Perimenopause can cause severe symptoms that may make you feel like you’re dying. Help is available, and a doctor can recommend over-the-counter (OTC) or prescription medications, therapies, and other treatments to help manage your symptoms.

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Perimenopause is the transition period leading up to menopause. Your body’s hormone levels start changing, which can lead to various physical, mental, and emotional symptoms that may be severe and distressing.

It’s important to be aware that perimenopause symptoms may begin before your menstrual periods change. Keep track of your symptoms, and remember that there’s no shame in asking for help — your doctor can help you find relief.

Perimenopause symptoms can be physical, mental, and emotional. They can range from mild to severe. Some people may not experience all the symptoms. Your experience may be different from someone else’s.

Physical symptoms

The physical symptoms of perimenopause can be wide-ranging and may include:

Many of these symptoms result from changing hormone levels in your body.

Certain symptoms may also influence one another. For example, if you have trouble sleeping, fatigue may lead to reduced physical activity and weight changes.

Mental health symptoms

Some people may experience changes in their mental health and ability to think during perimenopause, such as depression, anxiety, and memory or concentration changes.

Though changing hormone levels can lead to imbalances that contribute to these symptoms, other factors can also play a part.

For example, life changes like retirement, children leaving the home, and noticeable differences in your body or health can contribute to mental health symptoms during perimenopause. These changes may cause or worsen stress.

The unpredictability of perimenopause symptoms may also contribute to feelings of anxiety and panic attacks. Together with physical symptoms like insomnia or fatigue, these mental health symptoms may lead to feelings of severe distress.

Emotional symptoms

You might also notice changes in your mood and emotions during perimenopause, such as:

  • irritability
  • sensations of sadness, grief, loss, or isolation
  • a sense of helplessness
  • existential dread or depression
  • diminished self-esteem

Hormonal changes can lead to abrupt mood shifts, but plenty of other factors can also affect emotional health. For example, you might:

  • have difficulty accepting changes in your appearance
  • feel like you’re losing control of your body and thoughts
  • experience challenges with unpredictable and disruptive symptoms, like incontinence or hot flashes
  • get frustrated from insomnia that persists despite fatigue

Whatever you experience, it’s important to remember that help is available.

Many treatments, including medications and therapy, can help relieve perimenopause symptoms. However, they can take time to access and may not work right away.

In the short term, you could try these strategies to relieve symptoms:

  • Take a walk: Walking may distract you by offering a change of environment and might improve your mood.
  • Talk with someone you trust: Talking about depression and suicidal thoughts with someone you trust may be comforting, particularly if they’ve had similar experiences.
  • Practice yoga: Yoga may help reduce stress and relieve feelings of anxiety and depression. It may also relieve some types of pain and help you sleep better.
  • Do something relaxing: Choose a favorite activity that can help you relax and relieve distressing thoughts. You might want to try reading, watching a favorite movie, or listening to soothing music.
  • Get comfortable: Perimenopause can cause symptoms like hot flashes, severe headaches, and painful or heavy periods. To relieve physical discomfort, try drinking something cooling, dressing in light clothing, and taking OTC pain relievers as directed by your doctor.

Talking with a qualified healthcare professional as soon as you start noticing symptoms is essential. Be clear and specific about:

  • symptoms you experience
  • how symptoms affect your life
  • the methods you’ve tried to find relief

It may help to keep a daily record of your symptoms, noting which symptoms occur, when you notice them, and what you’re doing at the time. Also, note home remedies or OTC treatments you try.

Treatments for perimenopause symptoms can come in several forms.

Medications

Hormone therapy is a common treatment for perimenopause symptoms. It can involve taking estrogen alone or estrogen and progestin to replace these hormones in your body.

Doctors can prescribe hormone therapy as pills, skin patches, gels, and other formulations.

Certain medications, such as antidepressants and blood pressure medications, may also help relieve symptoms like hot flashes and sleep issues. Your exact treatment plan depends on your symptoms and overall health.

Mental health therapy

If you have depression symptoms or other mental health conditions, mental health therapy may help. Guidelines from 2019 for evaluating and treating perimenopausal depression noted that cognitive behavioral therapy, which focuses on adjusting how people think and behave, may be effective in reducing depression symptoms.

Consider contacting a mental health professional to find out whether therapy may be right for you.

Learn more about finding a therapist.

Lifestyle changes

According to a 2023 research review, lifestyle factors like eating habits and physical activity levels may influence the frequency and severity of perimenopause and menopause symptoms.

Adjusting these factors may help manage your symptoms, but it’s a good idea to consult a healthcare professional to find adjustments that work for you. Your doctor can recommend physical activities that are safe and appropriate for you, and a registered dietitian can help you balance your diet in a way that supports your health.

Natural products

Some people often tout natural products like supplements as effective ways to reduce perimenopause and menopause symptoms. You may see advertisements or read personal stories about supplements like:

  • black cohosh
  • dong quai
  • soy isoflavones
  • dehydroepiandrosterone

The National Center for Complementary and Integrative Health notes that there’s little evidence to support the benefits of menopause supplements. Also, they may interact with other supplements and medications and cause adverse effects.

It’s essential to always talk with your doctor before trying supplements to manage your perimenopause or menopause symptoms.

Learn more about natural remedies for perimenopause.

Thoughts of death, dying, and suicide often arise in response to pain and distress, even if you don’t truly want to die.

Active thoughts of death, dying, or suicide are a medical emergency. During a mental health crisis, you can get help in the United States 24/7 by:

Trained crisis counselors can offer free, confidential support and connect you with additional resources.

Learn more about finding crisis counseling and other suicide prevention resources.

Perimenopause can affect people differently. In some cases, the symptoms may be so severe that they can make you feel like you’re dying.

But you’re not alone, and help is available. If you’re experiencing a mental health crisis, chat with the 988 Suicide & Crisis Lifeline or call it at 988.

Talk with your doctor about treatments that may provide relief for long-term symptom management.

Crystal Raypole has previously worked as a writer and editor for GoodTherapy. Her fields of interest include Asian languages and literature, Japanese translation, cooking, natural sciences, sex positivity, and mental health. In particular, she’s committed to helping decrease stigma around mental health issues.