Does Perimenopause Have To Suck This Bad? Actually No, Doctors Say

Growing up, I heard the women in my life talking about perimenopause and menopause often. My mom called her hot flashes “personal summers,” and she’d begrudgingly go find a ceiling fan to stand under whenever one struck. From air hunger to frozen shoulder, there are also so many surprising perimenopause symptoms that can pop up and negatively affect your quality of life. So, when is perimenopause or menopause bad enough that it’s clinical? If you’re wondering when to see a doctor for perimenopause, specialists actually wish women would come in as soon as their symptoms cause any sort of discomfort.

Perimenopause is that oh-so-delightful lead-up to menopause, in which your ovaries slowly stop producing estrogen and your periods become irregular. That hormone shift also brings with it all kinds of symptoms, from hot flashes and low libido to difficulty sleeping and mood swings. Perimenopause can last for years, and many women think that it just kind of sucks, and they have to grit their teeth and bear it. For a lot of us, that’s what we saw the women in our families do. But menopause specialists say that’s simply not the case.

When To See A Doctor For Perimenopause

If you’re having any perimenopause symptoms that bother you, make you uncomfortable, or are affecting your quality of life, make that appointment. You can’t halt perimenopause, but hormone therapy — which adds the right levels of estrogen and progesterone back into your body — can help ease the symptoms, according to the Cleveland Clinic.

“If you're suffering in any way, why? You're not going to get a gold medal for seeing how long you can white-knuckle this until you finally ‘give in,’” says Dr. Sophia Yen, co-founder and chief medical officer of Pandia Health, which provides telehealth birth control and menopause-related care. “I've heard so many women be like, ‘I'm just going to suck it up. I'm just going to barrel through this. It can't be that bad.’ But why suffer at all? We have drugs. We have science. Please let us help you.”

Yen says that according to the FDA, these are the four signs you’re a good candidate for hormone therapy:

1. You have hot flashes.
2. You experience night sweats.
3. You have genitourinary symptoms, which include vaginal pain, itching, and dryness.
4. You’re at risk for osteoporosis. There are certain racial minorities this applies to, and those who are lactose intolerant (and therefore not getting enough calcium), Yen says.

Insurance companies often use these same criteria when deciding if they’ll cover hormone therapy for menopause, she notes. And if you have irregular periods without symptoms, Yen says you should tell your doctor you want to get on hormonal birth control. Going into perimenopause already on the pill or using a vaginal birth control ring can help you avoid the hormonal ups and downs that cause things like hot flashes, vaginal pain, and other symptoms.

“If you have too much estrogen, you get migraines, headaches, and tender breasts. And then with a drop of progesterone, you get moody and you have problems sleeping. But if you're on progesterone and estrogen from a birth control pill or ring, that covers your birth control needs as well, so it's a twofer, then going into menopause is so much easier.”

Bioidentical estrogen — meaning estrogen medications that mimic exactly the kind your body produces — are available in lots of forms, Yen says, from gels, patches, and sprays to pills.

How To Find A Menopause-Savvy Doctor Near You

In a perfect world, you’d visit menopause.org and find a provider certified by the Menopause Society, which tells you they’re up to date on the latest research and national guidelines for treating menopause, Yen says. Unfortunately, there are only around 3,000 certified providers in all of North America, compared to the 75 million women currently in perimenopause, and Yen cautions women that only about 30% of OB-GYNs receive training on menopause in medical school.

That’s bleak, so what the hell are we supposed to do? Honestly, quiz your doctor, Yen suggests.

“You call the office and you say, ‘Does this person consider themselves a menopause expert? What is this person’s attitude towards hormone replacement therapy?’ Don’t waste your time or money if they’re going to be like, ‘My attitude is the lowest amount of estrogen for the shortest amount of time.’ That is old-school if they answer that. If they answer, ‘Estrogen causes breast cancer,’ they are not [up-to-date on] the latest and greatest.”

If you’re searching for a doctor who’s caught up on the latest menopause research, you should check at academic health systems near you — “anything with a .edu” behind their web address, Yen says. You should also steer clear of any provider recommending treatments for menopause that are not FDA-approved, like testosterone pellets, and opt for an MD over a naturopath or chiropractor, she says.

Where You Can Learn About Menopause, Since Good Information Is Hard To Come By

It’s really frustrating to head into perimenopause knowing it could last years, and not being able to find a doctor who knows enough to answer your questions. If you want to educate yourself (as unfair as it is that we have to), Yen recommends signing up for virtual talks hosted by the nonprofit HerMedicine.org. They offer free, live, interactive talks with physicians and experts on women’s health topics, including perimenopause and menopause. She also recommends the book Estrogen Matters by Dr. Avrum Bluming and Dr. Carol Tavris.

Ultimately, if you visit your doctor, Yen says there’s one question to pose to them when they offer you a treatment for your perimenopause symptoms: “There are 40 to 100 symptoms of perimenopause and menopause, and all of those will be improved with estrogen. Anytime anybody tries to give you anything but estrogen, ask them, ‘Has this been tested in a randomized clinical trial against estrogen, and who won?’ And the answer, to my knowledge of all the research out there, is estrogen beats everything.’”

So, while it’s not necessarily easy to find the perfect provider, there is help and relief out there for those of us suffering through intense night sweats and painful sex. Turns out we don’t just have to suffer through our personal summers for years after all.