Women’s Health
Anxiety, joint pain, loss of libido, bladder leakage. Most people never connect these to perimenopause or menopause. If you cannot work out what is going on, this is worth five minutes. Your periods may still be regular, they may have started to change, or they may have stopped years ago. It is the same list of symptoms either way. You end up with a score for each area and a page you can print and take to your appointment. Most women arrive here having been told, more than once, that nothing is wrong.
Read the list slowly. A lot of what follows does not sound hormonal, which is exactly why it goes unnoticed. Each symptom on its own belongs to a different specialty, so each one gets treated on its own, or dismissed on its own, and nobody stands far enough back to see the shape of it. Seeing them together is the point of this exercise.
Page 1 of 2
Over the past few months. 0 is not at all, 3 is severe.
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Tick anything that applies. Nothing here is scored.
Your results
This number is a summary of what you reported, not a diagnosis. There is no cutoff that decides anything. What matters more is which areas scored high, and that is what the breakdown below shows.
Print it and bring it with you. It is the fastest way to start a real conversation, and it means you do not have to remember all of this on the day.
Only 7 percent of the physicians you would expect to treat it, the FP, IM and OB/GYN residents, finish training feeling prepared to manage menopause. If no one connected your symptoms, that is the reason. Your scores are above. I wrote a guide that explains what sits behind them. What perimenopause and menopause change in the body, when it usually starts, why symptoms like joint pain and palpitations get blamed on something else, what the risks to bone and heart look like over time, and what the treatment options really are. Free, and yours to keep.
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Email delivery is being set up. Until then the guide downloads directly. Questions or want a call? drnelson@peedoc.com
Perimenopause is the transition into menopause. It commonly begins in the early to mid forties, can start as early as 35, and often starts while periods are still regular. The ovaries are running out of eggs, and the body pushes harder to get the ones that are left to respond. Hormone levels stop holding steady and start swinging, sometimes higher than anything you saw when you were younger, sometimes far lower. The swings are what produce most of the symptoms, which is why this stage can feel so erratic.
This is also when bone loss begins. Women lose roughly ten percent of the bone density in their spine across the transition, most of it in a narrow window around the final period.
None of this has to be endured. A steady dose of bioidentical progesterone, estradiol or testosterone can smooth the swings and bring symptoms down, and bone protected now is worth far more than bone rebuilt later. The earlier the pattern is recognized, the more of this stage you get back.
Menopause is a single day: the one year anniversary of your final period. The average age is 51. After it, the swings stop and hormone levels settle low and stay there. Symptoms often calm down, and it is easy to read that as the problem resolving.
What continues underneath is quieter. Risk rises for cardiovascular disease, dementia, osteoporosis and fracture, and the vaginal and bladder tissue thins in a way that drives recurrent urinary tract infections, which in older women can progress to urosepsis. The dementia finding that frightened a generation of physicians came from women who started hormones well over a decade past menopause. Starting close to menopause is a different proposition, and some of that evidence points toward lower risk rather than higher.
Every one of these risks can be acted on. Treatment after menopause protects both halves, the symptoms you can feel and the changes you cannot, and it is never too early to have that conversation. Most women who get properly evaluated wish they had done it years sooner.
Written by Roscoe Nelson, MD. General education, not a prescription. What is right for you depends on your history, and some women should not take hormones at all.