Perimenopause and Menopause: What Every Woman Should Know

Perimenopause and Menopause: What Every Woman Should Know

Let’s talk about something that affects every woman—but is often brushed aside, misdiagnosed, or misunderstood: perimenopause and menopause. As a primary care physician, I see many women who come in feeling like something is “off”—they’re tired, irritable, gaining weight, not sleeping, or experiencing unexpected changes in their periods. Often, the answer is hormonal.

This is a normal stage of life—but it doesn’t mean you have to suffer through it. Let’s break it down.

🌡️ What Is Perimenopause and Menopause?

• Perimenopause is the transition phase before menopause, typically starting in your 40s (sometimes late 30s). Hormones start to fluctuate, and symptoms begin—sometimes years before your periods stop.

• Menopause is defined as 12 months without a menstrual period, usually occurring between ages 45 and 55. After this point, your ovaries stop releasing eggs and produce much less estrogen and progesterone.

🚩 Common Symptoms

You may experience:

• Irregular or heavy periods

• Hot flashes and night sweats

• Mood swings, irritability, or anxiety

• Sleep disturbances

• Vaginal dryness or painful intercourse

• Decreased libido

• Brain fog or memory lapses

• Weight gain, especially around the abdomen

• Joint aches and fatigue

🧪 How Is It Diagnosed?

Diagnosis is primarily based on age, menstrual history, and symptoms; routine laboratory testing is not indicated in women over 45 with typical features. Measurement of follicle-stimulating hormone (FSH) or estradiol is not routinely recommended for diagnosis in women over 45, as these levels fluctuate and do not reliably distinguish menopausal status. Pregnancy testing should be performed if there is any possibility of conception, as perimenopausal women may still ovulate intermittently.

Additional laboratory workup can be considered for atypical presentations or when alternative diagnoses are suspected. Possible testing would include FSH, LH, estradiol, thyroid function, prolactin, androgen levels.

💊 Treatment Options: You Have Choices

You don’t have to treat menopause—but you can, and many women benefit tremendously.

1. Hormone Replacement Therapy (HRT)

This includes estrogen, progesterone, and sometimes testosterone:

• Estrogen helps relieve hot flashes, vaginal dryness, mood symptoms, and may protect against bone loss.

• Progesterone is given to women with a uterus to prevent uterine cancer from unopposed estrogen.

• Testosterone may help with libido and energy in some women, although this is used off-label in the U.S.

Forms of HRT:

• Pills, patches, creams, pellets or gels

• Vaginal rings or tablets (for local symptoms)

⚖️ Risks and Benefits of Hormone Therapy

✅ Benefits:

• Primary indications include moderate to severe vasomotor symptoms (hot flashes, night sweats) and genitourinary syndrome of menopause (vaginal dryness, painful intercourse).

• Many women also report improvement in sleep, mood, energy, joint aches/pain and sexual health among others.

⚠️ Risks (usually small in healthy women under 60):

• Potential risks may include an increased risk of blood clots or stroke (especially with oral estrogen)

• Slight increased risk of breast cancer with long-term use of combined estrogen/progesterone

• Increased risk of coronary heart disease (notably in older women or those with pre-existing cardiovascular disease)

• Increased risk of probable dementia (notably in women aged 65 and older)

• Increased risk of gallbladder disease

Hormone replacement therapy is generally not advised for women with history of breast cancer, stroke, blood clots, or liver disease unless carefully managed. The potential benefits and risks should be an individualized decision in consultation with your physician.

🎯 Who Are Good Candidates?

You might be a good candidate if:

• You’re under 60 and within 10 years of menopause

• You have moderate to severe symptoms affecting quality of life

• You’re generally healthy, without major cardiovascular or cancer history

⏳ How Long Can Treatment Be Continued?

• Most women use HRT for 3–5 years, but longer use can be considered on a case-by-case basis. Many women feel the benefits of ongoing use outweigh the potential risks and length of treatment should be decided on an individualized basis.

• It’s not a one-size-fits-all—some women need it longer for severe symptoms, and that’s okay with careful monitoring and an open discussion about potential risks.

🧪 Monitoring While on Treatment

Regular monitoring ensures your safety and keeps your treatment effective. This may include:

• Annual physicals and symptom review

• Mammograms (as recommended by guidelines)

• Pap smears (if applicable)

• Routine periodic laboratory monitoring of serum estradiol, progesterone, LH or FSH is not recommended as levels do not reliably correlate with clinical efficacy; dosing should be guided by symptom relief rather than hormone levels. However if you are on testosterone therapy as well, this should be monitored periodically with a goal to achieve serum testosterone levels within the physiologic premenopausal female range, and to avoid elevated levels that could lead to adverse effects such as acne, excess growth of coarse hair, male pattern baldness, deepening of the voice, loss of breast tissue and other male secondary sexual characteristics that may be irreversible.

🗣️ Final Thoughts

Menopause doesn’t have to be a season of suffering. You deserve to feel like yourself again. If you’re struggling with fatigue, mood swings, hot flashes, or changes that don’t feel right, don’t ignore it—come in and let’s talk.

As your Direct Primary Care doctor, I can spend the time needed to understand your symptoms and customize a plan that works for your body and your life.

Florida Direct Primary Care in St. Augustine

Dr. Bryant Wilson is a board certified internal medicine physician at Florida Direct Primary Care who develops individualized treatment plans that promote overall health and wellness, tailored to each patient’s unique health needs and goals. If you’re in the St. Augustine area and looking for a primary care doctor, contact us to learn more about our practice. Visit FloridaDPC.com, email us at info@FloridaDPC.com, or call 904-650-2882.

This web site is provided for educational and informational purposes only and does not constitute the provision of medical advice or professional services. The information provided should not be used for diagnosing or treating individual health problems or diseases. Those seeking medical advice should consult with a licensed physician.

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