By Lindsay Gellman, a writer who covers the business of health. Her writing has appeared in The Wall Street Journal, where she was a staff reporter, as well as in The New York Times, The New Yorker, Wired, Businessweek, and elsewhere. She teaches in New York University's graduate journalism program.
The road to menopause isn't for the faint of heart. Those we spoke with in perimenopause -- the stretch of about four to seven years, on average, before a person officially stops menstruating -- reported hot flashes that kept them awake at night, periods that became heavier and more erratic, and brain fog so severe they forgot common words. Some said their ear canals itched, they smelled smoke when there was none, or their shoulder joints suddenly locked up and became extremely painful. Whatever they might have been experiencing, too often, they felt dismissed by doctors and other people in their lives who failed to take their symptoms seriously. In online forums, TikTok videos, and Instagram posts, women wondered to themselves and each other: Why did no one tell us about this?
We asked doctors specializing in menopause what helps their patients, and we canvassed everyday women for the products and hacks that made them feel better -- even just a little. Everyone's body is different, and what helps some people might not work for others. These suggestions don't constitute medical advice or substitute for speaking to your doctor. We present this trove of information in the hope that you might find something that helps.
Doctors said they first talk with perimenopausal patients about fundamental aspects of health like sleep, movement, nutrition, and stress management. Of course, peri symptoms can make it harder to get good sleep or fit in exercise. But wherever you can, doctors said, make sure you're working on things like sleep hygiene -- limiting scrolling before bed, for example -- and getting enough whole foods, protein, and grains. Doctors also typically discuss potential treatments like low-dose combination birth-control pills, which contain both synthetic estrogen and progestin and help smooth the erratic hormonal swings of perimenopause with a steady dose of hormones. Another option might be hormone-replacement therapy, which provides a lower dose of hormones (though not enough to act as a contraceptive).
On Reddit, Facebook, and TikTok, where women often gather to compare notes and cheer each other on, there can also be plenty of misinfo. For example, online groups are full of women asking one another if symptoms like vomiting, significant weight loss, or protracted dizziness are a typical part of peri; they're not. Women are understandably eager to validate and normalize one another's symptoms, but in some cases, reassuring comments could stop someone from seeking medical care for these sorts of health issues -- or others -- when they should, according to Dr. Stephanie Faubion, director of the Mayo Clinic's Center for Women's Health. If symptoms like palpitations or dizziness are new to you, she said, you should get them checked out by a doctor to first rule out other causes. And though many coaches and influencers promote dietary supplements for perimenopausal symptom relief, doctors said there's generally little evidence to support the claimed benefits. (For the supplements that women recommended for this guide, we've included specific caveats.)
You will probably have a hot flash at some point; after all, up to 80 percent of women going through menopause do. Vanessa Schmidt Alardo, a 39-year-old dietician in Utah, recommends a neck fan like this collar version. Other women said the drugstore pendant version does just fine.
When it comes to sweat, one woman on Reddit wrote that deodorant from the French brand Uriage "has been VERY helpful to me." Another swore by the brand Mitchum, which she wrote was the "appropriate strength for sweaty peri armpits." Other posters said they liked using Lume deodorant or the glycolic acid body wash from Naturium on their underarms.
"I know it sounds woo woo, but meditation apps helped me -- particularly during the anxiety/rage/panic-attack phase, all of which were new to me. I used the Yoga Nidra app, which helped me to focus on my breathing and get my body back in line with my brain. When work stress got to be too much, I would close my office door, lie down under my desk, and listen to the app until I got my bearings." -- Jade, 48, Sydney, Australia
"Amber lights from evening onward help a bit with mood and sleep. I switch out some lightbulbs, use little amber reading lights (especially helpful reading before bed, or when getting up in the middle of the night but wanting to get back to sleep), or occasionally wear amber glasses. The Flux app gives me great control over my computer's blue light-to-amber light ratio throughout the day." -- Tiffany Lee Brown, 55, Oregon
Women I spoke with pointed to a couple dietary supplements that they said helped them sleep. Amy Little, a 40-year-old from Illinois, likes various supplements from the brand Estroven, which typically contain plant-based active ingredients like rhubarb extract and black cohosh. Little's sister, who is going through perimenopause, recommended it to her, as did people on Facebook. After having a hysterectomy last year, Little said she quickly went into menopause. She's on estrogen pills, which help regulate her mood, she said, but "Estroven helps my night sweats and sleep loss." She said it's important to check the ingredients to make sure you're not allergic to anything in it. And don't take the brand's supplements if you're pregnant, breastfeeding, or trying to conceive. Some studies have shown that black cohosh can help with the mood-related elements of peri symptoms.
Several women also said magnesium glycinate or magnesium oxide helped them sleep better, and a woman on Facebook recommended NatureMade's 250-milligram tablets.
