Understanding Perimenopause: What Every Woman Should Know

As women approach midlife, they may begin to notice changes in their bodies that can feel confusing or even concerning. One such phase, often misunderstood and underdiagnosed, is perimenopause the transitional period leading up to menopause.

What Is Perimenopause?

Perimenopause refers to the time when a woman's ovaries gradually begin to produce less estrogen, one of the key hormones regulating the menstrual cycle. This hormonal shift typically begins in a woman's 40s, although some may notice symptoms as early as their 30s. The entire transition can last anywhere from four to seven years, ultimately culminating in menopause—defined as the point when menstruation has ceased for 12 consecutive months.

It’s important to clarify that perimenopause is not the same as early menopause. Early menopause refers to the permanent end of menstruation before the age of 45, whereas perimenopause is a natural, albeit often irregular, progression toward that point.

Why Is Perimenopause So Difficult to Diagnose?

Unlike other medical conditions, perimenopause is not easily confirmed through blood tests or diagnostic imaging. This is because hormone levels fluctuate significantly during this time. Rather than a steady decline, estrogen and other reproductive hormones rise and fall unpredictably. We often describe these changes as “irregularly irregular,” making it difficult to identify a consistent pattern through testing alone.

Each woman’s experience is unique, and symptoms can vary widely—not just in type but in severity and duration. This variability often leads to confusion and, unfortunately, misdiagnosis.

Recognizing the Symptoms

Common symptoms of perimenopause include:

• Irregular menstrual cycles

• Hot flashes or night sweats

• Difficulty sleeping

• Vaginal dryness or discomfort during intercourse

• Mood swings or increased irritability

• Problems with memory and concentration ("brain fog")

• Anxiety without a clear cause

Not all women experience every symptom, and some may find their symptoms interfere significantly with daily life, while others notice only mild changes.

When to Seek Medical Advice

If you believe you may be entering perimenopause, it is important to consult your primary care provider or a gynecologist such as Dr Steven R. Goldstein, a Perimenopause Specialist in NYC . Unfortunately, it’s not uncommon for women to be told their symptoms are “in their head.” Let me reassure you: the symptoms of perimenopause are real, and they stem from genuine biological changes occurring in your body.

While perimenopause is a normal part of aging, that doesn’t mean you have to suffer in silence. There are effective strategies and treatments available to help manage symptoms, from lifestyle adjustments to low dose birth control pills

A Supportive Approach to Care

Physicians who specialize in perimenopause, such as Dr. Goldstein, who has practiced on Manhattan’s East Side for over 30 years, are especially attuned to the nuances of this transitional stage..

Perimenopause is a complex but natural phase of life. With the right information and support, it can be managed effectively, allowing you to maintain your well-being and quality of life.

Dr. Steven R. Goldstein MD is a past President of the International Menopause Society, a Certified Menopause Practitioner, and a Perimenopause Specialist in NYC. He is also the co author of the book “Could it be Perimenopause….?”. Dr Goldstein has helped thousands of women over three decades to

navigate the difficult stage of life called Perimenopause and understand what their bodies are going through.