Flo is now FSA/HSA eligible
Published: 14 Apr 2025
Perimenopause is the years of transitioning through menopause. At this time, estrogen fluctuation can be unpredictable, which can trigger a complex network of physical, mental/emotional, and psychosocial changes for women.1
It can last anywhere from a few months to eight years. But even with more than 1 million people in the United States going through (peri)menopause each year, we still have some way to go in understanding its health effects — and crucially, as a medical community, in supporting patients on their journey with it.2
“There’s a big gap in education around perimenopause, and menopause, among healthcare professionals,” says Dr. Allison Rodgers, reproductive endocrinologist and OB-GYN at the Fertility Centers of Illinois and a member of Flo’s medical board.3 “While we do get training in urogynecology and menopausal care, the experience and exposure can be very limited.”
“It’s typical that most of the patients that trainees see are in their reproductive age,” adds Dr. Renita White, an OB-GYN at Georgia Obstetrics and Gynecology and Flo medical board member, which means many rely on the “on-the-job training” that comes later in their careers.4
Dr. Rodgers and Dr. White are among growing waves of healthcare professionals championing change in the care of midlife women in recent years. But, as things stand for many OB-GYNs, “the real nuances of (peri)menopause and (peri)menopausal management come with experience — and a lot of self-education,” says Dr. Rodgers.
So, Flo’s here to help.
The impacts of perimenopause on patients
Familiar physical symptoms are often seen as the cornerstones of perimenopause. But Dr. White emphasizes the importance of digging deeper than this during patient care. Many of the wider symptoms are commonly misdiagnosed, resulting in delays to appropriate management, and disruption to the patient’s life.5
How the various physical, mental, and psychosocial changes are experienced (or indeed if they are experienced at all), can differ hugely between patients. So active listening, and an individualized approach, really matters.
Physical symptoms
Of course, some of the most common physical symptoms of perimenopause include unpredictable periods, hot flashes, night sweats, insomnia, brain fog, and vaginal dryness.
But broader physical symptoms are wide-ranging, and can include pelvic floor issues, shifts in sexual arousal and desire, headaches, low energy, thinning hair, dry skin/eyes/mouth, breast tenderness, palpitations associated with hot flashes joint/muscle aches, and changing cholesterol levels.6 7 Post-menopause can also increase women’s risk of cardiovascular disease, osteoporosis, and genital urinary syndrome.8
The Study of Women’s Health Across the Nation (SWAN) has found that menopause symptoms can present differently among different cultures and ethnicities, too — which is something to bear in mind when assessing and treating patients.9 For example:
- Women of African and Caribbean descent have the highest prevalence and longest duration of vasomotor symptoms, and they’re more severe. They’re also more likely to struggle with sleep.
- South-East Asian women may experience more forgetfulness, joint and muscle pain, sexual pain, and loss of sex drive.
- Hispanic women are more likely to undergo early or premature menopause.
Mental health
About 4 in 10 women have mood symptoms during perimenopause involving on-and-off bouts of irritability, tearfulness, and mood swings — often without a clear pattern to it, like that we observe in pre-menstrual syndrome (PMS) symptoms. But for some women, the mental health impacts of perimenopause can be more severe.10
Research suggests that perimenopausal women are at a significantly increased risk of depression (one pooled analysis of studies found that 33.9 of perimenopausal women experience it).11 And while there are limited studies on perimenopause and anxiety, many women report increased anxiety during this time, too.10
Psychosocial challenges
Part of what can make the symptoms of perimenopause so challenging for some is their impact on women’s perception of themselves and their place in the world. It’s important to be aware of this as a healthcare provider.
“The sudden onset of changes can trigger negative self-thought about getting older,” says Dr. White. “It's not uncommon that patients feel a sense of grief over a perceived loss of youth, or ability to have children.”
Symptoms like mood swings, brain fog, and fatigue can impact performance at work, leading to feelings of frustration, self-doubt, even worthlessness.12 Plus mood swings, changes in sexual desire, and a lack of education/understanding from male partners, may strain relationships at home.13
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An OB-GYN’s guide to perimenopause care: Advice from the experts
As Dr. Rogers said, a primary and ongoing step in providing informed and compassionate care for perimenopausal women is self-education. There are various sources of extra medical education for professionals available, and she recommends regularly exploring:
- ACOG (American College of Obstetrics and Gynecology)
- ASRM (American Society of Reproductive Medicine)
- NAMS (North American Menopause Society)
Learning aside, though, how can healthcare providers work to reduce stigma, promote openness, and ultimately better support perimenopausal patients in their practice?
