This article is the first of a four-part series in partnership with MHealthy and the U-M Menopause Clinic to further awareness about menopause and U-M benefits that assist in treating symptoms and health risks. 

A recent social media video showed a flustered woman speaking into her smartphone. She ticked off a few symptoms: irritability, bad night’s sleep, intermittent heart racing, excessive sweating.

“Siri, am I in perimenopause?”

The connotation was clear: The woman felt that a virtual assistant could offer a better diagnosis than her doctor. And while the scene was fictional, Natalie Saunders, MD, associate professor of obstetrics and gynecology at Michigan Medicine and Menopause Society-certified practitioner, said the woman’s unconventional attempt to get answers is, unfortunately, understandable.  

“Many women see a number of doctors of all specialties when they’re experiencing symptoms, but aren’t receiving answers or effective treatments,” Saunders said. “Even though more than a million women begin the transition into menopause each year, too many women aren’t having basic discussions with their doctors.” 

A recent Menopause Society study found that basic indicators of menopause, such as a woman’s age and reproductive stage, are assumed but not actually discussed during their visits. 

“Women are saying things like: ‘I’m not sleeping and my heart races sometimes,’ or ‘My mood is low,’ and even ‘I just feel off.’ These symptoms are often dismissed as part of the natural aging process, or a specialized health concern,” Saunders said. 

Turns out, women “of a certain age” who feel unheard by their doctors are turning to atypical resources, including social media, the wellness industry and menopause “retreats” for care, when their first step, Saunders said, should be a productive discussion. 

In an effort to elevate awareness about menopause and encourage support, Saunders will host a free webinar, “Navigating Menopause Together,” with Shubham Kalwani, DO, assistant professor in the U-M Department of Family Medicine and Department of Obstetrics and Gynecology. Saunders and Kalwani are Menopause Society-certified practitioners. 

Premenopause vs. Perimenopause

With the terms “premenopause” and “perimenopause” used somewhat interchangeably, it’s no wonder women are confused about what’s happening to their bodies. 

Premenopause encompasses the years after a woman has her first period (between pre-puberty to mid-teens) to when the initial symptoms of menopause begin. 

“Premenopause is a woman’s most fertile reproductive years,” Saunders said. “Generally, it means regular ovulation and hormone production. For some women, it means pregnancy and giving birth between these biological processes. This usually lasts for three-to-four decades before women notice an interruption.”

This interruption is called perimenopause, which can present a series of physical symptoms that signal ovulation and hormone production have become less consistent. For some women, Saunders said, perimenopause can be harsh. 

“I hear from women who tell me, ‘I don’t feel like myself anymore,’” Dr. Saunders said. “They’re struggling with severe hot flashes, sleepless nights, brain fog, mood changes and symptoms that are affecting their work and relationships. These aren’t minor inconveniences – they can have a profound impact on daily life.”

The most common symptoms of perimenopause include:

• Irregular periods, including longer or shorter time between cycles; heavier or lighter flow and skipping cycles

• Hot flashes (or flushes) with different intensity and frequency

• Sleep disturbance, characterized by changes in sleep patterns with and without hot flashes

• Mood fluctuation, including an increased risk for depression, especially in women with histories of depression

• Vaginal and bladder problems, such as vaginal dryness, increased urinary frequency and incontinence, and vaginal/urinary tract infections

• Changes in sexual lifestyle. Women with dryness issues can experience discomfort during intercourse, while other women become more enthusiastic because pregnancy is no longer a concern.

Certain symptoms are not visible, but can lead to significant health risks, including:

• Loss of bone density and increased risk of osteoporosis

• Increase in low-density lipoprotein (LDL), or “bad” cholesterol level and decrease in high-density lipoprotein (HDL) or “good” cholesterol level, leading to a higher risk of heart disease

Talk to Your Doctor

Although discussion within your social circles can be reassuring, Saunders recommends that women experiencing these symptoms or have a general “off” feeling start a discussion with their family doctors or gynecologists, for starters.

“Perimenopause can be a cautious time for women whose cholesterol levels have been generally healthy,” Saunders said. “In addition to treating the hot flashes and mood swings, we have to be vigilant about the silent symptoms that can lead to higher cardiac and stroke risk. Attention to bone loss is equally important, especially for women already at higher risk.” 

It’s also important for women to understand that perimenopause affects each woman differently. While one woman may notice mild symptoms, her neighbor might feel debilitated by the effects of what can be a constellation of symptoms. 

“Perimenopause is definitely not a one-size-fits all,” Saunders remarked, “but the risks for heart disease and bone loss are consistent for perimenopausal women. Because we have more research and our patients are more educated and proactive, we’re able to provide better treatment and quality of life for women of that certain age.” 

Part two of this series, “Menopause, Medicine and Myths,” will be published on Tuesday, Oct. 13.