An introduction to perimenopause, menopause and menopausal symptoms

by Dixie Mills, MD

Over a million women a year use our website, and most of them are trying to learn about menopause, perimenopause or other health problems arising from hormonal imbalance. So we work hard to provide a lot of help here, and in a moment we’ll try to answer all your questions.

Quick definitions for menopause and hormonal balance

Menopause is just a point in time — the date on which you haven’t had a menstrual period for a year. Perimenopause is the period of hormonal fluctuation that leads up to menopause; it can last from five to 15 years or longer. Early menopause does occur for a tiny fraction of women, but the term is mostly used by women — not practitioners — when symptoms occur much earlier than “normal.” Medical menopause is menopause brought about by medical treatment — typically hysterectomy or cancer treatment — and an incredible 25% of women enter menopause this way.

Hormonal balance is our normal state. When we have menopausal symptoms, we are suffering from hormonal imbalance — an abnormal state. About 80% of women today experience symptoms of hormonal imbalance — more than ever before — because of the extraordinary demands made on their bodies and the inadequate support provided. Fortunately, nearly all women can find relief from the symptoms of perimenopause and menopause by restoring that balance — naturally and without drugs. And we’re here to show you how.

Why do women come to us with so many unanswered questions? Why do so many women feel dissatisfied with the answers they’re getting from conventional medicine?

The simple answer is that conventional medicine breaks everything down into separate parts that can be separately controlled — and that’s not how the female body works. As you explore our website and find the answers you need, keep in mind that every aspect of your life affects your health — and that no symptom or health problem can be viewed (or controlled) in isolation.

So here are the resources for you in this section of our website. Read on for the answers you seek, then give us a call if you would like additional guidance.

Our most popular resources on menopause

To access an article, just choose from the list of excerpts below. To find more articles, use the search function below. Don’t see a topic that’s important to you? Let us know.

