which may mean a simpler experience and lower cost than a hospital setting. [CONFIRM: list of in-office procedures, e.g., endometrial ablation, hysteroscopy]

What is pellet therapy?

Pellet therapy is one way to deliver hormones. A pellet is a tiny implant, about the size of a grain of rice. It contains estrogen, testosterone or both.

During a short office visit, your provider places the pellet just under the skin of the upper buttock. The area is numbed first. The pellet then releases a steady, low dose of hormones over about three to four months.

Many women like pellet therapy because there are no daily pills, patches or creams to remember.

How pellet therapy may help perimenopause symptoms

For some women, balancing hormones can ease symptoms such as:

• Hot flashes and night sweats
• Poor sleep
• Mood swings
• Low energy
• Low sex drive

Results vary. Some women notice changes within a few weeks, while others take longer. Your provider will use lab work and follow-up visits to track how you’re doing and adjust your plan.

Pellet therapy is not the only option

Hormone therapy comes in many forms, including pills, patches, gels, rings and pellets. Some women do best with a non-hormonal approach. The right choice depends on your symptoms, health history and personal preferences.

A menopause-focused provider will walk you through the pros and cons of each option, not just one.

Risks and things to consider

As with any treatment, hormone therapy has risks. It’s important to know:

• Hormone therapy is not right for everyone, including some women with a history of certain cancers, blood clots or stroke.
• Once a pellet is placed, the dose can’t easily be changed until it wears
• Possible side effects can include acne, hair changes, breast tenderness, mood changes or unexpected bleeding.
• Estrogen and testosterone pellets are compounded, which means they are not FDA-approved products for women the way many pills and patches are.

A full health history, exam and lab work help your provider decide whether pellets or another approach is the safest fit for you.

When to see a provider

It’s a good idea to schedule a visit if you:

• Have periods that are heavy, very long or unpredictable
• Bleed between periods or after sex
• Have any bleeding after menopause
• Have hot flashes, sleep problems or mood changes that affect daily life
• Feel like your current treatment isn’t working

Bleeding after menopause should always be checked by a doctor.

Taking the next step

Perimenopause symptoms are common, but that doesn’t mean you have to live with them. Whether you’re dealing with heavy periods, hot flashes or both, a provider who focuses on menopause care can help you find a plan that fits your life.

Rhett Women’s Center has cared for women in the Lowcountry for more than 40 years, with offices in Mt. Pleasant and Georgetown. To talk about your symptoms and options, call 843-375-2210 or request an appointment.