Perimenopause refers to the transition period leading up to menopause, when a woman’s hormones begin to fluctuate and decline. This stage usually begins in a woman’s 40s but can start as early as the mid-30s. Perimenopause lasts up until menopause, which is marked by 12 consecutive months without a period. The average length of perimenopause is four years.
During perimenopause, estrogen and progesterone levels rise and fall unevenly, and periods may become irregular. Other common symptoms include hot flashes, trouble sleeping, vaginal dryness, mood changes, and bone loss. While perimenopause is a natural transition, the symptoms can significantly disrupt daily life for some women.
When to see a gynecologist
It’s recommended that women have an annual well-woman visit with their gynecologist beginning at age 18-21. During perimenopause, some women may benefit from seeing their gynecologist more than once a year to help monitor changes and manage symptoms. In general, you should make an appointment with your gynecologist if you experience any of the following:
- Your periods change, becoming irregular, heavier, or lighter
- Your cycles lengthen to more than 35 days or shorten to less than 21 days
- You have persistent menstrual cramps
- You have spotting between periods
- You’re missing 3 or more periods in a row
- You have prolonged or heavy bleeding during your period
- You’re experiencing symptoms like hot flashes, trouble sleeping, mood changes, vaginal dryness
- You have any abnormal vaginal discharge or odor
- You have pain or discomfort during sex
- You have new pelvic pain or pelvic pressure
- You’ve previously had abnormal Pap tests
- You have any other unusual symptoms or health concerns
Keeping your gynecologist informed about what’s going on with your body can help them determine if your symptoms are related to perimenopause. Your gynecologist can also rule out other conditions that may cause similar symptoms, like thyroid disorders, infection, or uterine fibroids. They can provide guidance on managing symptoms, monitoring your health, and determining if you need any diagnostic tests or treatment.
Tests and screening
During perimenopause, your gynecologist may recommend certain tests and screening to track changes and monitor your health:
- Pelvic exam – Checks for any abnormalities in the vulva, vagina, cervix, ovaries, and uterus.
- Pap smear – Screens for cervical cancer and precancerous changes.
- HPV test – Screens for the virus that causes cervical cancer.
- Mammogram – Screens for breast cancer.
- Bone density test – Measures bone loss, which increases during perimenopause.
- Blood tests – May check hormone levels, cholesterol, blood sugar, thyroid function.
- Pregnancy test – Rules out pregnancy if periods are missed.
- Ultrasound – Checks for uterine fibroids or other abnormalities.
Routine screening and testing during perimenopause allows your gynecologist to closely monitor your health. It helps detect any issues early when they are most treatable. Testing frequency depends on your health, symptoms, and medical history.
Treatment options
If you’re experiencing disruptive signs of perimenopause, your gynecologist can offer treatment to help manage symptoms. Treatment options may include:
- Hormone therapy – Estrogen and/or progesterone therapy helps relieve hot flashes, night sweats, vaginal dryness, and bone loss.
- Low-dose antidepressants – May help reduce hot flashes and mood changes.
- Vaginal estrogen – Treats vaginal dryness and discomfort.
- Lifestyle changes – Diet, exercise, stress management may help manage symptoms.
- Supplements – Vitamins, herbal remedies may help some women.
- Prescriptions – Medications for sleep, pain, or bladder control issues.
Your gynecologist can discuss the potential benefits and risks of each treatment option and work with you to develop an individualized approach. They can also provide referrals to specialists or counselors if needed.
Ongoing care through menopause
It’s important to continue regular gynecological checkups as you transition through perimenopause into menopause. Your gynecologist can help you determine the right timing for follow-up visits and recommended screening based on your symptoms and health status. They can monitor your hormone levels, ensure treatments are working, manage any complications, and support you through this transition.
In addition to physical changes, many women experience effects on their emotional health and quality of life during perimenopause. Your gynecologist can offer guidance, resources, and support regarding these changes as well. Remaining under the care of your gynecologist provides personalized oversight to help you stay as healthy as possible.
When to see a specialist
For most women, seeing their regular gynecologist is sufficient to manage perimenopause. But in some cases, you may need to see a specialist who focuses on this transition:
- A reproductive endocrinologist specializes in hormonal changes and imbalances.
- A menopause specialist specifically treats women in perimenopause and menopause.
- If you have severe symptoms, your gynecologist may refer you to one of these specialists for advanced testing, diagnosis, and treatment.
Reasons your gynecologist may recommend seeing a specialist include:
- You’re under 40 with perimenopause symptoms.
- You have very early or premature menopause.
- You have extreme hormone imbalance issues.
- You need specialized fertility treatment.
- Standard treatment hasn’t helped your symptoms.
- You’re at high risk for health complications.
- You need specialized testing or diagnostic procedures.
These reproductive health specialists have extensive training in perimenopause and the intricacies of hormonal changes. They can provide experienced guidance and alternative therapies to help treat challenging symptoms.
Partnering with your gynecologist
Navigating perimenopause can be difficult, but having an experienced gynecologist on your side makes the transition easier. The key is maintaining open, honest communication with your gynecologist about what’s happening with your body.
Tracking and writing down your symptoms, menstrual patterns, and health concerns will help you provide the details your gynecologist needs. Being involved in your care, asking questions, and voicing your preferences empowers you to take an active role.
Partnering with a gynecologist you trust provides the comprehensive, compassionate care needed during this life stage. While perimenopause can bring challenges, your gynecologist has the expertise to promote health, provide symptom relief, and help you smoothly transition into menopause and beyond.
Conclusion
Perimenopause can be a difficult transition marked by disruptive symptoms and uncertainty. But working closely with your gynecologist offers many benefits. Through regular checkups, screening tests, symptom management, and health counseling, your gynecologist can provide the specialized care you need as your body changes. Knowing what to expect, when to get help, and what treatments are available will allow you to navigate perimenopause with confidence and optimize your health.