Private health

Q:

I’m 47. I’ve always experienced water retention before my period, but since my cycle started getting unpredictable, I’m bloated all the time. I’ve cut down on salt, but my rings—and my waistbands—are still really tight. What’s going on?

A:

Swelling is quite common in the early stages of perimenopause. The reason? Progesterone, which has diuretic effects, typically goes into decline before estrogen does. And since estrogen can increase fluid retention, a relative excess can result in the bloat and puffiness you describe. While it can take a year or more for estrogen to drop to levels that ease fluid retention naturally, there are several ways to eliminate bloat in the meantime.

Limiting your salt intake is a good start, but I also suggest drinking at least six glasses of water daily to safeguard against dehydration, which can cause the body to hold on to fluids.

And it’s a good idea to eat two to three servings of foods such as strawberries, citrus fruit, watermelon and leafy greens daily. The water, fiber and enzymes they contain help flush fluids out of the body. Also smart: increasing your intake of Brussels sprouts, cucumbers and onions—all of which are high in sulfur compounds that help the kidneys eliminate excess fluid.

In addition, you may want to consider sipping a cup of hibiscus tea daily. Research shows that its chlorogenic acid, anthocyanins and flavonoids have a natural diuretic action. Finally, physical activity stimulates the body’s lymph system to move trapped fluids out of tissue, so I recommend you aim to get 30 minutes of exercise every day.

These steps should ease your swelling in one to two weeks, but if they don’t, see your doctor. She may advise taking oral progesterone or a prescription diuretic to eliminate perimenopausal fluid buildup.