Navigating menopause can feel overwhelming—especially when your symptoms are dismissed or misunderstood by your healthcare provider. From hot flashes and mood swings to fatigue, brain fog, and weight gain, hormone imbalance during perimenopause and menopause can deeply affect your quality of life. But you don’t have to suffer in silence. This guide will help you approach your provider with confidence, discuss menopause hormone replacement therapy (HRT), and advocate for a treatment plan that supports your long-term health.
Understand the Definitions
First, you need to understand the definitions of perimenopause and menopause. If you are still having a period, even an infrequent and/or irregular cycle, you are not menopausal. The moment a menstruating woman tells her provider that she thinks she is in menopause you will be dismissed. The only recognized definition is one year without a cycle. On average, this usually occurs around age 51. However, menopause can occur between ages 45 to 58, with most women experiencing it between 45 to 55.
Perimenopause is defined simply as the time before menopause. Most providers will tell women it is the ten years prior to menopause, but I would say it is more like 10 to 15 years before menopause. So, if you do the math, if you are over 35 year old, you are perimenopausal.
Starting at 35, we all experience steady declines in our progesterone levels. Beginning in our 40’s we start experiencing fluctuations in our estrogen levels, becoming more significant the closer we are to menopause. This combination triggers what we can the hormonal roller coaster. Symptoms vary from hot flashes, mood swings, menstrual changes, sleep disruption, low libido, memory issue, weight gain and motivation problems to only name a few. All these can vary in severity and duration. This, my dear, is perimenopause.
Identify Your Symptoms and Track Them
Before your appointment, keep a symptom journal. Track common signs of hormone imbalance like insomnia, night sweats, vaginal dryness, anxiety, memory lapses, low libido, and irregular periods. This documentation helps validate your experience and makes it harder for your concerns to be dismissed. Be specific—note severity, frequency, and triggers. This not only strengthens your case but shows you’re actively participating in your care.
Learn the Basics of Menopause Hormone Replacement Therapy (HRT)
Hormone replacement therapy, when appropriately prescribed, can significantly reduce menopausal symptoms and improve quality of life. Modern HRT is safer and more personalized than older versions, especially when started within 10 years of menopause or before age 60. Estrogen therapy (with or without progesterone) can:
- Protect against bone loss and reduce fracture risk
- Improve cognitive function and potentially lower Alzheimer’s risk
- Support cardiovascular health by improving lipid profiles and arterial function
Bioidentical hormones, which are structurally identical to those your body produces, are gaining popularity for being both effective and well-tolerated.
Know the Latest Research on HRT
Recent studies have debunked earlier fears from the 2002 Women’s Health Initiative (WHI). New evidence shows that estrogen therapy, especially transdermal estradiol combined with micronized progesterone, offers protective benefits when started around the time of menopause. According to The North American Menopause Society (NAMS), HRT remains the most effective treatment for vasomotor symptoms and prevents osteoporosis-related fractures in postmenopausal women.
How to Talk to Your Provider
- Be direct, yet collaborative: Start with, “I’ve been experiencing symptoms that seem to be aligning with perimenopause (or menopause if you are not having a period). I would like to discuss how to get these symptoms under control. Do you feel you can help me address my concerns?”
I recommend this approach because your provider may just tell you they are equipped to help you with your symptoms. Or if you are dismissed right away, it is time you find a hormone specialist and not waste your time. Most important to note is that you should schedule an appointment dedicated to just this topic. Your annual exam is not the appropriate time unless you are asking the above with ending with “Do you feel you can help me address my concerns at another appointment?” Annual exams are a wellness benefit and not a problem focused appointment. You will want dedicated time to voice your concerns and feel heard.
Red Flags: Your provider offers sleeping pills, contraceptive pills, or anti-depressants for your symptoms.
- Bring your data to your dedicated appointment: Share your symptom journal and any family history of osteoporosis, cardiovascular disease, or dementia.
Red Flags: Your provider tells you it is just a part of aging or you just need to exercise more and eat less.
- Ask about labs and tests: While hormone levels fluctuate, some providers use blood or saliva tests to get a baseline, especially in perimenopause. Keep in mind that saliva testing is not a covered benefit with most insurances.
Red Flags: Your provider tells you that hormone testing is not a covered benefit, hormone testing tells you nothing, or worse they just laugh.
- Use evidence-based language: Mention reputable sources like NAMS, The Endocrine Society, or The American College of Obstetricians and Gynecologists (ACOG) to show you’ve done your research.
Red Flags: Your provider tells you they aren’t aware of the research, or they don’t have time to look into that for you. Or they ask you “Did you google that?”
- Express your goals: Say, “My goal is to feel like myself again, maintain bone and brain health, and stay active. I’d like us to collaborate on a plan that supports this.”
Red Flags: Your provider tells you to get exercising and start seeing a therapist.
Collaborate with a Hormone Specialist on a Plan for Long-Term Health
Instead of a one-size-fits-all approach, ask about individualized hormone therapy options, lifestyle changes, and nutritional support. Some providers may recommend adding weight-bearing exercise, vitamin D along with other nutrients, or supplements that support hormone balance.
If your provider is dismissive, consider seeking a second opinion or working with a hormone specialist specialist.
Final Thoughts
Advocating for your hormonal health is not just about symptom relief—it’s about protecting your bones, brain, and heart for the long haul. With preparation, education, and a collaborative mindset, you can confidently discuss hormone replacement therapy and create a care plan that truly supports your well-being. You deserve to be with a provider who is open, listening and makes you feel heard.
Wishing You Health & Happiness, Tammy
