Perimenopause, Menopause and Beyond
Hot flashes? Mood swings? Sleep disruptions? You’re not imagining it—and you don’t have to power through it. Perimenopause care at WHA provides answers and support to help you feel more like yourself again.
Care that changes with you
Perimenopause—the transitional phase before menopause—typically begins in your 40s and can last anywhere from a few months to several years as your ovaries gradually produce less estrogen. About one to two years before menopause, that drop in estrogen becomes more sudden, and this is when many people experience the most intense symptoms.
Estrogen levels can swing from day to day, causing symptoms like hot flashes, night sweats, vaginal dryness, vulvar changes, headaches and shifts in libido—plus many more (there more than 30 commonly associated with perimenopause). The impact on your mood, memory and concentration is real; it’s a direct result of estrogen’s role in brain function, and it’s not in your head.
Until your periods stop completely, you can still get pregnant, so birth control is still important during this time. Once you’ve gone 12 months without a period, you’ve reached menopause. But that doesn’t mean symptoms stop. Estrogen production continues to decline, and you may notice longer-term changes in your skin, metabolism, weight distribution or bone strength.
A note: For a small few, menopause may arrive between the ages of 40 and 45, known as early-onset menopause. When it happens before age 40, it’s known as premature ovarian insufficiency.
There’s no single test to “diagnose” perimenopause. Hormone levels can fluctuate daily and don’t always give the full picture. That’s why your personal experience with symptoms and health history matters most. Only you know when you feel “off” or “different.”
You should consider making an appointment if symptoms are interfering with your quality of life, or even if you’re just unsure what’s going on. Talking to a provider can help you make sense of the changes and decide if treatment makes sense for you.
The goal of treatment is twofold: to provide relief from disruptive symptoms now, and to set you up for a healthy future by protecting your bone, heart and brain health for years to come.
Many people bring up perimenopause-related symptoms at their wellness visit—and that’s a great place to start. Be sure to track your cycles and symptoms in a calendar ahead of time, noting how often you bleed, how long it lasts and what symptoms you experience.
You and your provider will talk through your symptoms, treatment goals and any health concerns that could affect your options. Depending on your needs, we might begin symptom management that same day or schedule a follow-up to finalize or adjust your plan. Your treatment plan may include:
- Hormone therapy: Menopause Hormone Therapy (MHT) is the most effective way to relieve hot flashes, night sweats and vaginal dryness. While you may have heard about past safety concerns, decades of research have shown that for most healthy people starting within 10 years of menopause, the benefits of MHT (including long-term protection for your bones) often outweigh the risks. In some cases, testosterone may be an option for specific concerns like postmenopausal low libido.
- Non-hormonal medications: These may help manage symptoms like sleep disruption, mood swings or hot flashes.
- Lifestyle support: Nutrition, regular movement and stress-reduction strategies all play a role in how you feel—now and long term.
WHA has many certified nurse-midwives and OB/GYNs who are passionate about and trained in perimenopause care, who are dedicated to helping you feel more like, well, you.
Care for You
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Additional Resources
Menopause Preparedness Toolkit
A downloadable educational guide from the Society for Women’s Health Research designed to support individuals through the menopause transition with information on symptoms, midlife health, care planning, wellness and preparing for conversations with health care providers and loved ones.
Queer / LGBTQIA+ Menopause
A community-centered resource and support space focused on menopause experiences in LGBTQ+ communities, providing education, stories and connections related to aging and midlife health.
The Menopause Society
Find trusted information on menopause and midlife women’s health, including symptoms, treatment options and evidence-based guidance for patients and clinicians from a professional medical society.