Women's Health
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Perimenopause & Menopause:
The Basics
Menopause is often experienced between the ages of 40 and 58. It is distinguished by the loss of ovarian function, low estrogen and progesterone levels, and high FSH and LH levels (sex hormones). There is a period *before* menopause that causes physical changes known as "perimenopause" which lasts around 4-8 years.
Menopause can occur naturally with age or due to hysterectomy. Other factors that can influence timing of menopause include smoking and genetics.
Menopause is defined as the end of menstrual periods (for 12 consecutive months). The time before periods actually halt is known as "perimenopause".
Symptoms
Symptoms of perimenopause and menopause are different for everyone. Women may have some or all of the following symptoms.
✓ Hot flashes ✓ Brain fog ✓ Dry vagina/painful sex
✓ Trouble Sleeping ✓ Forgetfulness ✓ Fatigue
✓ Muscle/joint pain ✓ Less sexual desire ✓ Urinary issues
✓ Irregular periods ✓ Mood changes ✓ Weight gain
Sex Hormones
Estrogen
Created by the adrenal glands, the ovaries and fatty tissue, estrogen’s function ranges from controlling menstrual cycles, aids in breast development during puberty, maintains bone density, protects the heart, hydrates the skin and promotes healthy hair, and keeps the urinary tract and pelvic muscles functional.
Dips in estrogen can lead to:
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Difficulty losing weight
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Fatigue
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Infertility
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Thinning of hair/skin/nails
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Vaginal dryness and atrophy
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Weight gain around the midsection
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Increased risk of cardiovascular disease, elevated cholesterol
Progesterone
Progesterone is a steroid hormone produced in the ovaries after ovulation. It balances estrogen and prepares the uterus for implantation.
Decreases in progesterone can lead to:
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Irregular periods
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Hot flashes
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Night sweats
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Increased risk of osteoporosis
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Mood changes
Testosterone
Produced in the ovaries and adrenal glands, testosterone plays many important roles in women. Testosterone helps with libido, muscle mass, bone strength, brain health and memory, and energy.
Low testosterone can cause:
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Fatigue
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Low libido
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Brain fog/difficulty focusing
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Low bone mass
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Decreased muscle mass/strength
FSH
Follicular-Stimulating Hormone (FSH) is a hormone made by the pituitary gland in the brain. Its job is to stimulate the ovaries to grow follicles, produce estrogen and prepare for ovulation. As a woman enters perimenopause and menopause, the ovaries become less responsive. They don't produce estrogen as consistently, and they don't respond to FSH the way they used to. FSH is often used as a marker of menopause and elevated readings are expected.
DHEA-S
Dehydroepiandrosterone sulfate (DHEA-S) is a hormone made primarily by the adrenal glands. It acts a precursor (meaning the body uses it to make other hormones), including estrogen and testosterone. It stays stable in the bloodstream and is one of the most reliable markers of adrenal function.
As the ovaries produce less estrogen and progesterone, the body leans more heavily on the adrenal glands. DHEA-S can rise temporarily in early and mid-perimenopause. It helps "fill in the gaps" as ovarian output declines.
Dips in DHEA-S can lead to:
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Fatigue
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Low libido
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Mood changes
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Reduced resilience to stress
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Lower muscle mass
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Poor recovery
FAQs
Am I a candidate?
Treatment decisions today are guided primarily by your symptoms. In the past, care was often based on whether someone had gone a full year without a period, but we now know that’s only one piece of the picture. Many factors play a role in determining the right approach, including your overall health, any contraindications, and the potential risks and benefits of therapy.
What are the contraindications?
History of breast, endometrial or ovarian cancer. History of blood clot or stroke. Smoking. Liver disease. Your provider will discuss these with you.
What type of treatments are available?
Depending on if you are in perimenopause or menopause, your provider will discuss all the options with you. Treatment is also dependent on if you have a uterus or not. Treatments can include estrogen, testosterone and progesterone therapy. These are available in injectable, oral, and topical forms.
What are the side effects of treatment?
Side effects are dependent on the treatment type. Side effects can include vaginal spotting, breast tenderness, bloating, nausea, and headaches.
Are there nonhormonal medications?
Yes! Some options can include antidepressants for hot flashes, DHEA supplementation for painful intercourse, gabapentin or clonidine for hot flashes/sleep disturbance, and PT-141 peptide for low libido.