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.
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:
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
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:
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.
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.