Many women expect a blood test or lab work to determine whether they have begun perimenopause, but the body often tells the story before any exam can.
“It’s not the numbers on the page that should drive your medical care,” says Tiffany Woodus, MD, OB-GYN on the medical staff at Methodist Charlton Medical Center. “It’s how you’re feeling and how you’re coping.”
The first sign of change shows up in their menstrual cycle. Periods that once ran like clockwork may suddenly arrive earlier or later, last longer or shorter, or even skip a month.
“There literally is no rhyme or reason to what happens to your cycle,” Dr. Woodus says. “Those irregular cycles are the most common symptom we see with perimenopause.”
These shifts can feel unsettling, even alarming. But doctors say those changes are the body’s way of signaling the natural transition into menopause.
TESTS CAN BE UNRELIABLE
Hormones are unpredictable during this transition, and Dr. Woodus often tells her patients that lab work cannot reliably pinpoint the beginning of perimenopause or menopause.
“Our hormone levels fluctuate so significantly,” she explains. “If I see a patient in the morning, her levels may be one way. If I see her later that same day, they could look completely different.”
Instead, the better measure is what’s happening with your cycle. Is your period heavier? Lighter? Are the days between getting shorter or longer? Those changes speak louder than a lab result ever could.
Over-the-counter tests that claim to allow women to determine how close they are to menopause use a urine sample to detect follicle-stimulating hormone (FSH), which tends to be high in women nearing menopause. But because FSH is also high before ovulation, these at-home tests may not show much.
“They’re not necessary or helpful for your medical professional,” says Robin Kindred, MD, OB-GYN on the medical staff at Methodist Midlothian Medical Center. “No lab test is going to prove this more than your own symptoms and your lived experience.”
Dr. Kindred notes that the beginning of menopause is clearly defined as “the cessation of period,” literally 12 months without a menstrual cycle. But that may not strictly apply to every woman.
It’s time to get real about perimenopause care. We know it’s not in your head. And we know how to help.
HOW PERIODS GET IT WRONG
For some women, menstrual changes may not serve as a reliable guide. Women who have had a hysterectomy or live with polycystic ovary syndrome (PCOS) may not have regular periods to mark the transition.
Other conditions like weight changes, thyroid problems, autoimmune disorders like lupus, and of course, an unexpected pregnancy can disrupt menstrual cycles.
“That’s when we pay closer attention to other symptoms,” says Heather Havener, MD, OB-GYN at Methodist Mansfield Medical Center. “Hot flashes, night sweats, mood swings, or sleep difficulties can be just as telling.”
These signs, she adds, help doctors piece together the bigger picture of hormonal shifts.
TALK TO YOUR DOCTOR
All these physicians agree: The best tool in this transition isn’t found in a lab. It’s found in your doctor’s office, with a candid conversation.
“If you have concerns with your health or well-being, please go speak with your physician,” Dr. Woodus says. “If you don’t feel comfortable speaking with your doctor, that’s not the right one for you.”
No woman should feel brushed off.
“You’re not imagining things,” Dr. Woodus stresses. “These changes are real.”
Perimenopause doesn’t look the same for everyone. For some, it’s only irregular cycles. For others, the changes ripple into daily life, bringing fatigue, brain fog, or mood swings that make it harder to keep up.
DON’T SUFFER ALONE
There is good news: Relief is possible and readily available.
“You do not have to suffer,” Dr. Woodus says. “We now have safe and effective options to help you through this transition and give you the quality of life you deserve.”
So if your periods don’t look like they used to, take note. It could be your body’s way of asking for care and attention. And when you bring those changes to your doctor, you’ve already taken the most important step toward feeling better.
“Ultimately, it’s not about chasing a number in a lab test,” Dr. Havener says. “It’s about helping you feel your best.”
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