Dr. Rogers and Dr. White share their top tips.
- Prepare patients in advance
In a 2022 survey of 947 perimenopausal women, more than 60% of women said they did not feel informed about menopause at all, and more than 30% reported “dreading” it.14 In a separate 2020 survey, 42% of women reported their menopausal symptoms to be much worse than they expected.15 Which shows that healthcare professionals have a role to play in earlier education.
With perimenopause most commonly beginning somewhere between 45 and 55, both Dr. Rogers and Dr. White emphasize the importance of providing anticipatory guidance to female patients once they enter their 40s (or some researchers advise as early as 35).16
In Dr. White’s words, it’s about arming women with “the knowledge of what they might possibly expect in advance, so that they can enter perimenopause with confidence — feeling more informed, and less fearful.”
Generally, women may be less familiar with the potential psychological and emotional impact of perimenopause, so it’s vital to factor this into these early conversations. [10] - Be proactive in exploring symptoms
Research also shows that women in general can be reluctant to consult healthcare professionals about perimenopause [13] — and women of certain cultures and ethnicities, such as South East Asian women, may be even less likely to complain or seek help. [9]
“Even if a patient doesn't complain about symptoms, they may be experiencing mild or early symptoms and just don’t know it yet,” says Dr. White. So, once a patient enters the appropriate age range, OB-GYNs may wish to proactively enquire about potential perimenopause symptoms during wellness visits (and then, if they have symptoms, work to exclude other possible causes).
This way, you as the provider can take the first steps, rather than waiting until women ask for support. - Foster supportive, empathetic, and open conversations
Many women have been made to feel like (peri)menopause is something that shouldn’t be spoken about. This can make the experience of it all the more isolating.
“I always spend time encouraging women to embrace what is a normal and expected transition of life,” says Dr. White — which can help combat any misconceptions that it’s some kind of disease or disorder, or that it has to be seen in a negative light.
“I always try to put myself in a patient’s shoes, to understand how they’re feeling and what their goals may be,” adds Dr. Rogers. After all, our 40s and 50s are a time when life’s pressures might be heaviest: Many people will be juggling tiring careers, looking after children (or sending them off to college), and caring for aging parents. [10]
As a healthcare community, we want to minimize the challenges of perimenopause, so that the patient can move through the period with as much ease as possible. - Work collaboratively with the patient on an individual care plan
Whether it’s HT, non-hormonal medications, talking psychotherapy, antidepressants, or simple lifestyle changes — “I try to educate my patients about the risks and benefits of various different options relevant to their symptoms,” says Dr. Rogers, “and then we work together to explore what’s right for them.”17 This approach can help the patient feel more empowered and in control of their own perimenopause journey.
It’s important to take it slow when educating patients on the workings and implications of different treatments as, naturally, it can feel like information-overload. Dr. White also emphasizes the importance of making time for questions from the patient — and creating a judgement-free zone where they feel comfortable asking them. - Arm patients with credible sources of health information
According to the Centers for Disease Control and Prevention (CDC), in the second half of 2022, six in ten women used the internet to search for health information.18 But it can be a Wild West out there — not least when it comes to the topic of perimenopause.
“There is a lot of [menopause] misinformation directed at patients and consumers,” says Dr. Rogers. “There are so many supplements, herbs, and remedies that are not regulated by the FDA and not only may not be safe, but may not treat or cure what they advertise.” So it’s important to get ahead of the curve on this when it comes to patient care.
Try to inform patients as to what and who they can trust when it comes to perimenopause information. Enter Flo.
Flo: A partner in perimenopause care
Flo is so much more than a period tracker. It’s a health partner for women and people who menstruate throughout their lives. The Flo app has a hub of perimenopause resources and support that lives right there in a woman’s pocket, with extensive info on symptoms, treatment, lifestyle tips and more — all of which is reviewed by our board of industry-leading experts (which includes Dr. White and Dr. Rodgers), ensuring the highest standards of reliability.
“Flo’s mission [is] about putting the power in the patients’ hands,” says Dr. White. And “they go to such lengths to ensure their information is medically accurate and backed up by evidence,” adds Dr. Rodgers.
The patient can also download a monthly health report that details the perimenopause data and symptom patterns they’ve logged, then share it with you to support your care plan for them.
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Perimenopause may still be under-discussed, and often misunderstood. But with a holistic and compassionate approach, OB-GYNs – and all of us in the wider healthcare community – can play a crucial role in helping patients embrace it as a natural and manageable stage of life. Together, we can help women everywhere transition to menopause with clarity and confidence, rather than confusion or frustration.
