Everything You Need to Know About Perimenopause and Menopause

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For many, the journey through perimenopause and menopause is frustrating and worrisome. But it doesn’t have to be that way. Those going through perimenopause/menopause may be able to improve their experience by getting informed about perimenopause/menopause, their symptoms, how they are diagnosed, and available treatments. 

What is Perimenopause/Menopause?

Perimenopause and menopause are descriptors of menstrual function. One is considered menopausal when one full year has passed since their last menstrual cycle. This indicates that the body is no longer capable of ovulating and by extension, becoming pregnant. Typically, menopause develops in women around 51 years of age, but it can occur earlier or later. 

Perimenopause denotes a time near or between healthy menstruation and menopause. Perimenopause develops when the body is unable to produce the appropriate amount of estrogen or progesterone to properly complete a menstrual cycle. Depending on the individual, perimenopause may last for six months or as long as ten years before menopause occurs. 

The Hormonal Factors of Perimenopause and Menopause

As a woman grows older, factors of menstruation, particularly the values of estrogen and progesterone become dysregulated. This causes dysfunction that may at first appear similar to PMS. However, unlike PMS, the effects of perimenopause/menopause are long-lasting and, in some cases, irreversible.

Some describe estrogen as the essential female hormone responsible for most of the physical and neurological attributes of women. Progesterone is a regulatory hormone that supports healthy neurological activity by producing a neurotransmitter known as GABA. It also acts as a safeguard against estrogen dominance, which encourages healthy emotional activity, physical development, and neurological function. 

Symptoms of Perimenopause and Menopause

As perimenopause/menopause continues to develop and the balance of estrogen and progesterone worsens, serious symptoms may develop. Below are some of the symptoms most often associated with perimenopause and menopause. 

Symptoms Associated with Perimenopause

Symptoms of perimenopause may be due to poor production of estrogen or inadequate release of progesterone during menstruation. Depending on the cause, a woman going through perimenopause may experience a unique collection of symptoms. 

Perimenopausal symptoms induced by lack of progesterone include:

  • Bloating
  • Breast tenderness or enlargement
  • Cramps
  • Fibroids
  • Heavier or longer periods
  • Increased frequency of periods
  • Insomnia
  • Mood irregularities
  • Ovarian cysts

Perimenopausal symptoms caused by poor estrogen production include:

  • Acne
  • Fatigue
  • Forgetfulness
  • Heart palpitations
  • Hot flashes or night sweats
  • Increased length between periods
  • Migraines or headaches
  • Shorter or missed periods
  • Vaginal dryness
  • Weepiness
  • Weight gain

Despite the initial cause, perimenopausal women may experience some or all the symptoms listed in each section above. 

Symptoms and Long-term Effects of Menopause

Because menopause is caused by a decline in hormone production similar to perimenopause, it should not come as a surprise that many symptoms are shared between the two conditions. In addition to the symptoms listed above, menopause may also cause the following:

  • Brain fog
  • Depression
  • Hair loss
  • Hot flashes or night sweats
  • Loss of libido
  • Muscle pain, weakness, aching
  • Thinning skin
  • Weight gain

The major symptomatic distinction between perimenopause and menopause is that menopause is associated with greater occurrence of degenerative symptoms. As a woman progresses through menopause and estrogen and progesterone imbalances worsen, the risk of developing the following conditions increases:

  • Bone loss or osteoporosis
  • Cardiovascular disease
  • Decline in cognitive ability
  • Neurological disorders such as Alzheimer’s and Dementia
  • Prolapse of the bladder

After menopause concludes, most symptoms dissipate. However, the degenerative issues such may remain. Therefore, even if the most obvious physical symptoms of menopause are gone, it is important that menopausal women pursue diagnosis and treatment to protect their wellness. 

Testing for Perimenopause and Menopause

Typically, perimenopause/menopause is identified by the patient before any professional diagnosis is required. However, being tested and confirming the suspicion is still beneficial. 

Standard testing for perimenopause/menopause includes hormone assessment in the form of a blood panel. Testing for potential contributors such as adrenal activity or thyroid function may also prove to be useful. Furthermore, testing for FSH (follicle stimulating hormone) and LH (luteinizing hormone) may conducted. These hormone tests can be used to confirm if a woman is very near or has already entered into menopause. However, at the point where tests provide confirmation, symptoms have typically already progressed far enough that menopause is easily diagnosed. 

