Perimenopause and Menopause Symptoms: When to Seek Help and How Virtual Care Can Support You
Menopause and the years leading up to it are a natural stage of life, but that doesn't mean the symptoms that come with it are always easy to manage on your own. Hot flashes, mood changes, sleep disruption, and other shifts can affect daily life in ways that deserve real support, not just a shrug and a "that's just part of getting older." Knowing what to expect, when to reach out for help, and how virtual care can support you through this transition can make a meaningful difference.
What Is Perimenopause, and How Is It Different From Menopause?
These two terms are often used interchangeably, but they describe different parts of the same journey. Menopause refers to a single point in time: the day that marks twelve full months since your last menstrual period. Perimenopause is the stretch of time leading up to that point, when estrogen, progesterone, and testosterone levels gradually decline and periods often become irregular. Once you have gone a full year without a period, you are considered postmenopausal. On average, perimenopause lasts around six years, though this varies quite a bit from person to person. Because cycles can become unpredictable during this time, with periods that come late, skip a month, or arrive unexpectedly, many people do not realize they have reached menopause until they look back and recognize a full year has passed since their last period.
Perimenopause Can Start Earlier Than You Think, Especially for Women of Color
Most people associate menopause with the mid to late forties, and on average, menopause does occur around age 45 to 47. But perimenopause, the lead up to that point, can begin much earlier than expected. In a conversation on the Tree of Life podcast, board certified family medicine physician Dr. Dionne Castillo explained that while perimenopause is often described as starting about six years before menopause, research and clinical experience suggest that timeline can look different across racial groups, with earlier onset commonly reported among Black women and, to a lesser extent, Latina women, compared to Caucasian women. Dr. Castillo pointed to broader gaps in women's health research funding and access to care as likely contributors, though more research is still needed to fully understand why. The takeaway is simple: if you are in your late thirties or early forties and starting to notice changes, it is worth talking to a physician rather than assuming you are too young for perimenopause.
Early Signs That Often Get Overlooked
Hot flashes tend to get the most attention, but they are often not the first sign of perimenopause. Many people notice changes in mood, focus, and sleep well before hot flashes ever start. During the same podcast conversation, Dr. Castillo described brain fog, anxiety, low mood, and trouble sleeping as some of the earliest and most commonly missed symptoms, since they are easy to dismiss as stress or simply having a lot going on. Estrogen plays a role in supporting brain connections and regulating neurotransmitters, so as levels shift during perimenopause, it is common to notice:
Brain fog, including trouble finding words or short term memory lapses
New or worsening anxiety, irritability, or low mood
Trouble falling or staying asleep
Persistent fatigue, even after a full night's sleep
Weight changes that do not respond to the usual diet and exercise habits
New joint or shoulder stiffness
Irregular periods
Hot flashes and night sweats
Because these early symptoms are often mental and emotional rather than physical, they can be easy to brush off or explain away. Paying attention to what feels different for you, and writing it down, can make these changes easier to recognize and easier to discuss with a physician.
Why You Should Never Just Push Through It
A common theme from Dr. Castillo's conversation with Dr. Smithbey was this: do not wait it out on your own. Getting evaluated matters, in part because perimenopause is generally what is known as a diagnosis of exclusion. That means a physician will first want to rule out other conditions that can cause similar symptoms, such as thyroid disorders, diabetes, or vitamin deficiencies, since there is no single lab test that confirms perimenopause on its own. Ruling these other causes out, or identifying and treating them if they are present, is an important part of getting a clear, personalized answer instead of guessing.
Common Menopause Symptoms
As you move closer to and through menopause itself, symptoms often continue or shift. Some of the most common include:
Hot flashes and night sweats
Sleep disturbances or insomnia
Mood changes, irritability, or increased anxiety
Fatigue and low energy
Changes in weight or metabolism
Brain fog or difficulty concentrating
Vaginal dryness and changes in libido
When to Seek Help
There's no single moment when it becomes "okay" to ask for support. That said, a few signs suggest it's a good time to talk with a physician: symptoms are interfering with sleep, work, or relationships, mood changes feel bigger than usual or are affecting your day to day, hot flashes or night sweats are frequent or intense, or you simply have questions about what's happening in your body and want a personalized plan instead of guessing. Perimenopause and menopause are not something you have to push through alone.
How Virtual Care Can Support You Through Perimenopause and Menopause
An integrative approach to perimenopause and menopause looks at more than a single symptom. It considers hormones, nutrition, sleep, stress, and emotional well being together, since these systems are closely connected. Virtual care makes this kind of ongoing, whole person support easier to access.
Personalized evaluation: A full review of your symptoms, health history, and goals to understand what's happening in your specific case.
Hormonal and lifestyle guidance: Support that may include nutrition, sleep, stress management, and movement recommendations alongside medical treatment.
Medication review when appropriate: Options are discussed and, when clinically appropriate, prescriptions are sent electronically to your pharmacy.
Ongoing followup: Symptoms can shift over time, and virtual visits make it easier to check in and adjust your plan as needed.
A judgment free space: A chance to ask questions about a stage of life that isn't always talked about openly.
What to Expect From a Virtual Visit
Your first visit typically runs about 60 minutes and covers your symptoms, medical history, and what matters most to you, whether that's better sleep, more stable mood, or simply understanding what's normal. From there, a personalized care plan is built around your goals. Followup visits are shorter, around 30 minutes, and focus on how you're responding and what, if anything, needs to be adjusted.
Frequently Asked Questions
What is the difference between perimenopause and menopause?
Perimenopause is the transitional period leading up to menopause, when hormone levels gradually shift and periods often become irregular. Menopause is a single point in time, the day marking twelve months since your last period.
Is it normal to have anxiety or mood changes during perimenopause?
Yes, hormonal shifts during perimenopause and menopause can affect mood, and many people notice increased anxiety, irritability, or brain fog well before hot flashes start. It's worth discussing with a physician, especially if it's affecting your daily life.
Can perimenopause and menopause symptoms be managed without hormone therapy?
For many people, yes. Nutrition, sleep habits, stress management, and other lifestyle factors can meaningfully ease symptoms. Whether hormone therapy makes sense depends on your individual health history and goals, which is best discussed one on one with your physician.
How do I know if what I'm feeling is perimenopause or something else?
Symptoms like irregular periods, brain fog, mood changes, and hot flashes can point to perimenopause, but a proper evaluation is needed to rule out other causes, such as thyroid or blood sugar issues, and confirm what's going on.
Can I discuss perimenopause or menopause symptoms in a virtual visit instead of going in person?
Yes. Perimenopause, menopause, and hormonal wellness are among the concerns commonly supported through virtual visits, with in person referral available if it's ever needed.
This article is for general educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. It does not describe any individual patient case. Always talk with a qualified physician about your specific symptoms and health history before making changes to your care.
Learn More: The Midlife Reset Podcast
For more on this topic, watch Dr. Shakeilla Smithbey's conversation with Dr. Dionne Castillo, a board certified family medicine physician, on the Tree of Life podcast, Episode 15, "The Midlife Reset: Perimenopause and Wellness." They talk through what perimenopause really looks like, why it is so often under discussed, and how to advocate for yourself when seeking care.
Watch the episode: The Midlife Reset: Perimenopause and Wellness, Episode 15
If perimenopause or menopause symptoms are affecting your sleep, mood, or day to day life, you don't have to figure it out alone. Dr. Shakeilla Smithbey offers virtual visits that look at the whole picture and build a plan around what you need.
