Perimenopause To Menopause: Important Things to Know

The human body changes over time, both externally and internally. Hormones are one of the body’s great regulators and both men and women experience hormonal fluctuations throughout their lives.

For women, the transition through perimenopause to menopause is a time of major hormonal fluctuation. The phases are often confused with each other, but true menopause is when a woman has not menstruated for a full year. Perimenopause is the phase leading to menopause and lasts an average of four years, although it can range from a few months to 10 years. A woman’s body typically begins to start the perimenopause process at age 35.


Perimenopause usually begins between the age of 35 and 50 when the ovaries begin to produce less estrogen. The imbalance of estrogen and progesterone often results in missed periods as well as side effects like hot flashes (the most common side effect of perimenopause), fatigue or low energy, difficulty sleeping, decreased libido and what some women call “PMS plus” —instances when pre-menstrual side effects worsen.

Like many transitions, perimenopause can be physically and emotionally challenging. There is no quick fix for troublesome side effects but many women find relief in lifestyle changes that improve overall health, including:

  • Adding moderate exercise to your daily schedule
  • Improving nutrition
  • Avoiding smoking and alcohol
  • Reducing stress
  • Increasing water intake
  • Practicing good sleep hygiene

Hormone replacement therapy (HRT) and bioidentical hormone therapy (BHT) provide side effect relief for some women. These therapies help balance hormone levels that vary throughout perimenopause. However, using hormones to control symptoms are NOT mandatory. The first question to ask is, “how much do my symptoms affect my daily life?” And if the answer is not at all, then no hormones are needed at that time. The fluctuations of the hormones are like the waves of the oceans. Symptoms are variable depending on lifestyle habits, stress during that particular period in your life, weight loss or weight gain, climate and weather changes and Mother Nature.


Even though menopause is the official ending of your menstrual periods, the hormone fluctuations that created side effects during perimenopause are still occurring, meaning that some perimenopause symptoms may remain (or return) and new side effects could appear during menopause.

Once women reach menopause they are at greater risk for developing osteoporosis, a disease that weakens bones. The post-menopausal drop in estrogen is directly related to loss of bone mass. Because there are no symptoms of bone loss, it’s often only after a bone-related injury that the presence of osteoporosis is discovered. Bone mineral density tests (BMD) are x-rays that measure bone density. Screening should begin if you have any of the following risk factors or at the cessation of the menstrual cycle. The following puts you at a higher risk of developing osteopenia or osteoporosis:

  • Advanced age
  • Your race – Caucasians and Asians have a higher prevalence of osteoporosis
  • Family history of osteoporosis
  • Body frame – people with petite frames can have a higher risk because they often have less bone mass to begin with.

Likewise, your doctor can offer osteoporosis treatment and prevention suggestions which may include:

  • Eating foods high in calcium
  • Calcium and vitamin D supplements
  • Bone density medications
  • Estrogen therapy
  • Exercise, especially weight bearing exercise
  • Medically Supervised Weight Management
  • Avoiding smoking and alcohol

Health Care Options for Perimenopause and Menopause

Perhaps one of the most important things to know about perimenopause and menopause is that you aren’t alone. Approximately three million women transition to menopause every year and there are abundant health care options for both phases. Each woman will enter this phase in her life. During these transition years, remember that these symptoms are not forever. Your doctor can help get you through the storm, by teaching you to dance in the rain.

Certainly the scope of this topic is much more in depth and much more individualized than can be covered here. Knowing that the greatest years of your life don’t have to be the darkest days, lends hope for every woman to reclaim her body.

Dr. Raman’s Concierge Medical Practice is focused on caring for each person as a whole, not just a list of symptoms. Our office is committed to helping our patients stay well and maintain good health rather than treating patients only after they become ill.

For more information or to schedule an appointment with Dr. Raman, please contact us today.

The Importance of Well Woman Exams: Keep It On Your Calendar

Recommendations about women’s health screening have changed in recent years, and often-conflicting information can lead to confusion. For instance, according to the American College of Obstetricians and Gynecologists, not every woman needs an annual screening for cervical cancer, known as a Pap test. Authorities on breast cancer also vary on their recommendations for mammograms, but it is important to listen to your body and be proactive—no matter what the guidelines may say.

What hasn’t changed, however, is an across-the-board recommendation for annual well woman exams. In fact, annual well woman exams are considered routine preventive care as outlined by the Affordable Care Act.

Pelvic Exams

Even if a Pap test is not performed, an annual pelvic exam allows your doctor to check your vulva, vagina, cervix, uterus, rectum, ovaries, and pelvis, comparing each part of the pelvis with the results from the previous year’s exam. As a woman enters various phases of the hormonal cycle in her life, there will be changes in a woman’s anatomy. Regular pelvic exams help to track these changes and give patients opportunities to discuss any concerns with her physician.

Clinical Breast Exams

A clinical breast exam (CBE) is part of a well woman visit, which offers an opportunity to discuss a personal schedule for mammogram screenings. Many health authorities now recommend biennial (every two years) mammogram screenings for women ages 50-74. Other equally reliable authorities continue to recommend annual mammograms beginning at age 40 and continuing beyond age 74.

**It is essential to remember that the best defense against breast cancer is a good offense. Monthly breast self-exams should be done in-between clinical breast exams. The biggest reason for non-compliance in doing monthly breast self-exams is, “I don’t know what I am feeling for.” This is precisely why a woman should make this part of her monthly routine. The more familiar a woman is with the findings in her breast during self-exams, the more she will know what is normal and what is not. With practice, each month will become easier.  

Colorectal Screenings

Colorectal cancer screening guidelines, as well as most patients’ reluctance to get screened, have remained relatively stable over the years.

The stigma of the prep for the colonoscopy and the sensitive nature of the procedure can quickly cause undue stress and anxiety.

Most colon cancers arise from a single polyp. A colonoscopy can detect and treat the polyp during the procedure itself. But often if the polyp is not removed, this can and often does lead to colon cancer. Isn’t it better to endure a few hours of discomfort for the prep and procedure of a colonoscopy rather than enduring a removal of part of the colon for a treatable colon cancer?

A Discussion About Overall Health

An annual well visit also focuses on general overall health and maintains an ongoing discussion between you and your doctor about healthy lifestyle choices, reducing or eliminating health risks, weight concerns and healthy aging (inside and out). Screenings that facilitate these discussions include full in-depth discussions on physical, emotional, psychological and environmental stressors. A detailed blood work and physical exam with blood pressure, body mass index (BMI) screenings and body fat analysis will help identify the source of symptoms. A symptom is your body’s way of talking with you. DON’T IGNORE THESE WARNING SIGNS!

As your well woman exam appointment approaches, you might consider other issues that affect your overall health and be prepared to cover these areas with your doctor, including:

  • Contraceptive counseling
  • Tobacco, alcohol or drug use
  • Depression screening
  • Vaccines and immunizations
  • HIV screening
  • Sexually transmitted infection (STI) screening

View your annual well woman exam as an opportunity to partner with your doctor on the business of your good health. The active role you take in your day-to-day health is encouraged and supported by your doctor, and your well woman visit is the best way to review and fine-tune your efforts.

Dr. Raman’s Concierge Medical Practice is focused on holistic care and good health maintenance through routine wellness exams.

For more information on well woman exams or to schedule an appointment, please CONTACT our office today! You can also learn more by connecting with Dr. Raman on Facebook, Twitter, LinkedIn, and Pinterest.