Many said they found their way to better sleep by cutting back on alcohol, caffeine, or both. Lauren Caggiano, a 40-year-old in Fort Wayne, Indiana, told me she's learned she feels best overall when she limits both, as well as chocolate. Caggiano went into artificial menopause when she was 37 during treatment for breast cancer. Because the cancer was responsive to hormones, she underwent ovarian suppression with Lupron, a medication that stops the ovaries from making estrogen. As a result, she experienced symptoms like hot flashes and joint pain. Chocolate and spicy foods were off the table, as they made her hot flashes worse. Now that she is cancer-free, her menstrual cycle has returned -- but she believes she's in perimenopause and recognizes some of those familiar symptoms returning too. She told me she limits herself to one cup of coffee each day and just a couple drinks each month.
Amy Beckley, a 44-year-old in Boulder, Colorado, said she started having heavy, frequent periods about two years ago, which disrupted her sleep. Her doctor suggested she try a weekly microdose of rapamycin, also known as sirolimus, which works as an immunosuppressant and is primarily used in situations like organ transplantation or cancer treatment. The drug has also become popular recently with people interested in anti-aging and longevity. Early results of a recent trial suggested the drug could help delay ovarian aging, too, but it's mostly too soon to say. Still, Beckley told me, since starting the treatment in June, "my periods are better and I don't wake up at 3 a.m. anymore."
Those with extremely heavy periods should be cautious when considering an endometrial ablation procedure, women urged. In a perimenopause Facebook group, one woman wrote that her ablation many years ago eliminated her pain and heavy bleeding and was covered by her insurance. But one downside, she wrote, was that without having periods, she wasn't sure how far into perimenopause she was. Another woman wrote that her best friend had the procedure, but it went poorly, and after months of postoperative pain, she chose to have a hysterectomy.
Women online encouraged those experiencing vaginal dryness or pain during sex to speak to their doctor about whether they might benefit from vaginal estrogen cream, which has been shown to help alleviate those symptoms. The creams carry a U.S. Food and Drug Administration warning about cancer risks. But many physicians say the warning is inaccurate and outdated, since the creams contain very low doses of estrogen, which isn't absorbed systemically.
"This is a quality-of-life issue for women," said Dr. Sharon Malone, chief medical adviser of Alloy Women's Health. Sometimes, even patients whose symptoms have torpedoed their sex life are afraid to fill their prescriptions for the cream because of the warning, she said. "Even for women who have had breast cancer," Dr. Malone said, "the amount of estrogen in vaginal estrogen is so low that even they can safely use it." Vaginal estrogen products can also boost long-term health by preventing urinary tract infections, she added.
A 36-year-old woman in Los Angeles who recently started having perimenopause symptoms told me her "joints suck," and when she threw her back out a few weeks ago, she was in so much pain in her hips and tailbone area that she couldn't sit down for a couple days. She searched online for something to help and came across a belt meant to stabilize the core and reduce pain.
"I thought the Serola belt looked ridiculous, but I was so desperate that I ordered it anyway," she told me. "I put it on, and I felt instantly better." The trick, she added, is to wear the belt low on your hips -- not around your waist.
Multiple women said the supplement glucosamine sulfate helped them with joint pain. Jo Edwards, a 51-year-old in Devon, England, said her hips, knees, and other joints hurt so badly she was struggling to sleep through the night. Of the available brands, "my GP said use whichever is the cheapest option," she said. "Definitely less sore so far." And Lisa Williams, a 50-year-old in Melbourne, Australia, said the supplement "cured my severe hip and shoulder pain."
Glucosamine sulfate is generally considered safe, with a few exceptions; it could interact with certain drugs or cause side effects, so it's important to check with your doctor first before trying it. Dr. Faubion said it might provide some pain relief for people with osteoarthritis of the knee.
Melanie Shanks, a 62-year-old in Chicago, told me a fall a decade ago triggered a right shoulder injury that was very slow to heal; her identical twin sister also experienced shoulder pain around the same time. She now believes they both suffered from adhesive capsulitis, or frozen shoulder, a condition leading to pain and stiffness in the shoulder joint that women commonly experience as they age. After Shanks attended months of physical therapy, a provider finally offered a steroid injection, which helped significantly. Shanks said she wished she'd known to ask for one right away.
Shanks also said this helped immensely with shoulder pain.
Women with restless leg syndrome suggested getting your iron levels checked and said supplements helped them.
In a perimenopause Facebook group, one woman sought advice for dry eyes. Someone recommended a microwavable heat mask from Optase, which she learned about from her eye doctor. Another said using a humidifier in her bedroom and getting a mini one for her car made a huge difference.
Many women posted on Facebook and TikTok about itchy ear canals, which doctors said could be a peri symptom (a drop in estrogen might result in thinning mucus membranes). One commenter said an ice pack pressed up against their ear helped.
"You must get your sleep hygiene together. Reduce stress. Keep an I HATE EVERYONE AND EVERYTHING journal to track how you sleep, how you feel. It takes tracking to manage the symptoms with trial and error." -- @LeslieAlexis via Diem
"Kvetching with other women in peri- and menopause is super important, whether it's on Reddit or the phone or taking a long walk together and flat-out complaining. Then we laugh."
-- Tiffany Lee Brown, 55, Oregon