Could it be Perimenopause? Symptoms Women Often Miss.
Women are made to make babies.
At least, that’s what the medical system’s focus on women’s health has been. The amount of research on women outside of its relation to bearing children is extremely minimal.
For reference, there is roughly 8–10 times more published research on pregnancy than menopause, despite menopause impacting every woman who lives long enough and affecting approximately one-third to one-half of her lifespan.
Women were left out of the research
Did you know that women were rarely included in research studies until 1993?
Before the 1990s, many medications and treatment guidelines were developed primarily from studies involving men.
This led to important gaps in understanding side effects, absorption, and effectiveness specific to women.
Due to menstrual cycles, varying hormone levels, and the possibility of pregnancy, us women are a bit harder to study than our male counterparts.
Then, to make matters worse, hormones became a little taboo in 2002 after the Women’s Health Initiative study was released and the press got ahold of it and told the world that estrogen causes breast cancer.
Patients were terrified. Prescribers were terrified. Prescriptions for hormones for women dropped by more than 80% when they weren’t great to begin with. Fast-forward to 2026, and the conversation is changing, but we are still so far behind.
We missed an entire generation of women who had to suffer through the symptoms, be gaslit into thinking they were going crazy or were just stressed out, and be left to deal with an increased risk of cardiovascular disease, osteoporosis, and dry vaginas when they didn’t need to.
Why weren’t we taught more about menopause?
Traditional OB/GYN training in medical school includes very little, if anything, on perimenopause or menopause. Don’t get me wrong; I am in no way belittling their specialty, as it is already complex, and there is plenty of risk involved in pregnancies, deliveries, and everything else they have to manage. But if perimenopause and menopause aren’t being taught to THEE women’s health providers, then who ARE they being taught to?
The answer is no one.
Thankfully, that is starting to change. Due to some big voices in women’s health, there has been a major push to improve the care women receive outside of pregnancy and to get this education into the curricula for MDs, DOs, PAs, and NPs. We have a long way to go, but it’s a start. And you have to start somewhere.
What I learned about menopause in PA school
I personally don’t remember learning much about perimenopause or menopause in PA school outside of:
Menopause is defined as 12 months without a menstrual period.
There are a few medications you can use for hot flashes.
If a woman bleeds after 12 months without a period, get an ultrasound to rule out cancer.
When I look back at my first few years as a PA, I realize I was also blinded to the world of symptoms that perimenopause, menopause, and changes in hormones can cause outside of hot flashes. Now, I was working in a gastroenterology department, so women weren’t coming to me directly for help with their hormones, but they were coming to me with new-onset bloating; changes in bowel habits, including diarrhea or constipation; iron deficiency; elevated liver enzymes; increased weight gain around the abdomen; and tests suggesting fatty liver. At the time, the possibility that the menopause transition could be contributing to the bigger clinical picture was not part of the conversation.
Then I started listening, noticing a trend, and doing my own research. I sought out my own training through books, podcasts, continuing education courses, and repetition, repetition, repetition. Whoa, were my eyes opened and I’ve worked in healthcare since I was 15 years old.
Perimenopause is so much more than hot flashes
Did you know that as perimenopause starts, estrogen, progesterone, and testosterone start to decline. Some a bit more chaotically than others?
You can develop:
Joint pain
Frozen shoulder
Anxiety
A feeling like you suddenly have ADHD
Reduced sex drive
Bladder infections
A dry vagina
Insomnia, hello, 3 a.m., and you can’t go back to sleep
Migraines
Heart palpitations
Changes in digestion
The list goes on and on. Now imagine how many women were told, “That’s just because you’re stressed, and it’s part of becoming this age.”
Facts about menopause
Its current definition is one year without a menstrual period. Not a great definition, in my opinion, but it’s what we have right now.
Average age: 51.5
Perimenopause can start 7–10 years prior to that one day of menopause. Everything else is referred to as post menopausal.
A normal range for menopause is 45–55. So, let’s do the math. If you reach menopause at 45, perimenopause could start at 35. Let that sink in a bit.
And to top it all off, perimenopause hits when we are having kids, climbing the career ladder, taking care of our parents, and trying to take care of ourselves all at once. Great timing to be dealing with the chaos of changing hormones.
What we know now
Estrogen is not the breast cancer villain it was once portrayed to be. Breast cancer risk depends on the specific hormone regimen, duration of use, and the individual woman’s baseline risk. Estrogen alone has not been shown to increase breast cancer risk in the major randomized WHI trial.
“Bioidentical” is a marketing term created to make you think certain products are more “natural.” Bioidentical simply means that the hormone has the same molecular structure as a hormone your body produces. FDA-approved estradiol and micronized progesterone are bioidentical hormones. They are available through regular pharmacies, come in standardized doses, and may be covered by insurance.
Replacing your estrogen reduces the risk of osteoporosis and possibly cardiovascular disease and dementia.
Estrogen, progesterone, and testosterone all deserve a discussion regarding replacement, as they all have their own benefits.
There is NO cookie-cutter approach. There are numerous variations in the types, doses, and routes through which hormones can be used. If the first thing you try doesn’t work, know that we have other options!
Perimenopause and menopause are not optional. Every single woman who lives long enough will go through this journey. It doesn’t mean life is over; it means finding the right people in your corner to support your journey, ensure you are feeling your best, and make sure you are aware of your options. If you are gaslit by a medical provider, don’t give up. We are out there in growing numbers, and we want to help you better understand your options.
Not simply to add more years to your life, but to add more life to your years!
This information is for general education and is not a substitute for individualized medical advice.
