Areas of expertise
Menopause and Perimenopause
The transition can run 5 to 10 years, and most of it happens while your labs still look normal. That is the part almost no one prepares women for.
What is happening
It begins long beforeanything stops.
Perimenopause is the years of change leading up to menopause, and it commonly starts in the early forties, sometimes sooner. Menopause itself is a single point defined in hindsight, twelve consecutive months without a period. Everything in between is the transition, and it is where most of the symptoms actually live.
During those years your hormones do not decline in a straight line. They fluctuate, sometimes considerably, which is why one blood draw on one day can come back reassuring while your sleep, your mood and your cycle tell a completely different story. Being told your labs are fine is not the same as being told what is happening to you.
This is also the stage where women are most often asked to wait it out. I would rather understand where you are in the transition, what is driving the symptoms you have now, and what deserves attention for the decades that follow.
What you may recognize
The signs of a transition already underway.
- Cycles that come closer together, or further apart
- Periods that are heavier, lighter or unpredictable
- Hot flashes or night sweats
- Waking at 3am and not getting back to sleep
- Anxiety or irritability that feels out of character
- Brain fog, or losing the word you were reaching for
- Weight settling differently despite no change in habits
- Joint aches and stiffness
- Vaginal dryness or discomfort with intimacy
- Low desire, or a body that responds differently
These are not separate problems. They are one transition, showing up in several places at once.
How this is approached
What your care can include.
- 01
Working out where you actually are in the transition, using your history and your symptom pattern rather than a single value on a single day.
- 02
Treatment options considered against your own medical history, including hormone therapy where it is appropriate for you, explained in plain language before anything is decided.
- 03
Relief for what is affecting your life right now, whether that is sleep, mood, temperature, or comfort and desire.
- 04
Attention to the longer horizon this stage influences, including bone, metabolic and cardiovascular health.
- 05
Adjustment over time, because a transition that lasts years is not served by a plan made once.
You will always know what we are doing and why. Decisions are made together, not handed to you.
← All areas of expertiseQuestions
The three I am asked most.
How do I know if I am in perimenopause?
Usually by the pattern rather than by a test. Changes in your cycle alongside sleep, mood, temperature or energy shifts tell us more than one hormone level does, because those levels move considerably during this stage. We look at the whole picture together.
Do my periods have to have stopped?
No. Most of the symptoms women come to me with happen while they are still having periods. You do not have to wait until they stop to be taken seriously or to get help.
Is hormone therapy something I could consider?
For some women it is a good option and for others it is not, and that depends on your own medical history rather than on a general rule. It is a conversation, and one I have with you in full before anything is prescribed.