Perimenopause Care: Understanding the Transition Before Menopause

Perimenopause is the transitional phase before menopause — and for many women, it’s the most unpredictable and confusing part of the midlife journey.

It usually begins in the 40s, but can start earlier. This is when the ovaries begin to wind down their hormone production, particularly estrogen and progesterone. But the shift isn’t gradual — it’s erratic. Levels rise and fall unpredictably, often from month to month (or even week to week), which can cause a wide variety of symptoms.

What Happens to Your Periods

One of the earliest signs of perimenopause is a change in your menstrual cycle. You might notice:

• Shorter or longer cycles — One month your period arrives after 24 days, the next after 40.
• Heavier bleeding — Some women experience flooding or clotting, especially in early perimenopause.
• Lighter or missed periods — Others skip cycles or barely bleed at all.
• More painful periods — Cramping can increase even if you’ve never had cramps before.
• PMS-like symptoms — Mood swings, breast tenderness, or bloating can show up earlier or feel more intense.

It’s common for your body to oscillate between “normal” and “not normal” for several years before your periods eventually stop.

Menopause is officially diagnosed after 12 months without a period, but perimenopause can last 4 to 8 years before that.

What Perimenopause Feels Like

The physical and emotional symptoms of perimenopause go well beyond your cycle. Hormonal shifts can ripple through every system of the body. You might experience:

• Difficulty sleeping (especially falling or staying asleep)
• Hot flashes or night sweats
• Mood changes, anxiety, or irritability
• Fatigue or low motivation
• Weight gain (often in the belly)
• Brain fog or memory issues
• Vaginal dryness or low libido

Not every woman has all of these. Some experience just a few, others get hit hard. And because these symptoms are so varied, they’re often misattributed to stress, aging, or “just life.”

How Perimenopause Is Treated

Perimenopause isn’t something to “wait out.” While it’s a natural life phase, it can significantly affect your health, relationships, and quality of life.

The good news? There are options.

Care during perimenopause focuses on improving quality of life, managing symptoms, and supporting long-term health. Depending on your needs, this might include:

• Symptom tracking — to identify patterns over time
• Lab testing — to clarify what your hormones, thyroid, or nutrients are doing (though in early perimenopause, results may fluctuate)
• Lifestyle strategies — including nutrition, sleep support, and movement to improve energy and stability
• Non-hormonal options — like targeted supplements, adaptogens, or medications for mood, sleep, or vasomotor symptoms
• Hormone therapy — for those who are good candidates, low-dose hormone replacement (often bioidentical) can ease symptoms and protect long-term health

Treatment is never one-size-fits-all. Some women benefit most from simple, steady support. Others need a more in-depth, layered approach. The key is having a plan that respects what your body is doing — and helps it do it more smoothly.

Perimenopause Care, in Real Life

• 1 in 5 women seek clinical help for perimenopause or menopause symptoms.
• Among women with disruptive hot flashes or night sweats, only ~35% receive a prescription treatment.
• Just 40% of women ages 40–64 report that a clinician has ever talked with them about menopause.
• Only ~7% of resident physicians feel well prepared to manage menopause care.

Why We Exist

Midlife shouldn’t feel like a mystery. Too few women get timely guidance — so our clinic puts education, access, and tailored treatment front and center.

Source notes available upon request.

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