80% to 85%
of women in midlife may experience hot flashes and night sweats
Perimenopause and Menopause: What to Ask Your Primary Care Provider
Changes in sleep, mood, periods, weight, sexual health, and focus are common during perimenopause and menopause. Understanding these changes can help you feel more confident talking with your primary care provider and finding the support that's right for you.
What should patients know about perimenopause and menopause symptoms, and what questions should they ask their clinician?
During perimenopause and menopause, you may experience changes in your physical, emotional, and sexual health; each woman’s experience is unique.
Symptoms may include:
- Irregular menstrual cycles
- Hot flashes and night sweats
- Sleep disruption
- Mood changes
- Brain fog
- Sexual health changes
- Weight changes
- Vaginal dryness or discomfort
If symptoms are affecting your sleep, mood, relationships, work, or overall well-being, patients should contact their primary care or gynecology provider. They can help you understand your options and find support that's right for you.
Perimenopause is gaining more attention online as women share their experiences with hot flashes, brain fog, sleep disruption, weight changes, and irregular periods. The increased conversation is helping many recognize symptoms they may not have realized were connected to the menopause transition.
For many, those changes begin in their 40s as the body transitions toward menopause. The experience can be confusing, frustrating, and difficult to sort out, especially because symptoms vary and can overlap with other health concerns.
Ann Miller, RN, BSN, RNC-OB, the nurse clinician in the menopause clinic at UI Health Care, says common symptoms patients bring up include vasomotor symptoms (hot flashes and night sweats), cycle changes, sleep disruption, brain fog, and weight changes.
Miller says perimenopause is the transition leading up to menopause, when changing hormone levels may cause irregular periods, and you may begin to experience the common symptoms of menopause. It typically begins in a woman’s 40s, although it can start earlier or later. Menopause officially begins when you have gone 12 consecutive months without a menstrual period.
Women should not feel like they must suffer through symptoms that are affecting their daily lives. A primary care or gynecology provider can help determine which symptoms may be related to menopause, identify whether further evaluation is needed, and discuss options for symptom management.
Navigating perimenopause and menopause: When to reach out for care
Some changes during perimenopause and menopause may be expected. But symptoms should not be dismissed if they are affecting sleep, relationships, work, daily routines, or quality of life.
Holly Bolger, DO, an obstetrician gynecologist and Certified Menopause Provider at UI Health Care, says patients should reach out when symptoms affect their ability to function or feel like themselves.
“If the symptoms are disruptive to their quality of life, disruptive to their ability to function, and to be their best self, they should contact their provider,” Bolger says. "These are symptoms that are out of the norm, and if they are starting to affect your day-to-day life, it’s time to reach out.”
A common side effect that may be difficult to discuss is your sexual health during menopause. Menopause can cause vaginal dryness, pain with sex, or changes that affect relationships and emotional well-being. Your provider can suggest treatments to help with these issues.
Bolger notes that if you experience an absence in menstrual cycles or a significant change in menstrual cycles accompanied by other perimenopausal symptoms before the age of 40, you should see your provider. “If you start menopause unusually early, your provider will want to assure you don’t have any underlying health conditions and speak with you about your fertility, bone, and heart health.”
What to track before an appointment with your health care provider
A helpful menopause appointment is not just about listing symptoms. It is about helping your primary care provider understand what has changed, how long it has been happening, and how it affects your daily life.
Miller recommends tracking menstrual cycle changes, symptoms, and any management techniques you have already tried. The more specific information you can share, the easier it is for your provider to assess your symptoms and discuss your options.
Before an appointment to discuss perimenopause and menopause, patients may want to write down:
- Your top one or two concerns
- How your menstrual cycles have changed, including your last menstrual cycle and any changes to cycle frequency, duration and amount of bleeding
- Whether you are having hot flashes or night sweats
- How sleep has changed
- Mood changes, irritability, anxiety, or feeling unlike yourself
- Brain fog or focus concerns
- Sexual health concerns, including vaginal dryness or pain with sex
- Weight or body composition changes
- What you have already tried
- What you hope will improve
- Your health history, medications, and family history questions
“Coming into an appointment with a primary care provider or gynecology provider with your top one or two concerns can help focus the visit,” Bolger says. “There are many symptoms that can overlap, and they can influence each other.”
Are menopause symptoms disrupting your daily life?
Your primary care provider can help you sort through symptoms, review your health history, and talk through options that may fit your goals.
Why your primary care provider is a good first step for menopause care
Patients may wonder whether they need a specialized menopause clinic, a gynecology appointment, or a visit with their primary care provider. For many people, primary care is a good place to start.