Some patients who have concerns that they are going through perimenopause/menopause are unable to convince their doctor to get tested. If you find yourself in such a situation the best course of action is to track your symptoms and record their occurrence. This provides a timeline that can provide convincing data and aid in diagnosis. If this is not enough for your doctor, it may be time to find a new physician willing to listen to your concerns. 

Treatment Options for Perimenopause and Menopause

When treating perimenopause/menopause, the primary goal is to restore and maintain the appropriate balance of estrogen and progesterone. Treatment is typically aimed at imitating the menstrual cycle by mirroring the natural rotation of estrogen and progesterone. Several methods may be used to achieve this goal. 

Bioidentical Hormone Replacement Therapies

Supplying the body with hormones to restore and improve balance is a common treatment approach. A variety of hormone therapy options are available including topical creams or gels, sublingual (under the tongue) delivery, oral administrations, and injections. Each of these approaches have their own benefits and drawbacks depending on the patient’s individual needs. 

Before engaging in hormone therapy, it is important to consider the quality and source of the hormone medication. Studies show that synthetic hormones, and some naturally derived variants, can seriously damage the body. Research raises concerns of increased incidence of cancer, stroke, heart disease, dementia, and breast cancer. In contrast, bioidentical hormones, which the body views and uses as if they were its own, have been shown to be much safer and may actually limit the risk of degenerative disease while also improving perimenopause/menopause. Therefore, hormone therapies utilizing bioidentical hormones should be the first choice when treating perimenopause/menopause.  

Learn more about the difference between HRT and Bioidentical HRT here.

Lifestyle Changes

An essential component of alleviating perimenopause/menopause is adopting a healthy lifestyle. Getting enough sleep, optimizing diet, and engaging in healthy exercise are three critical components of normalizing bodily function and hormone activity. Speak with a doctor for more information about improving sleep quality and creating an individualized diet and exercise plan. 


It is common for women going through perimenopause/menopause to experience a wide range of nutritional deficiencies. Worse still, this often happens without their knowledge. Alleviating these issues may be done by supplying the body with the right nutrients. The following supplements may be beneficial on your own perimenopause/menopausal journey:

  • B Complex
  • Fish oil
  • GABA
  • Iron
  • L-Theanine
  • Magnesium
  • Melatonin
  • Vitamin D

If you’re looking for high-quality supplements, we recommend HoltraCeuticals.

Perimenopause and Menopause Support

Even though the vast majority of women will experience perimenopause/menopause during their lifetime, there is still a great deal of mystery and uncertainty surrounding the topic. Because of this, many women experience significant anxiety, frustration, and concern when faced with the prospect of moving through menopause. In reality, perimenopause/menopause may be effectively treated and managed as long as the appropriate steps are taken. Hopefully, by learning more about perimenopause/menopause, its symptoms, testing protocols, and treatment options, you have gained the knowledge needed to more confidently progress on your wellness journey. 

At Holtorf Medical Group, our physicians are trained to utilize cutting-edge testing and innovative treatments to address perimenopause and menopause. If you are experiencing symptoms of perimenopause/menopause, but aren’t getting the treatment you need, call us at 877-508-1177 to see how we can help you!


1. Kent Holtorf, MD. “The Bioidentical Hormone Debate: Are Bioidentical Hormones (Estradiol, Estriol, and Progesterone) Safer or More Efficacious than Commonly Used Synthetic Versions in Hormone Replacement Therapy?” https://www.holtorfmed.com/download/natural-hormone-replacement/The_Bioidentical_Hormone_Debate.pdf
2. Kent Holtorf, MD. “Hormone Study Confusion.” https://www.holtorfmed.com/download/natural-hormone-replacement/Hormone_Study_Confusion.pdf
3. Kent Holtorf, MD. “Natural (Bio-identical) vs. Synthetic HRT.” https://www.holtorfmed.com/download/natural-hormone-replacement/Natural_vs_Synthetic_HRT_Literature_Review.pdf.
3. Kent Holtorf, MD. “Breast Cancer and BHRT.” https://www.holtorfmed.com/download/natural-hormone-replacement/BHRT_and_Risk_of_Breast_Cancer.pdf.

About Holtorf Medical Group

The Holtorf Medical Group specializes in optimizing quality of life and being medical detectives to uncover the underlying cause of symptoms, rather than just prescribing medications to cover-up the symptoms. We are experts in natural, prescription bioidentical hormone replacement and optimization, complex endocrine dysfunction, fibromyalgia, chronic fatigue syndrome and Lyme disease.

We’ve dedicated our practice to providing you the best in evidenced-based, integrative medicine that’s not only safe and effective, but provides measurable results.