Conditions
Menopause and hormonal health
Perimenopause is frequently missed, frequently dismissed, and rarely explained properly. Symptoms often start years before periods change, which is part of why it goes unrecognised.
More than hot flushes
Sleep disruption, anxiety, joint pain, palpitations, brain fog and a sense of not being oneself are all common, and all commonly attributed to something else.
The cognitive symptoms in particular alarm people, and they are worth naming: many women in their late forties worry they are developing early dementia when they are experiencing perimenopause.
How I approach it
Symptom pattern and timing first. Hormonal testing has real limitations in perimenopause because levels fluctuate substantially, and a single measurement can mislead; where I test, I interpret it in that light.
Alongside that, the things that make hormonal transition harder: thyroid function, iron, vitamin D, blood glucose regulation, sleep and stress physiology.
HRT is a decision for you with your GP or a menopause specialist. My role is usually the surrounding picture, and making sure something else has not been missed.
The cognitive and long-term angle
There is a genuine relationship between hormonal change and cognitive symptoms, and a longer-term one with brain and metabolic health. Given my main clinical interest, this is where I pay particular attention.
Related
Discuss your case with Dr Greenland
A short discovery call is the usual starting point. It costs nothing, and it is the fastest way to find out whether this approach fits your situation.