Last updated: Nov 19, 2008
perimenopause
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Insomnia
Take a bath and/or sip relaxing teas with valerian or chamomile before bed. Make your bedroom a shrine, including blackout shades, and skip the exercise right before bed. An over-the-counter sleep aid like Tylenol PM is OK occasionally, but see your doctor if youre dealing with perpetual insomnia.


Bone concerns
Fill your diet with bone-building foods, such as calcium-fortified orange juice, sardines, salmon, almonds, and soybeans. Supplement with 1,200 to 1,500 milligrams of calcium daily (take 600 milligrams in the morning and 600 milligrams at night) as well as 800 IU of vitamin D. “You need calcium, but if you dont have vitamin D, you cant absorb it,” says Mary Jane Minkin, MD, an ob-gyn and a clinical professor of obstetrics and gynecology at Yale University Medical School in New Haven, Conn. In addition, aim to do 30 to 40 minutes a day of vigorous weight-bearing exercise like walking. And, if your doctor recommends it, take an osteoporosis drug like Actonel, Boniva, Evista, or Fosamax.

Hot flashes
Keep cool by layering your outfits in breathable, heat-wicking fabrics and sleeping on bedding that wicks away moisture. Consider adding soy to your diet, too. “Some people find that eating tofu and edamame or drinking soy milk keeps the hot flashes away,” Dr. Minkin says. Effexor, an antidepressant, may also help. “I start patients on a low dose of 25 milligrams,” says Jennifer Wu, MD, an ob-gyn at Lenox Hill Hospital in New York City. “We prescribe this to help control the vasomotor center in the brain that controls body temperature and perception of heat and cold.” Supplement with black cohosh (20 milligrams, twice a day), but make sure to purchase black cohosh that actually contains the active ingredient. “You want to be sure that youre purchasing a regulated product with this active ingredient,” Dr. Minkin says. Some experts recommend the brand Remifemin.

Mood swings
Exercise for 20 minutes a day, at least three times a week, to boost your energy and feel less irritable. Eating small meals and a number of protein-rich snacks throughout the day can also help you cope with emotional ups and downs. Yoga, meditation, massage, and acupuncture can also help you de-stress. Chasteberry fruit and black cohosh are herbal mood stabilizers that may help too.

Vaginal dryness
Try estrogen products that work directly to heal vaginal tissue, restore moisture, and relieve discomfort. Theres estrogen cream (Estrace, Premarin) or tablets (Vagifem) that you put directly into your vagina at bedtime, or estrogen-releasing rings (Estring) that are inserted into your vagina by you or your doctor and are replaced every three months. If youre concerned about products with estrogen, pick up an estrogen-free vaginal moisturizer, such as Replens or K-Y Liquibeads. Skip scented soaps, bubble baths, and douches to avoid further discomfort.