Bye-Bye, Shut-Eye
More than one-third of women going through perimenopause—which starts with menstrual cycle changes and related symptoms and ends one year after your last period—experience insomnia, often awakening frequently during the night. " Fluctuations in estrogen can cause changes in body temperature that can trigger nighttime hot flashes or night sweats, which may then wake you,"explains Hrayr Attarian, MD, a sleep expert at Northwestern University's Feinberg School of Medicine. The interrupted sleep doesn't just leave you wiped out; it can also make you more likely to pack on pounds by increasing production of the hormone ghrelin, which boosts hunger, and reducing the hormone leptin, which suppresses appetite. Two other possible causes of restless nights: sleep apnea, the stop-and-start breathing that develops in approximately 20 percent of peri- and postmenopausal women, and restless legs syndrome, a disorder that creates an irresistible urge to move your legs, especially at night. It's twice as common in women as in men; hormones may be a contributing factor.

Try this: If don't have sleep apnea or restless legs syndrome, one way to reduce sleep problems is to go on hormone therapy (HT), according to a 2014 review Attarian coauthored in the journal Menopause. If that's not an option (for instance, if you've had a heart attack or breast cancer) consider the supplements isoflavones (Attarian recommends the product Estroven, taken according to the label's directions) or Pycnogenol. In addition, the anticonvulsant drug gabapentin can also reduce the hot flashes associated with nocturnal wake-ups, says Attarian. Talk to your doctor about which option is best for you.

Wait, What?
While people typically use the word menopause to describe the tsunami of symptoms that occur as the end of one's menstrual life draws nigh, the term technically refers to the moment in time when it's been a full year since a woman's final period.

Out, Out, Damn Spots
Because of the hormonal changes it brings, perimenopause has been called puberty in reverse. As Debra Jaliman, MD, an assistant clinical professor of dermatology at Icahn School of Medicine at Mount Sinai in New York City, explains, an imbalance of decreasing estrogen and relatively steady levels of testosterone can cause oil glands to go into overdrive, leading to breakouts, particularly around your chin, jaw, and mouth.

Try this: Look for facial products that contain retinol, the vitamin A derivative that does double duty as both a wrinkle and blemish fighter by exfoliating your skin and decreasing oil production. If you need something stronger, don't despair: "I put patients on spironolactone, a blood pressure medication that's been used off-label to treat acne since the 1980s," says Jaliman. "It blocks the production of male hormones like testosterone."
Photo courtesy of companies.

Tool Kit
Three retinol treatments that work day and night to prevent breakouts triggered by perimenopause:

Murad Skin Perfecting Lotion
The oil-free formula designed for blemish-prone skin is perfect for everyday use and has a bonus hydrating ingredient: hyaluronic acid. $38;

Dr. Dennis Gross Skincare Clarifying Colloidal Sulfur Mask
This calming mask heals breakouts, moisturizes, and minimizes pores. $42;

PCA Skin Intensive Clarity Treatment: 0.5% Pure Retinol Night
Salicylic acid and the antioxidants lilac leaf cell culture extract and bakuchiol amp up this spot treatment's acne-zapping potential. $106;

Brain Drain
Yes, those bouts of forgetfulness are a thing: According to a 2012 study in Menopause, when researchers gave perimenopausal women a battery of cognitive tests, they found that women who identified themselves as having memory issues did in fact have more trouble staying focused on challenging tasks and performed poorly on tests of working memory, the ability to process new information. Once again, you can blame the loss of estrogen. "Estrogen can help buffer brain cells against stress and helps maintain levels of mood- and brain-boosting neurotransmitters such as serotonin and dopamine," explains Gary Small, MD, director of the UCLA Longevity Center.

Photo by Jonathon Kambouris.

Healthy habit: You may be able to ward off the cognitive decline that comes with growing older by following a Mediterranean diet focused on fruits, vegetables, whole grains, legumes, and nuts, as well as healthy fats from olive oil and fatty fish, like tuna or salmon. Increasing your nut intake (30 grams of walnuts, hazelnuts, and almonds daily) and olive oil consumption appears to be key in providing a protective effect, according to a 2015 study in JAMA Internal Medicine. "The Mediterranean diet is rich in healthy fats that help fight inflammation and high in antioxidants that help fend off the oxidative damage that can wear away at your brain," says Small. And don't forget to stay physically active: Research has shown that regular exercise can help protect against age-related problems with memory and thinking.

Learn how manage your changing hormones in your 30s and 50s too.


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