Navigating perimenopause can feel overwhelming.  Managing unpredictable periods and the symptoms caused by your fluctuating hormone levels is no walk in the park.  Social media knocks on your door every minute with a new product proclaiming to make you feel better. Yet, who do you believe? How about an OB/GYN who is a Menopause Society Certified Practitioner?  Read on to gain a better understanding of what perimenopause is, what you might experience, and the science-backed options available to help you manage symptoms.

💡MMRx tip: Remember, your symptoms are real and you deserve treatment that helps you feel better.

The Beginning - What Is Perimenopause?

Perimenopause is the time when your body gradually transitions out of its reproductive years before you reach menopause. This process usually starts about four years before your final period, during which your hormone levels—especially estrogen and progesterone—begin to fluctuate and eventually decrease until they stop altogether. Although the average age for perimenopause to begin is around 47, this can vary because everyone’s journey is unique.

When you enter menopause, your monthly periods stop because your ovaries no longer release eggs or produce estrogen. While perimenopause is a natural part of life, many people find its symptoms challenging. Understanding what to expect and exploring treatment options can make this transition much easier.

💡MMRx tip: Tracking your menstrual cycle can help determine where you are in the transition.

How Do I Know If I Am In Perimenopause?

One of the most noticeable signs of perimenopause is a change in your menstrual cycle. However, some women begin to experience other symptoms even if their cycles stay regular, and others—such as IUD users or those who have had an endometrial ablation or hysterectomy—might not have periods at all. Around four years before your final period, your estrogen and progesterone levels start to fluctuate—sometimes rising higher than usual and other times dropping much lower. These shifts can make your periods occur more or less frequently or even change the length of your cycle (for example, you might notice your period comes every five weeks instead of every four). In addition to these cycle changes, the hormonal fluctuations can lead to other symptoms, such as:

• Irregular Periods: Your cycle might become unpredictable.
• Hot Flashes and Night Sweats: Some people experience waves of heat—hot flashes during the day or night sweats when you sleep.
• Mood Changes: Shifts in hormones can lead to feelings of anxiety, depression, or irritability.
• Sleep Problems: Hot flashes or mood changes may make it harder to fall or stay asleep, often leading to daytime fatigue.
• Weight Gain: Declining estrogen can increase your waistline.  as where you carry your fat shifts to your abdomen.
• Joint Pain: Some people have joint aches and pains due to declining estrogen.
• Headaches: Women with a history of migraines related to their period might find their headaches get worse in perimenopause.
• Breast Tenderness: Unpredictable increases in estrogen levels in perimenopause can stimulate the breast tissue and cause tenderness. The second half of your menstrual cycle (a.k.a. The luteal phase) often shows decreased progesterone levels instead of increased, further contributing to breast tenderness.

Other symptoms like vaginal dryness tend to develop later, after your periods have stopped, and can sometimes make sexual activity uncomfortable.

💡MMRx tip: Talk to a menopause specialist before purchasing any over-the-counter products advertised to treat your symptoms. Most lack science supporting their claims.

🧪Do I Need Any Blood Tests?

Maybe. If you're over 45 and noticing changes in your period or other menopause-related symptoms, these are usually a normal part of perimenopause. In most cases, your clinician will recommend treatment rather than extensive hormone testing—since a single blood test isn’t enough to confirm perimenopause. However, because thyroid symptoms can mimic those of perimenopause, your clinician will likely check your TSH (thyroid stimulating hormone).

If you're under 45, your clinician may order blood tests to rule out other causes, such as thyroid or pituitary issues, and may check your FSH (follicular stimulating hormone) to confirm that you're indeed in perimenopause.

At any age, MyMenopauseRx clinicians will offer to order wellness labs to assess your metabolic health if you haven't had them in the past year. Remember, perimenopause involves not only changing hormones but also an increased risk of elevated cholesterol, insulin resistance, and type 2 diabetes.

💡 MMRx tip: Skip the over-the-counter hormone tests and save your $.  Instead, seek medical care using your health insurance.

🌱Can Hormone Therapy Help?

For many people, hormone therapy is an effective way to manage perimenopause symptoms—especially hot flashes, night sweats, and mood changes. Estrogen is the key treatment for reducing these symptoms. If you still have a uterus, you'll typically be advised to take progesterone along with estrogen. However, if you’ve had a hysterectomy (surgery to remove the uterus), estrogen alone may be sufficient.  It’s important to remember that hormone therapy isn’t suitable for everyone, nor does it work for everyone.

💡MMRx tip: Ask your PCP or OB/GYN if they are menopause trained and let them know it is o.k. if they are not.   If they are not, you can get virtual care from a MyMenopauseRx Menopause Society Certified Practitioner covered by health insurance.

💊Other Treatment Options

Depending on your specific symptoms, your menopause clinician may recommend other treatments too. These can include:

• Antidepressants: Sometimes used to help with mood swings, anxiety, depression, and hot flashes.
• Vaginal Estrogen: Helpful if you’re experiencing vaginal dryness or discomfort during sex, or urinary complaints.
• Birth Control Pills: Helpful to manage period problems and perimenopause symptoms.
• Lifestyle Changes: Simple steps like regular exercise, a balanced diet, and good sleep habits can also make a big difference.
• Over-The-Counter Supplements: Vitamins and supplements can round out your holistic menopause care plan.

Many people ask about “natural remedies” like herbs or supplements. While these might sound appealing, it’s really important to talk with your healthcare practitioner before trying them—especially if you have a history of breast cancer—as they aren’t always proven to work and could sometimes cause harm.

Final Thoughts

Perimenopause is a natural part of life, and while its symptoms can be challenging, there are plenty of options available to help you feel your best. Understanding what’s happening in your body and knowing your treatment options can empower you to manage this transition with confidence.

If you have any questions or need further guidance, please don’t hesitate to reach out to us at MyMenopauseRx. We’re here to support you every step of the way!