Perimenopause and menopause are natural milestones for women entering their midlife, bringing new physical and emotional changes that vary widely. Because every woman experiences this transition differently, understanding the broad range of symptoms can make navigating these changes more manageable and less overwhelming.

As part of the Valley View University Women’s Health Series, Haley Hoffman, DO, a family medicine physician at Roaring Fork Family Practice, discusses what every woman should know as they begin perimenopause and menopause.

Watch Dr. Hoffman’s full talk here.

Here are some key takeaways.

What Are Perimenopause and Menopause?

Perimenopause is the transition period leading up to menopause. It can last anywhere from three to seven years and often begins when a woman is in her late 40s to early 50s.

Menopauseis when menstrual periods stop permanently. It’s diagnosed after 12 consecutive months without a period. In the U.S., the average age when menopause begins is 51.

Why it Happens

Women are born with all the eggs they will ever have. Over time, these eggs are lost, and once the supply reaches a certain level, the body can no longer maintain regular periods.

As the egg supply dwindles, perimenopause begins. During this time, periods become irregular—cycles may become shorter, longer, lighter or heavier.

“Essentially, the system goes ‘haywire’,” Dr. Hoffman says.

Menopause begins when the woman’s egg supply is officially depleted. At this time, the ovaries stop producing estrogen and progesterone—the reproductive hormones that regulate menstruation. These hormonal changes are what lead to menopausal symptoms.

“It’s important to remember this is a normal, natural process of aging for women,” Dr. Hoffman emphasizes, while acknowledging it can still be uncomfortable and complicated.

Treatment

For most women in their 40s and 50s, hormone testing isn’t needed to diagnose perimenopause or menopause because hormone levels fluctuate too much to be reliable. Instead, providers focus on the symptoms women are experiencing.

“Every woman’s experience is going to be different, and we’re going to use your symptoms to guide us in your treatment,” Dr. Hoffman says.

Hormone replacement therapy (HRT) is commonly used to ease menopausal symptoms like hot flashes, night sweats and vaginal dryness, and is also known to support brain, heart and bone health.

However, when it comes to treatment and balancing benefits and risks, timing is key.

What is the critical window hypothesis?

The critical window hypothesis suggests that the effects of menopausal hormone therapy depend greatly on when a woman begins treatment relative to menopause.

Starting therapy earlier—typically before age 60 or within 10 years of menopause—may offer more benefits. On the other hand, beginning treatment later may carry higher risks.

Are There Non-Hormone Treatment Options?

Not everyone can take hormones, and not everyone wants to take hormones, Dr. Hoffman acknowledges.

There are FDA-approved medications for hot flashes, including:

• Paroxetine mesylate (Brisdelle)
• Fezolinetant (Veozah)

Antidepressants (SSRIs and SNRIs) are often recommended by providers when hormone therapy is not an option.

Non-pharmacologic treatments that may help provide relief for menopausal symptoms include:

• Cognitive Behavioral Therapy for Insomnia (CBT-I)
• Mind-body interventions
• Exercise and yoga
• Acupuncture

The bottom line: treatment decisions for menopause—whether hormonal or non-hormonal—are best made with your primary care provider or women’s health provider, who can review your symptoms and medical history to determine the treatment option that is best for you.

Schedule an Appointment

Dr. Hoffman is currently accepting new patients at Roaring Fork Family Practice in Willits. To schedule an appointment, visit https://www.vvh.org/roaring-fork-family-practice/ or call 970.963.3350.

To sign up for future Valley View University presentations, visit http://www.VVh.org/VVU