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Perimenopause: Do I need a doctor?

Leah writes:

I’m so confused. I’m 49, I’m healthy and I generally feel great except that recently my breasts have been really sore, I’ve started waking in the middle of the night and my period used to be like clockwork, but now it is all over the place.

Is this something I need to talk to my doctor about?

My response:

Let’s get one thing clear. If you are reading this and saying to yourself “Why do I need to talk to my doctor?” that is absolutely on point!

Perimenopause and post menopause are life phases—and menopause is merely one day that marks the end of menstruation—so similar to puberty, they are not ailments and do not require women to seek medical attention.

However, hormone fluctuation, hormone imbalance and hormone decline can lead to uncomfortable symptoms for some women. And you deserve quality of life. Therefore, it is important you have a health team member—preferably one who is “hormone literate” –someone you can consult with regarding your own specific health journey.

The experiences that are often associated with hormone fluctuations are frustrating, because they are most often the ones that can be easily dismissed. This is especially true in our mid-thirties and throughout our forties, when many of us are not really sure if we’re dealing with perimenopause, or symptoms of being stressed out due to our kids, work, relationships, caring for aging parents or life in general.

So, when should you consult your doctor or seek out the advice of a midlife health expert?

Often, women tend to put nuances in our health—whether slight or severe—on the back burner. However, not investigating these changes can mean overlooking something more serious that might be going on. You should always rule anything serious out; it’s better to be safe than sorry.

In this video, my own doctor, Dr. Julie Durnan, Naturopathic Doctor at Restoration Health Clinic in North Vancouver, offers the following list as a guideline for recognizing hormone balance in perimenopause and when you should see a doctor:

  • Heavy periods/longer flow

  • Shorter cycles (less than every 25 days)

  • Sore, swollen or lumpy breasts

  • Waking in the middle of the night

  • Increased cramping

  • Onset of night sweats, especially right before your period

  • New or increased migraines

  • New or increased premenstrual mood swings

  • Weight gain without changes to diet or exercise

In women’s health, as with many things in life, knowledge is power. Here are some tips for working with your health care practitioner:

  • Track your experiences: this will help you share your story and it will help your health care provider find solutions that are right for you. Note things like when did this start? How long? To what extent is it disrupting your quality of life? For example, “My periods have been easy all my life. However, for the last 8 months they have become so heavy that it’s impacting my ability to even exercise!”

  • Get informed: Talk to friends, take a book out of the library, or attend a course or event with a reputable health care professional who can help curate and translate the best information and research on perimenopause, menopause & post menopause.

  • Give perimenopause conversations the time they deserve: Perimenopause is not simple, so try to give it the attention and space it deserves. If you are seeing a hormone expert or naturopath, the allotted appointment time is likely going to be in the 30-60 minute range. If you are seeing your family doctor, the appointment time will most likely be shorter so be sure to mention your reason for the visit in advance. Say, “I’d like to talk about perimenopause during this appointment—specifically about [list any challenges or questions you might have].” And even ask if it’s possible to book an extended appointment time. Help your doctor more effectively plan the visit so you have a better opportunity to have your health needs met.

Remember that not all doctors are hormone balance experts. If you happen to be consulting with someone who specializes in women’s health, midlife health, or hormone health, fantastic! You must realize, though, that general practitioners can’t be experts in everything, and they typically receive no more than an hour of training on the perimenopause-to-menopause transition subject in medical school.

However, they are trained to respond to the symptoms you present. So, if you present as depressed or sleep-deprived, then they have medicinal ways to address and offer treatment. It helps to know in advance how you intend to navigate your perimenopause journey—are you looking for lifestyle tweaks, supplementation recommendations, hormone therapy or prescription options. Perhaps you’re interested in learning more about nutrition or acupuncture. Getting informed in advance and knowing some of the approaches that resonate for you personally, will help to steer you in the right direction.


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