A UAB expert outlines strategies women and their partners can use when entering perimenopause.What may begin as hot flashes, mood swings or restless nights can signal a defining transition in a woman’s life — perimenopause.

Women’s health expert Kelley Borella, DNP, associate professor in the University of Alabama at Birmingham School of Nursing, draws on her clinical experience to help women better understand this stage of life.

“Perimenopause is when a woman’s body begins shifting toward the end of her reproductive years,” Borella said. “While these changes are a normal part of aging, understanding them can help women take steps that support their overall health and well-being.”

Recognizing perimenopause as a natural life stage can empower women to make choices that protect both physical and emotional health.

Understanding perimenopause

Perimenopause can begin as early as a woman’s 30s or as late as her early 50s. It is driven by hormonal changes, especially fluctuations in estrogen, which can affect menstrual cycles, sleep, mood, libido and overall health.

“One of the biggest shifts during this time involves menstrual bleeding patterns, which can become unpredictable as ovulation becomes irregular,” Borella stated. “Without ovulation, the body does not produce enough progesterone to balance estrogen, causing the uterine lining to build up and shed irregularly.”

This can lead to skipped periods, prolonged bleeding or spotting between cycles.

“It is important to note that going several months without a period can increase the risk of endometrial cancer,” Borella said. “If a woman has at least four periods per year and her symptoms are not bothersome, she may not need medication.”

If a woman goes longer than this without a cycle, a health care provider may prescribe a form of progesterone to be taken for 10 days each month to trigger a withdrawal bleed and help maintain uterine health during this transition, according to Borella.

Empowering proactive care

There are several strategies women can use to reduce discomfort during perimenopause, such as lifestyle changes and self-care.

“Regular exercise is one of the most effective ways to manage symptoms,” Borella said. “It can help regulate mood, improve sleep, support heart and bone health and even reduce the frequency of hot flashes.”

For women experiencing hot flashes, avoiding common triggers such as smoking, alcohol and spicy foods can make a noticeable difference.

“Keeping a journal of when hot flashes occur can help identify personal triggers that may be avoided,” Borella said.

By combining these practical strategies with awareness of emotional changes, women can navigate perimenopause with confidence and maintain overall well-being.

Partner and family support

Perimenopause is a physical, emotional and relational transition. Partners and family members can help women navigate this stage with understanding and support.

Providing patience during mood swings or fatigue, encouraging healthy habits, helping to create a comfortable home environment and listening without judgment are ways to support women during this time.

“Open communication about symptoms like hot flashes, vaginal dryness or changes in libido helps both partners understand what’s happening and find solutions together,” Borella said.

Breaking the stigma

According to Borella, raising awareness and encouraging open conversation about perimenopause is essential. Many women feel confused or alarmed when symptoms begin, particularly if no one has prepared them for what to expect.

“By offering clear explanations and providing practical strategies to manage symptoms, health care providers can normalize this transition by treating it as a natural, healthy part of aging rather than a medical problem,” she said.

Creating a space where women feel heard, informed and supported helps them approach perimenopause with confidence, knowledge and control rather than fear.