by Dr. Zoë Kelly Linkletter, ND
If you’re a woman in your mid-30s to early 40s and you've been waking up drenched in sweat, losing words mid-sentence, or feeling like a stranger in your own body, you may be in perimenopause. Discussing this topic and getting answers from your doctor can be frustrating, and this isn’t your imagination.
Not all doctors have training in the midlife transition. Medical school offers very little education on perimenopause and menopause, and many physicians finish residency having spent only a few hours on the topic. Hormone therapy in particular is widely misunderstood in the medical community, and outdated fears still shape how it is discussed.
The good news is that you can take steps to make your visit productive. Here's how to advocate for yourself.
1. Prepare for Your Visit
The most powerful thing you can do before your appointment is learn about perimenopause and the treatment options available. Going in informed helps you ask better questions and recognize when you're getting complete information.
Know the symptoms. Perimenopause can begin years before your final period, and symptoms go well beyond hot flashes. Common symptoms include:
Hot flashes and night sweats
Irregular, heavier, or lighter periods
Sleep disturbances and insomnia
Brain fog, memory lapses, and difficulty concentrating
Mood changes, irritability, anxiety, or low mood
Fatigue
Vaginal dryness and discomfort with intimacy
Decreased libido
Joint and muscle aches
Heart palpitations
Headaches or changes in migraine patterns
Weight changes, especially around the midsection
Urinary urgency or recurrent urinary tract infections
Hair thinning and dry skin
Know your treatment options. Menopausal hormone therapy comes in both commercially available and compounded preparations. Commercially available products are FDA-approved and standardized in dose and delivery. Compounded preparations are custom-made by a pharmacy and may be tailored to individual needs. It's worth understanding the differences so you can discuss which approach may be right for you.
Recommended reading. These books are good places to start:
“Estrogen Matters: Why Taking Hormones in Menopause Can Improve and Lengthen Women's Lives — Without Raising the Risk of Breast Cancer” by Avrum Bluming, MD and Carol Tavris, PhD
“The Menopause Moment: Mindset, Hormones and Science for Optimal Longevity” by Kelly Casperson, MD
“The New Menopause: Navigating Your Path Through Hormonal Change with Purpose, Power, and Facts” by Mary Claire Haver, MD
2. Describe Your Symptoms
"I have brain fog" or "I have hot flashes" tells your doctor very little. The more specific you are, the easier it is for your provider to understand how much your symptoms affect your life and to take them seriously.
Describe the frequency, severity, and impact of your symptoms. For example:
Hot flashes: Instead of "I get hot flashes," try "I have hot flashes about 2 times per day, and I sweat through my pajamas every night."
Brain fog: Instead of "I'm foggy," try "I can't remember names and appointments, and it is seriously affecting my work performance."
It can help to track your symptoms for a few weeks beforehand. Jot down what you're experiencing, how often, and how it disrupts your sleep, work, relationships, or daily life. Bring your notes with you.
3. Express Your Interest in Specific Therapies
Don't wait for your provider to bring up treatment options. Many won't, so speak up about what you'd like to explore.
If you're interested in menopausal hormone therapy, say so directly. You can let your provider know that you're aware it is considered the most effective treatment for hot flashes and that it is FDA-approved for treating them and for preventing osteoporosis. Saying this signals that you've done your homework and want a real conversation about it.
If you'd like to explore other options, tell them that, too. Depending on your health history and preferences, you may want to discuss:
Birth control, which can help regulate cycles and ease symptoms for some women in perimenopause
SSRIs and related medications, which can reduce hot flashes and support mood
Herbs and supplements, which can support many perimenopausal symptoms
Whatever you're considering, being clear about your preferences helps your provider tailor a plan that fits you. Be sure to share every supplement or herb you take, since some can interact with medications.
4. Find a Provider Who Listens and Understands
Many providers, regardless of their background in midlife care and hormone therapy, will listen and support your care when you use the strategies above. A well-prepared patient can even increase a provider's knowledge, so don't be afraid to bring in resources or questions.
But if you feel dismissed when you describe your symptoms, it may be time to find another provider. You deserve to be heard, and you shouldn't be told that your symptoms are "just stress" or "just aging."
Many naturopathic providers have a strong focus on midlife care for women and are often more educated on this topic than the average conventional provider. You can also search the Menopause Society website to find providers who have additional education and a focus on menopause in their practice.
The Bottom Line
Perimenopause is a normal life transition, but if you’re having significant or bothersome symptoms accompanying it, you don’t you have to suffer through it.
By preparing for your visit, describing your symptoms clearly, speaking up about the therapies you're interested in, and finding a provider who listens, you can get the support you need to feel like yourself again.
Looking for support in your perimenopause journey? I invite you to schedule a visit with myself or another one of our team members today.
See you in clinic,
Dr. Zoë Kelly Linkletter, ND
Read Dr. Zoë’s full bio here.
Disclaimer: This article is for educational purposes only and is not intended to diagnose, treat, or replace individualized medical advice. Treatment decisions, including the use of hormone therapy, should be made with a qualified healthcare provider based on your personal health history. If you are experiencing severe or concerning symptoms, please contact your healthcare provider promptly.