Estée Lauder

URINARY INCONTINENCE

Declining hormone levels lead to a thinning of the urethra and a weakening of the pelvic muscles, which can cause leakage. With stress incontinence, you accidentally pee when you sneeze; with urge incontinence, you just don’t make it to the bathroom in time. Although as many as 60 percent of women suffer from incontinence during menopause, the symptoms are usually mild during perimenopause. Pelvic floor physical therapy and even classic Kegel exercises can help with stress incontinence, as can the tamponlike Poise Impressa, which puts pressure on the urethra to minimize leakage. To control urge incontinence, ask your doctor about mirabegron (Myrbetriq), an Rx pill that relaxes the muscles around the bladder, increasing its capacity to store urine.

Breast tenderness

With breasts this sore and swollen, you might at first guess that you’re pregnant. It’s possible, as long as you’ve had a period in the last 12 months (so if you’re not on birth control, do check!). But it’s also possible that you’re one of the nearly 15 percent of perimenopausal women who experience what’s called mastalgia, usually a few days before their period begins. This common PMS symptom can be exacerbated by the fluctuating estrogen levels during perimenopause. In addition to taking acetaminophen or NSAIDs for immediate relief, Pinkerton suggests taking 200 milligrams of magnesium oxide daily starting two weeks before your period. Research shows it helps by decreasing fluid retention. Studies have also found that taking a daily dose of 1,200 units of vitamin E or 3,000 milligrams of evening primrose oil—both of whichhave antiinflammatory properties—for six months can ease symptoms.

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PERCENT That’s how much more likely it is to get frequent headaches after entering perimenopause. VAGINAL DRYNESS

For nearly one-third of women in late-stage perimenopause, the drop in estrogen affects vaginal lubrication and tissue elasticity, which can make sex painful. Until recently, the best ways to combat vaginal dryness were over-the-counter lubricants and vaginal moisturizers or prescription vaginal rings, creams, and tablets that deliver estrogen directly to the vagina. The new nonestrogen pill ospemifene (Osphena), taken orally once a day, mimics estrogen to make tissue thicker and less fragile. The nonestrogen treatment prasterone (Intrarosa), a vaginal insert that reduces symptoms resulting from the thinning and inflammation of the vaginal walls, has been FDA-approved and should be available this year.