Your Guide to Perimenopause & Menopause

We all know that menopause — the end of your menstrual cycle and natural reproductive years — is an inevitable stage of life. But oftentimes, it can sneak up and catch us off guard. Maybe you think you’re still years off from that stage, or that you’ll know once you start having hot flashes. The reality is that menopause and the transition period immediately before, known as perimenopause, look different for everyone. Some people enter these phases at younger ages than others, while symptoms can vary from person to person. As there is no definitive starting or ending point to perimenopause or menopause, knowing some of the most common signs and symptoms can help you better navigate these phases and be proactive about your health. Here’s everything you need to know:

Your menopause journey is uniquely yours, but you don't have to navigate it alone. Whether you're just starting to notice changes or you've been dealing with symptoms for years, it's never too early—or too late—to take action.

Perimenopause is the 4-10 year transition when your ovaries gradually produce less estrogen, typically starting in your 40s. Hormone levels fluctuate wildly, causing unpredictable symptoms.

Menopause occurs after 12 months without a period (average age 51). Your ovaries have stopped producing much estrogen and progesterone. Symptoms typically last about 7 years but can persist longer.

Comprehensive menopause care isn't just about comfort—it's about empowering people to age with strength and vitality for decades to come.

The symptoms typically associated with menopause actually occur during perimenopause and can last beyond menopause. While the experience is different for everyone, common symptoms can include:

• Hot flashes, chills, and night sweats
• Irregular or skipped periods
• Breast tenderness
• Vaginal dryness and discomfort during sex
• Mood swings or changes
• Trouble sleeping
• Lowered sex drive
• Fatigue
• Weight gain
• Trouble concentrating, brain fog, and memory issues
• Headaches
• Depression, anxiety, or irritability
• Dry skin
• Joint or muscle aches
• Thinning hair
• Frequent urination, urinary incontinence, and urinary or vaginal infections

Some individuals may have worse symptoms than others, and some may have little to no symptoms at all. Likewise, some symptoms may be consistent, while others may fluctuate. Typically, however, symptoms tend to be stronger and more frequent one to two years before menopause hits.

Many of these symptoms can also have other causes aside from menopause, so it’s important to talk to your primary care provider about any changes in your physical and mental health or if you are concerned about any symptoms. Reach out to your primary care provider, if you experience any of the following:

• Spotting after your period
• Blood clots during your period
• Bleeding after sex
• Periods that last way longer or shorter than usual

In most cases, your primary care provider will be able to determine whether you are perimenopausal or postmenopausal based on your symptoms. In some cases, however, your primary care provider may order blood tests to measure follicle-stimulating hormone (FSH) or estradiol levels. Other tests that measure thyroid, liver, or kidney function may also help your provider determine your course of care.

Though perimenopause and menopause may be unavoidable, there are numerous ways to relieve uncomfortable, painful, or bothersome symptoms. If your symptoms are interfering with your daily life, talk your provider about the following:

Hormone Replacement Therapy (HRT): Initially popularized in the 1960s and widely used in the 1990s, HRT use plummeted after a 2002 Women’s Health Initiative study linked it to increased risks of breast cancer, heart disease, and stroke. However, follow-up research exposed critical methodological flaws in that study, particularly that it focused on older women, on average 10 years post-menopause, and used only one type of hormone delivery—a combination pill with estrogen and progestin. This limited the applicability of its findings to younger, recently menopausal women and to other forms of HRT.

Recent research indicates that HRT can be beneficial and relatively safe when started within 10 years of menopause onset or before age 60. Healthcare providers increasingly recommend initiating treatment early in perimenopause to maximize symptom relief and possibly reduce risks such as cardiovascular disease. Many perimenopause and menopause symptoms are the result of lower estrogen and progesterone levels - in fact, 70% of women see major improvement in hot flashes within 8 weeks of starting HRT. Modern HRT is more individualized, with various delivery methods:

• Patches/gels: These forms provide consistent levels of medication, and blood clots are less likely.
• Pills: Preferred by some for convenience, but they come with a slightly higher blood clot risk.
• Combination therapy: Your healthcare provider can customize your therapy to your needs.

Other, Non-Hormonal Medications:

• Antidepressants (selective serotonin reuptake inhibitors): These medications can reduce hot flashes by 25-69%, and help with depressed mood
• Gabapentin: This medication may help reduce hot flashes, but side effects can include dizziness, drowsiness, coordination problems, vision problems, and fatigue.
• Fezolinetant (Veozah): Newest FDA-approved option for hot flashes

Lifestyle Changes:

• Exercise: We recommend 150 minutes of moderate-intensity cardio exercises (like walking or swimming) per week, as well as strength training twice per week.
• Nutrition: We recommend taking in at least 25 grams of fiber daily, and to limit sugar to 25 grams daily. Incorporating plenty of colorful fruits and vegetables to your diet will help provide the right balance of nutrients.
• Stress management: Cognitive behavioral therapy with a therapist, meditation, active movement like sports or dance, and hypnosis can all help reduce symptom impact.
• Metabolic Health: Maintaining a healthy balance of body fat and lean muscle mass can significantly reduce hot flash severity.

Modern hormone therapy is much safer than you might think. For average-risk women, combination hormone therapy increases breast cancer risk by about 2 in 100 people after 5 years. Low-dose hormone patches carry minimal blood clot risk. Your provider will assess your individual risk factors and help you determine what's right for you.

Effective treatments for perimenopause and menopause symptoms exist whether you choose hormones, medications, lifestyle changes, or a combination. Most symptoms improve over 2-5 years as your body adjusts.

One Medical’s providers are here to help you through all phases of life. If you have questions about perimenopause or menopause or are concerned about your symptoms, book a perimenopause/menopause consultation today. Because you deserve to not just survive this transition, but thrive through it and beyond.