By the time most women learn the word perimenopause, they’re already in it. Few medical providers mention this five- to 10-year stretch before menopause called perimenopause. It can trigger hot flashes, sleepless nights, mood swings, and brain fog while your period is still showing up. When no one names what’s happening, women are left to wonder—and too often, to feel dismissed.
Kelli V. Burroughs, MD, an OB-GYN who specializes in perimenopause and menopause care at UT Physicians Women’s Center – Bellaire Station, said the silence around perimenopause is a medical failure—and one she’s working to correct.
“We have not done a great job, from a medical standpoint, of preparing patients for the transition into their wisdom years,” Burroughs said. “To be honest, there is a lack of education among providers.”
Most medical schools and residency programs do not provide comprehensive menopause or perimenopause training. When the topic is addressed, it is often limited in scope rather than incorporated as a core part of medical education. It is also a conversation that should extend beyond OB-GYN care and include family medicine providers, as well.
“We’re not having these detailed conversations with women in their 40s during well-woman visits about what they may experience as they move further into that stage of life,” she said. “If those conversations are not happening regularly, patients aren’t adequately prepared.”
Perimenopause vs. menopause: What’s the difference
Menopause is a specific milestone: 12 consecutive months without a menstrual cycle, not influenced by birth control. In the U.S., the average age is 51. Perimenopause is the transitional phase before that—typically beginning around age 40, but can occur in the 30s—when hormones start to fluctuate and symptoms appear, even as cycles continue, often irregularly.
“Mothers and sisters are good trendsetters, since it is hereditary,” said Burroughs, an assistant professor in the Department of Obstetrics, Gynecology and Reproductive Sciences at McGovern Medical School at UTHealth Houston. “That can be somewhat of an indicator when they can expect their onset.”
Perimenopause signs and symptoms
Hot flashes and night sweats top the list of symptoms women can experience in perimenopause, though 25% of women don’t. Other symptoms include fatigue, vaginal dryness, decreased sex drive, sleep disruption, or irritability. Then there’s brain fog. Burroughs said this causes trouble multitasking and remembering simple things, like the name of a household item.
Weight gain is also common and often not connected to hormonal changes, yet metabolism slows as estrogen declines. Joint pain and frozen shoulder are other conditions that show up, which illustrates how perimenopause affects the body on a multi-system level.
A woman’s experience with perimenopause varies widely: some women have few symptoms until cycles stop entirely, while others feel the shift years earlier.
“It’s very unpredictable as far as symptomatology,” Burroughs said.
Is it hormones—or something else?
The physical symptoms get most of the attention, but perimenopause can affect how women feel emotionally, too—and that part is harder to sort out. According to Burroughs, feelings of depressed mood, apathy, and irritability may develop during perimenopause or be exacerbated by declining hormone levels—a period Burroughs describes as “a gray zone.”
Some key questions can provide more understanding:
- Were these feelings present before perimenopause, or are they new?
- Do they coincide with other physical symptoms, like hot flashes?
Burroughs said some women do well with an antidepressant medication like sertraline, commonly known as Zoloft, while others respond better to hormone therapy. And some need both. If your mood feels unfamiliar or out of character, it’s worth bringing up at your next appointment, rather than pushing through alone.
Treatment options: More than just hormones
Perimenopause affects bone density, cardiovascular health, brain health, and daily quality of life. Burroughs said it deserves the same attention as any other midlife health condition.
Hormone replacement therapy is often the first line of treatment for hot flashes and other symptoms by replacing what’s been depleted. Burroughs encourages women to have an open mind: “What we have thought about hormone replacement therapy is very different than what we know now,” she said.
She encourages patients to feel empowered and ask questions, such as how to attack it from a lifestyle standpoint. Lifestyle factors—sleep, exercise, diet, and stress management—are just as much a part of treatment as any prescription.
“Hormones are just a tool in the kit; they’re not a miracle drug,” Burroughs said.
Tackling the myths
Burroughs hears the challenges and myths of perimenopause in her patient appointments. One of the biggest myths she encounters is that the symptoms aren’t real, or that struggling with them is a personal failing.
“This is truly a biological change that is out of the person’s control,” Burroughs said. “Your hormones are shifting, decreasing, and impacting multiple systems throughout the body, and it needs to be addressed and analyzed for possible treatment.”
Advice for women
Burroughs recommends women come prepared to their appointments: know which symptoms bother them the most, rate their severity, and think about what they’ve already tried. Most importantly, don’t wait.
“Recognition leads to relief,” Burroughs said. “If you can recognize that something is happening, it allows you to have that conversation with your physician, and they can help guide you.”