Perimenopause is the transition between premenopausal, fertile periods and menopause (marked by a year without menstrual flow). These myths are important to note, as 79 percent of perimenopausal women have night sweats and daytime flashes, and at least one-quarter of all perimenopausal women experience heavy or flooding menstruation.

Perimenopause lasts from four to 12 years and is similar to adolescence in unpredictability of flow and unexpected bodily changes. What perimenopause is not is low estrogen. Contrarily, midlife estrogen levels average one  third higher than in the average 20-something; for the 20 percent of perimenopausal women who are symptomatic, estrogens are 100 percent higher than normal.

What are night sweats?

So what are night sweats, if not estrogen deficiency? Chaotic, sudden plunges in estrogen levels trigger flushes, sweats, and anxiety. Like withdrawal in an addict, these precipitous drops trigger the brain’s release of the powerful stress hormone, norepinephrine. Our internal thermostat then malfunctions, so it thinks we’re too hot. The many stressors attributed to perimenopause also trigger flooding sweats.


“...79 percent of perimenopausal women have night sweats and daytime flashes...”

But there are solutions and actions women can take  to alleviate these effects. Increasing exercise, stopping smoking, and practicing relaxation methods such as meditation, yoga, breathing, and laughing with each flush will allow most to cope. But, if sweats are waking you up night after night, there is currently no proven relief method. Birth control pills or menopausal-type hormone therapies, although often prescribed, have not been shown effective or safe for perimenopausal flushes. After all, if estrogen is high and misbehaving, it doesn’t make sense that taking more would help.

Progesterone is proven effective for menopausal flushes, is safe (doesn’t cause breast cancer or heart disease), and its major side effect is improved sleep! It makes sense because progesterone, estrogen’s counterbalancing hormone, is low during perimenopause. Progesterone acts on our core temperature, is a brain-stabilizing, calming hormone, and makes good sense for perimenopausal hot flush treatment.

Why is there increased perimenopausal menstrual flow? First of all, higher estrogen and lower progesterone levels cause both perimenopausal flooding and fibroid growth. Fibroids are benign growths in the muscle of the uterus — less than 10 percent of the time, they push into the flooding uterine lining.

Instead of asking for an ultrasound, start ibuprofen (yes, over-the-counter non-steroidal anti-inflammatory/pain pill) and take a 200 mg tablet with each meal on every heavy flow day. Ibuprofen decreases flow by 25 to 50 percent. Also, use a menstrual cup that holds half of a whole period’s usual flow and is less likely to leak. And keep in mind, all women survive perimenopause, including those miserable with night sweats, broken sleep, and flooding menstruation.