• Menopause — ending the confusion
  Conventional medicine and the sensational media have created so much confusion among women about menopause. It’s helpful to shed these myths and mistruths as you begin to take control of your health.
• Good news about sex and menopause — the pleasure has just begun
  Marcelle Pick talks one-on-one with Dr. Christiane Northrup about sex and menopause.
• Perimenopause — the beginning of hormonal change
  Most women are surprised to learn how early perimenopause can start — often in your 30’s — and how many symptoms it causes. Learn more about the physiological changes in your body as you start your transformation.
• Phytotherapy — the key to hormonal balance?
  Women have been drawing on the healing properties of medicinal plants and herbs since the dawn of time. Scientific research today is showing us how phytotherapy works upstream of where stronger pharmaceutical drugs do their work, to offer women a safe alternative for restoring health and hormonal imbalance.
• Weight gain in perimenopause and menopause
  After years of barely keeping their weight “in check,” many women entering menopause are shocked and dismayed by sudden weight gain in the waist, hips, and belly. But this is not the beginning of the end, rather an opportunity to make the changes that keep you strong and healthy for decades to come.
• Talking with your partner about menopause
  If you’re in a relationship and going through menopause, your partner may need some help understanding what’s happening inside you. Here are some tips from Women to Women on how to talk to your partner about menopause.
• Talking about menopause with your doctor
  Though “menopause” is frequently the subject of media attention and conversation these days, many women in perimenopause and menopause have difficulty talking with their doctors about this important transition. Here’s how to open the door on the subject, set the tone for a positive, mutually respectful doctor–patient relationship, and get the help you want and deserve.
• Test your menopause IQ
  Take our menopause IQ test...
• Bridging the gap — talking with your partner about menopause
  Information about communication in relationships during menopause.
• Signs and symptoms of perimenopause and menopause
  A look at the fundamental symptoms of hormonal imbalance, why they emerge during menopause and perimenopause, and what you can do to get natural relief.
• Soy: a natural solution in menopause
  An outline of what we’ve observed about soy from over 20 years of clinical experience, when and why we recommend it to women in perimenopause and menopause, why it works for many but not for everyone, and how to determine for yourself whether to give it a try.
• Estrogen dominance — is it real?
  Dr. John Lee argued that perimenopausal symptoms are caused not by a lack of estrogen but a lack of progesterone. This simplistic idea has led many to claim that progesterone alone will remedy the symptoms of perimenopause. We sort the truth out from the fiction.
• Help for hot flashes and night sweats
  A look at the basics of hot flashes and night sweats, and how you can decrease their frequency and severity with natural methods that support hormonal balance from within.
• Rekindling sexual desire — the soul of your libido
  Aside from the physical changes that can impact a woman’s libido as the years go by, there are less tangible, psychosocial issues that can thwart our sexual response. This article examines how to deconstruct the inner beliefs about beauty and body image that no longer serve you, reframe personal power in relation to your sexual identity, and rekindle the fire in your sexual relationship.
• Vaginal dryness — you have options
  Vaginal dryness ranks as one of the top-ten problems experienced by women in menopause. But even women on conventional forms of HRT report that their vaginal dryness persists. Here is the Women to Women approach to resolving this bothersome symptom of hormonal imbalance.
• Treatments for vaginal dryness — natural estrogen products and more
  Here’s an overview of the range of bioidentical estrogen options available by prescription, as well as non-hormonal products that can help provide relief from vaginal dryness. We encourage you to give these products a try until you find one or a combination that works for you.
• Conditions associated with vaginal dryness
  Information and advice on conditions that may underly a woman’s vaginal dryness: from atrophic vaginal changes and atrophic vaginitis to lichen sclerosis and vulvodynia, it’s important to identify the cause of your vaginal dryness and discomfort and get the treatment you need.
• Menopause/FSH tests: what they can and cannot do
  Unfortunately, those home hormone tests for FSH levels don’t prove whether or not you’re in menopause. Your doctor may not give you great answers, either. Here’s how to tell what’s going on.
• Black cohosh for menopausal symptoms
  If you’ve been thinking of giving black cohosh a try but have some reservations, here’s a synopsis on its use for menopausal symptoms; research on its underlying mechanisms of action; precautions, what to look for, and typical dosages; and why it works best when laid overtop a core foundation of dietary, lifestyle and gentle endocrine support measures.
• Red clover for menopausal symptoms
  Clover is a special herb, in that it contains four different isoflavones found helpful for menopausal symptoms, as well as beneficial coumestans and lignans. Learn more about red clover’s ability to moderate negative effects of both low and high estrogen levels in the body. Includes information on what to look for and typical dosages, side effects and safety, and links to additional reading.
• Should I take antidepressants for menopause?
  Antidepressants are being heavily marketed to the menopausal woman and her doctor for symptoms such as hot flashes and roller-coaster emotions. But menopause is not a psychological disorder, and antidepressants are not the magic bullet their makers might have us believe. Here’s what you need to know about safety, efficacy, and alternatives — before you fill that prescription!
• Birth control pills in perimenopause
  Some of us have been on the Pill for 30 years or more and wonder when to get off. Others are being told to start BCP’s now to relieve perimenopause symptoms. What gets lost in this merry-go-round is that the Pill contains hormones just like HRT does, and sooner or later we all have to get off. Let’s review the alternatives you may want to consider.
• Post-menopause — what is menopause and what happens after the change?
  Although most of our website is devoted to women’s health in the years before and leading into menopause, this article is about the years post-menopause and how to make this the best time of your life.
• Post-menopausal bleeding
  — what does it mean? Up to 20–30% of women experience spotting or what seems like a period post-menopause. This can happen for a number of reasons, and knowing the cause can be critical to your health. Fortunately, post-menopausal bleeding is highly treatable — but the best protection is information. Here’s what you need to know.
• Hyperplasia of the uterus
  Here’s an description of why and how a uterine exam and endometrial biopsy are performed, how to interpret your results, and an overview of your options in follow-up. Knowing what to expect in advance will provide you with the information and confidence you need to make good decisions for your long-term health.
• What I love about menopause
  Start with this article to give yourself a realistic picture of what lies before you. The truth is, you can feel and look better than you ever imagined, even if your symptoms right now are terrible. Here’s how.
• If Mama’s not happy, nobody’s happy
  Women to Women offers suggestions for connecting with and talking to teen children about menopause.
• A look at menopause across cultures
  Why do the women of some cultures experience significant problems in menopause, while others barely have (or need) language for such symptoms? Here’s a cross-cultural look at the menopausal experience, some theories on the true “purpose” of menopause, and insight into how expectations can mold our realities.
• Empty nest syndrome — redefining yourself once the kids are grown
  Many women in menopause also experience the emotional strain of their children growing up and leaving home. Read about empty nest syndrome and learn more.
• Low sex drive in women — causes and solutions
  Almost every woman will experience changes in her libido and sexual response during perimenopause. Here we look into the physical (and beyond) to explain what’s happening to you and why — and what you can do to feel like yourself again.
• FAQ’s on menopause, perimenopause, and post-menopause
  Many of our patients’ and readers’ questions on menopause have prompted the articles we publish on this website. But no matter how many questions we hear, there will always be more to explore. Here are a few more that you, too, may find yourself asking.

Our website offers help in three ways:

• Articles in women’s health from the perspective of our practitioners.
• A personalized, at-home program that provides the foundation of health we recommend for every woman.  To learn more, call us at 1-800-798-7902 .
• Clinical care at our medical practice in Yarmouth, Maine.

Our Personal Program is a great place to start

The Personal Program promotes natural hormonal balance with nutritional supplements, our exclusive endocrine support formula, dietary and lifestyle guidance, and optional phone consultations with our Nurse–Educators. It is a convenient, at-home version of what we recommend to all our patients at the clinic.

• To learn more about the Program, go to How the Personal Program works.
• To select the Program that’s right for your symptoms, go to Choose the plan that works for you.
• To assess your symptoms, take our on-line Hormonal Health Profile.
• If you have questions, don’t hesitate to call us toll-free at 1-800-798-7902. We’re here to listen and help.

Original Publication Date: 11/14/2005
Last Modified: 08/17/2009
Principal Author: Dixie Mills, MD