You’ve heard of menopause—but perimenopause, what’s that? Perhaps you’ve heard the term muttered at your doctor’s office, after a slew of uncomfortable and seemingly out-of-the-blue symptoms prompted you to make an appointment.
Or, there’s a good chance you’re hearing it for the first time, now. You can think of perimenopause as the prelude to menopause, which is when 12 months have passed since your last period.
Perimenopause is a hormonal transition that can span years (up to a decade, actually) and begin as early as 35—though it usually starts in your 40s.
Though perimenopause is as ordinary as puberty, menstruation, and other hormonal events, it gets a fraction of the attention. In fact, research shows a striking 92% of us want more education surrounding perimenopause and menopause.
Like so many facets of women’s health, it’s often overlooked. But for those looking for answers, heading to the gynecologist is often a good start. That’s why we called on TikTok’s favorite OB-GYN—Dr. Ali Rodriguez, known online as The Latina Doc—to shed some light on this (unnecessarily) enigmatic phase.
From talking to your mom to taking estrogen-boosting supplements, she offers insights on how to thrive during perimenopause—even if hot flashes and sleepless nights have you feeling out of sorts.
Bridging Gaps of Knowledge
When Dr. Ali first started her rotations in medical school, she wasn’t entirely sure which field of medicine she wanted to pursue.
When one of doctor’s she worked with let her attend a delivery, a “switch went off and I was like, okay, I really want to be an OB-GYN,” she tells me. “I was excited—and not just with the pregnancy part of it, but the women’s health aspect.”
Dr. Ali was doing her medical residency when she realized “there’s a huge gap of knowledge as far as what I consider important information for everyone to know.” So, she took to social media to help bridge gaps of knowledge among her few hundred social media followers.
A few years later, the number of folks she’s making female reproductive health accessible to is in the millions—and growing. Her medical practice has also expanded; most of her patients today are in perimenopause or menopause.
When I ask about which symptoms her patients most commonly flag, she notes period changes. “Usually my patients will come in because they realize that their periods are getting heavier, more crampy, or just the opposite,” she says.
That includes irregular periods or light spotting where consistent five-day periods once were. Hot flashes, weight-gain, and mood-related symptoms, like irritability, anxiety, or depression, are also commonplace.
If you're curious, the full list is 34 symptoms-long, and ever-growing to encompass people’s wide-ranging experiences. Every body is different.
“Those are very, very common and expected changes to happen with perimenopause,” says Dr. Ali. And since our bones depend on estrogen, joint pain, muscle aches, and fatigue are also within the spectrum of common symptoms.
“[It’s] almost like a feeling of not feeling like yourself,” Dr. Ali describes. It can be difficult to put into words or pinpoint what’s going on for those who are beginning perimenopause.
But what exactly spurs this years-long phase? According to Dr. Ali, by definition, it’s a decrease in ovarian function. “Your ovaries are not producing as much hormone, so there’s a decrease in estrogen, progesterone, and testosterone from the ovaries,” she says.
That doesn’t mean your body isn’t producing lots of estrogen and other vital hormones, it’s simply at a different level than before. And those pesky symptoms? They’re essentially your body recalibrating to a lower dose.
Symptoms Suck, But There’s Lots You Can Do
While there’s no sugar-coating the symptoms, which are likely to peak around menopause when the ovaries stop producing hormones altogether, there are lots of ways to adapt to bodily changes.
In Dr. Ali’s experience, some general practitioners are prone to brushing off symptoms as temporary, when that’s not necessarily the case.
Rather, she sees it as something ongoing—meaning it requires ongoing treatment and check-ins, to be reevaluated based on what’s working (or not working) for you.
“Now, are you going to be having these severe symptoms and feeling terrible from that point on? No,” says Dr. Ali. “Thankfully there’s treatment options and for some it does [naturally] get better over time.”
She emphasizes getting educated about perimenopause, whether that means scheduling an appointment, calling a friend, or getting candid with your mom. Since genetics play a role in symptoms, talking to family can give you a sense of what to expect.
Experienced in creating custom treatment plans for her patients, Dr. Ali always starts with the basics: nutrition and exercise. When it comes to nutrition, it’s about “avoiding things that are going to cause inflammation in the body, so an anti-inflammatory diet,” she says.
Aside from incorporating nourishing foods into everyday meals, she also emphasizes a regular (and realistic) exercise routine—which can be especially helpful in alleviating mental health related symptoms. “Exercise is so good for our bodies, but it’s also really good for our mental health,” she says.
Then, there’s the world of pharmaceutical therapies, medications, and supplements, which Dr. Ali bases on comfort levels and the unique needs of her patients. “It really is just having that open conversation with your doctor,” she says. “It could be a period of trial and error, seeing what works for your body or schedule.”
While she’s an advocate of hormone replacement therapy and how its improved quality of life for so many of her patients, there are lots of natural and dietary supplements that can help those who are hesitant to start hormones.
“[It’s] usually through a combination of mental and physical tools, resources, and treatments that people can find some balance and hopefully thrive,” says Dr. Ali.
Perimenopause Affects Every Body Differently
Comparison is a thief of joy—and according to Dr. Ali, perimenopause is no exception.
Many of her patients find treatments transformative, whereas some may not require any treatment at all. Some may deal with hot flashes here and there or feel short fused but that symptoms are, ultimately, manageable.
This is where genetics and lifestyle factors come into play, making the perimenopause journey totally unique for all who experience it. In Dr. Ali’s words, “everyone’s symptoms are going to present differently.”
With that, it’s important to avoid comparisons. While your symptoms might involve fatigue or joint pain, your friend may have relatively mild symptoms in comparison.
“I think keeping in mind we’re all built differently, having that as your baseline mentality is going to help too,” says Dr. Ali.
Research on Women’s Health Is Predictably Lacking
Though nearly half the world’s population will experience perimenopause or menopause at some point, it’s not uncommon for symptoms to be misdiagnosed.
In fact, a survey suggests 1 in 3 women have been diagnosed with a healthcare condition before discovering their symptoms were menopause-induced.
When I ask Dr. Ali why so many general practitioners are likely to misdiagnose perimenopause, she points to a lack of education. OB-GYNS like herself, on the other hand, receive deeper insight and encounter it more frequently during residency.
Even so, she doesn’t think the level of education is sufficient, especially considering the growing demographic of perimenopause-aged people worldwide. To ensure she’s able to keep up with the needs of her patients’, she buys books and attends menopause-related conferences.
“I think it’s often overlooked because women’s health in general is not valued, and we know there’s proof of that, so it doesn’t have the best track record,” she tells me. “I think we need to continue the conversation and continue being loud about it so that it’s taught better.”
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We hope you found this post informative — but remember: we’re not doctors and this post is not medical advice! While all posts are fact-checked and well researched, we always recommend you chat with your doctor about any questions or concerns you might have regarding a medical condition.
We’re here to support and educate, but never with the aim of disregarding professional medical advice you’ve been given. Phew, now that that’s out of the way, you can go on living unapologetically free.