Miller says many perimenopause and menopause concerns can be effectively managed in a primary care setting, particularly for patients who do not have a complex medical history or significant risk factors. Primary care providers can help evaluate symptoms, provide guidance and reassurance, discuss treatment options, and, when appropriate, prescribe hormone therapy.
Miller says a menopause clinic provider at UI Health Care can provide additional support for patients with more complex health conditions or treatment considerations, such as cardiovascular disease, cancer history, or other factors that may affect menopause treatment options and management.
For patients with chronic medical conditions, determining whether hormone therapy is a safe option may require a more in-depth discussion,” she says. “In some cases, we may explore non-hormonal treatments instead. This is often the case for patients with a history of certain cancers or other health conditions that can affect treatment decisions.”
Menopause treatment options should match your goals and health history
There is no one-size-fits-all approach to perimenopause or menopause care. Treatment depends on your symptoms, goals, health history, risks, and preferences.
Bolger says many patients come in after seeing online that they should be on hormones, should have hormone levels checked, or may be “missing the boat” in getting ahead of menopause symptoms.
She says care should start with a conversation about goals and disruptive symptoms. She clarifies that hormone levels are typically not necessary to discuss treatment options.
“In general, the utility of checking hormone levels, especially in that perimenopause-menopause transition, is not very useful,” Bolger says.
She says hormone levels usually do not determine how close someone is to menopause or whether treatment options can be discussed.
“Checking hormone levels does not impact or direct my ability to offer treatment options,” she says.
Treatment options for symptoms may include lifestyle changes, sleep support, cognitive behavioral therapy, hormone therapy for appropriate candidates, or non-hormonal therapies.
Medications may help with some symptoms, but they are not the only part of care. Miller says hormone therapy can be beneficial for some patients, but it depends on symptoms and health history. Health history matters, including cardiovascular health, cancer history, age, and timing since menopause.
"Our goal is to improve your quality of life, while meeting you where you are, and helping you find the support and treatment options that fit your needs."
Ann Miller, RN, BSN, RNC-OB
Bolger also emphasizes that hormones are only one tool.
“Non-hormonal therapy options can provide meaningful relief from many common perimenopausal and menopausal symptoms, offering effective alternatives for patients who cannot take hormone therapy or choose not to use it.”
Bolger emphasizes that treatment is often most successful when supported by healthy lifestyle habits, including regular strength training and a balanced approach to nutrition. Concerns about weight gain and changes in body composition are common and frequently discussed during menopause appointments.
According to Bolger, lifestyle changes should be discussed in a way that empowers patients. She encourages patients to thoughtfully evaluate nutrition, movement, alcohol use, and other habits. Recognizing that small, sustainable changes can help support their health and well-being.
Bolger notes that increased awareness of perimenopause and menopause has also brought misinformation. Patients should be cautious about treatment claims that sound highly customized but are not supported by evidence. She says custom-compounded hormone therapies are not recommended as a routine treatment option, especially in the form of injections and pellet therapy.
She says patients may see advice online that appears credible but may not follow evidence-based guidelines.
“Patients should be cautious about therapies and supplements that are marketed without strong scientific evidence,” Bolger says. “Be wary of websites or clinics that are primarily focused on selling supplements, products, subscription-based services, or recommending routine hormone level testing that is not supported by evidence-based guidelines. It is critical to ensure that the information you are receiving is accurate, evidence-based, and aligned with current medical recommendations.”
Bolger encourages patients to seek information from trusted, reputable organizations such as The Menopause Society, which provides evidence-based resources for patients and health care professionals.
You do not have to just deal with symptoms of menopause
Perimenopause and menopause are normal life stages, but that does not mean every symptom has to be ignored. Sleep disruption, hot flashes, mood changes, sexual health concerns, weight changes, brain fog, and quality-of-life concerns are all worth discussing with a provider.
Miller says the idea that patients should simply tolerate menopause symptoms is outdated.
“I just think that’s an old way of thinking, honestly,” Miller says. “We have many options to address your concerns. “Our goal is to improve your quality of life while meeting you where you are and helping you find the support and treatment options that fit your needs.”
Start with your primary care provider, bring your top concerns, and ask what options fit your symptoms, goals, and health history. Your care can be tailored to you and your needs.
Talk with your provider about your menopause symptoms
If hot flashes, sleep changes, mood changes, sexual health concerns, weight changes, or brain fog are affecting your life, start with your primary care provider.
