By Teresa Hicks
What may begin as hot flashes, mood swings or restless nights can signal one of the most defining transitions in a woman’s life—perimenopause.
Kelley Borella, DNP, CRNP, WHNP-BC, FAANP (BSN 2002, MSN 2005, DNP 2014), Associate Professor at the University of Alabama at Birmingham School of Nursing, Interim Assistant Dean of Graduate Clinical Education - MSN, and Co-coordinator of the Women's Health Nurse Practitioner Specialty, draws on her clinical experience to help women better understand this new stage of life.
“Perimenopause is when a woman’s body begins shifting toward the end of her reproductive years,” Borella said. “While these changes are a normal part of aging, understanding them can help women take steps that support their overall health and well-being.”
Recognizing perimenopause as a natural life stage, rather than a medical issue, can empower women to make choices that protect their physical and emotional health.
Understanding perimenopause and its symptoms
Perimenopause can begin as early as a woman’s 30s or as late as her early 50s and is driven by hormonal changes, especially fluctuations in estrogen. These shifts can affect menstrual cycles, sleep, mood, libido and overall health.
“One of the biggest shifts during this time involves menstrual bleeding patterns, which can become unpredictable as ovulation becomes irregular,” Borella stated. “Without ovulation, the body doesn’t produce enough progesterone to balance estrogen, causing the uterine lining to build up and shed irregularly.”
This can lead to skipped periods, prolonged bleeding or spotting between cycles.
“It’s important to note that going several months without a period can increase the risk of endometrial cancer,” Borella said. “If a woman has at least four periods per year and her symptoms aren’t bothersome, she may not need medication. However, if she goes longer than that without her cycle, a health care provider may prescribe a form of progesterone taken for 10 days each month, to trigger a withdrawal bleed and help maintain uterine health during this transition.”
Understanding these changes and knowing when to seek care can help women navigate perimenopause and protect their long-term health.
Empowering proactive care
There are several strategies women can use to reduce discomfort during perimenopause, such as lifestyle changes and self-care.
“Regular exercise is one of the most effective ways to manage symptoms,” Borella said. “It can help regulate mood, improve sleep, support heart and bone health, and even reduce the frequency of hot flashes.”
For women experiencing hot flashes, avoiding common triggers such as smoking, alcohol and spicy foods can make a noticeable difference. She added, “Keeping a journal of when hot flashes occur can also help identify personal triggers that may be avoided.”
By combining these practical strategies with awareness of emotional changes, women can navigate perimenopause with confidence and maintain overall well-being.
Partner and family support
Perimenopause is not just a physical transition; it’s also an emotional and relational one. Partners and family members play a vital role in helping women navigate this stage with understanding and support.
This can mean being patient during mood swings or fatigue, encouraging healthy habits like exercise and good sleep, and helping to create a calm, comfortable home environment. Simply listening without judgment and showing empathy can go a long way as well.
“Open communication about symptoms like hot flashes, vaginal dryness or changes in libido helps both partners understand what’s happening and find solutions together,” Borella said. “Whether that means trying lubricants, adjusting intimacy routines or scheduling relaxing time together. Approaching perimenopause as a shared experience rather than an individual struggle strengthens connection, deepens trust and reminds both partners that this is a natural life stage they can navigate together.”
In addition, talking with family and friends about emotional and physical changes can provide additional support and can further help reduce stress.
Breaking the stigma
Raising awareness and encouraging open conversation about perimenopause is essential. Many women feel confused or even alarmed when symptoms begin, particularly if no one has prepared them for what to expect.
Borella emphasized that health care providers play a key role in initiating these conversations early.
“By offering clear explanations and providing practical strategies to manage symptoms, providers can normalize this transition by treating it as a natural, healthy part of aging rather than a medical problem,” she said.
Creating a space where women feel heard, informed and supported helps them approach perimenopause with confidence, knowledge and control rather than fear.