Staying on top of perimenopause symptoms

NEWTOWN, Pa. (WPVI) -- Women have come to expect big changes during menopause, but some of those can start years earlier in perimenopause.

As a dietitian and exercise instructor, Tabitha Zoltak-Epstein, of Newtown, Pennsylvania, thought she was on top of her health.

So it was frustrating when she became irritable, anxious and had trouble sleeping.

"I would be able to go to sleep but not stay asleep, wake up. Lots of brain fog, difficulty concentrating on things," she recalls

Because Zoltak-Epstein's hormone levels had dropped, Dr. Debra Somers, a Temple Health gynecologist, suggested estrogen replacement.

Dr. Somers says perimenopause can start from the late 30s up to the late 50s.

"Perimenopause can last from 1 year to 5 years to 6 years," she notes, adding, "Some people have no symptoms whatsoever, but other people have a lot of symptoms."

And symptoms can come and go.

"There's a fluctuation of the hormones. So not feeling great, then all of a sudden they're feeling wonderful again. That can last for a few months and they're not feeling good again. So it's not that you're going crazy, it's that your hormones are fluctuating," Dr. Somers advises.

She says women need to address any symptoms with a doctor, to get ahead of potential long-term health risks.

"Perimenopause is when everything starts, it's the beginning of the heart and bone loss," she says.

A thyroid exam is important, because many problems commonly start about then, with symptoms that overlap with perimenopause.

If hormone replacement is needed, it can take many forms, including low-dose birth control pills.

Non-hormonal options include antidepressants for anxiety, and gabapentin for hot flashes.

"Medical marijuana has worked for insomnia for a lot of people, also, but then melatonin's worked. For hot flashes, you can do the gabapentin," she says.

Zoltak-Epstein says medication leveled out her problems, till she could ramp up healthy living.

Now, she's off all medications.

"Exercising every day, getting outside," Zoltak-Epstein says, "And getting at least 7 hours of sleep every night."

Her bedtime ritual includes reading, no electronics, lavender oil, and calming sounds.

Altogether, it's made her easier to live with.

"Don't get me wrong. Not every day is a great day. Some days are better than others," Zoltak-Epstein notes with a laugh.

She also eased her stress by learning all she could on perimenopause through reliable sources.