An estimated 31 million women are in the middle of perimenopause - the time leading up to menopause when a woman's hormone levels (namely estrogen and progesterone) begin to fluctuate and decline. If you're one of them, you may feel irritable or anxious, or your skin and hair may feel dry. Your sleep cycle may be out of whack or your libido in hibernation. Perimenopause is most likely the culprit, but many of us have never heard of it.

Just as in menopause, there are no definites with perimenopause: It can begin as early as the mid-30s but mostly takes place during your 40s; it can last just a couple of years or almost a decade; and symptoms vary from barely noticeable to severe.

The most common symptoms

• Irregular periods
  
• Mood swings
  
• Short-term memory loss
  
• Allergies
  
• Irritability
  
• Minor depression
  
• Headaches or migraines
  
• Skin and eye dryness
  
• Vaginal dryness
  
• Constipation
  
• Hot flashes
  
• Insomnia
  
• Night sweats
  
• Fuzzy thinking
  
• Heart palpitations
  
• Anxiety
  
• Decreased sexual desire
  
• Reduced stamina
  
• Water retention
  
• Urinary incontinence

If you have four or five of the above symptoms, you should consider having your hormones checked with a salivary hormone test to see if you're experiencing perimenopause.

Symptoms of perimenopause have often been mistakenly treated individually - relegating a woman's complaints to depression, sleep disorders or even "it's all in your head" diagnoses. Slowly, we are recognizing perimenopause as a natural cycle of the body and treating it as such.

Feel better with natural remedies

With education and care, most of the symptoms are very manageable. Leading nutritionist and bestselling author of Before the Change: Taking Charge of Your Perimenopause, Ann Louise Gittleman, M.S., C.N.S, has identified some surefire natural remedies:

• Flaxseed oil: Helps with dry skin and hair, depression and fatigue.
  
• Evening primrose oil: Alleviates cramping, breast tenderness, irritability, headaches and water retention.
  
• Multivitamins and magnesium: A combination of B-complex vitamins, vitamin C (1,000 mg. three times a day), vitamin E (400 to 1200 units) and magnesium (500 to 1000 mg. before bedtime) can get your system back in balance; especially helpful for energy, mood swings and insomnia.
  
• Zinc: Helps build strong bones and strengthens immune system.
  
• Natural progesterone cream: Used as a skin cream, this can help with depression, sex drive, fatigue, blood sugar levels, irritability, bone loss, fat gain and thyroid dysfunction.
  
• Soy isoflavones: Can reduce intensity of hot flashes and may help prevent breast cancer.

In addition, experts agree that the following supplements and herbs can also reduce perimenopause symptoms.

• St. John's wort: Can help with mild or moderate depression or anxiety.
  
• Ginkgo biloba: Can clear up fuzzy thinking and short-term memory problems.
  
• Calcium (600 mg.) and vitamin D (200 IU 2-3 per day): For bone strength and protection from osteoporosis.

Note: It's best to check your hormone levels with a salivary hormone test before taking herbs with estrogenic properties (phytoestrogens), such as ginseng, dong quai and black cohosh. Due to the fluctuation of your hormones, it's not always advisable to take these herbs while in perimenopause, although they're excellent for menopause.

Get healthy, get ready

As with all health issues, tempering your lifestyle to fit your changing body is essential. Because women are now living a third of their life post-menopause, perimenopause is the perfect time to set the stage for a healthy lifestyle. Don't wait to make the changes in your life to help you get through perimenopause:

1. Exercise three times a week for 30 minutes. It can dramatically reduce symptoms in perimenopausal women, including stress, irritability and insomnia.
   
2. Manage your stress. Begin a meditation practice; pamper yourself with massage or hot baths and essential oils.
   
3. Talk about it with other women. Check out Power-Surge.com, a community of experts and women in varying stages of menopause that commiserate, inspire and share information.
   
4. Quit smoking and drinking. Knocking off caffeine is a good idea, too.
   
5. Educate yourself. Talk to your acupuncturist, herbalist or doctor about it. Arm yourself with information.
   
6. Practice sound nutrition. Stay away from refined carbs, get the right fats (such as a teaspoon of olive oil, almonds or flaxseed oil), have a daily source of natural protein (such as organic eggs, chicken, beef or tofu), eat lots of vegetables and a moderate amount of fruit.
   
7. Hydrate, hydrate, hydrate. Eight to 10 glasses a day. You can't go wrong here.