When You Should See a Doctor About Menopause (or Perimenopause) Symptoms

It’s true that some people make it through perimenopause without many (or any) symptoms whatsoever. But what about everyone else? If you’re dealing with a new, frustrating or even painful symptom — like hot flashes, heavy periods or painful sex — you may feel like you’re supposed to just suck it up and muddle through.

We’re here to tell you that although that might’ve been the case in the past, it’s not anymore. You have options — and your healthcare provider can help.

“‘Just grin and bear it’ isn’t a solution,” says menopause specialist Pelin Batur, MD. “The conversation around menopause has finally started to shift to fostering wellness, listening to women and taking a look at the big picture for each individual person.”

Options for treating troubling symptoms of menopause range from home remedies and lifestyle changes to prescription medications and hormone replacement therapy. But only a healthcare provider can help you decide what’s right for you.

Dr. Batur outlines 12 times when you need to talk to a provider about your menopause symptoms.

Your periods have changed

Think of perimenopause as the not-so-glamorous runway to the big show (which, in this case, is menopause itself). Perimenopause can start as much as a decade before menopause, and during this time, you may start to experience symptoms.

“Perimenopause is often a time of transition when women experience screwed-up menstrual cycles,” Dr. Batur acknowledges. “For most people, this marks the last few years before your final menstrual cycle.”

There are a couple ways your period can change during this time — and all of them warrant a conversation with your healthcare provider, though some are more pressing than others.

You start missing periods

Dr. Batur says you should talk to your healthcare provider about missed periods, whether or not they seem problematic.

“I think everybody should be seen by their doctor once a year anyway,” she advises. “So, when you're starting to skip for prolonged periods of time, bring that up.”

Perimenopause and menopause are natural, normal phases of life, so there’s no “cure.” But this time can bring lots of changes to your body, so it’s good to discuss it with your provider.

For starters, they’ll want to make sure there’s no other reason why your periods have stopped, like a thyroid issue. Plus, if it is menopause, your provider will also want to discuss how to keep you healthy going forward.

“As you start to lose some of the protective benefits of estrogen, you increase your cardiovascular risks,” she explains, “so, your doctor will want to talk to you about preventive health measures.”

Dr. Batur also flags two times when you should make an appointment to talk to your healthcare provider about missed periods.

After you skip periods, your return period is very heavy

If you don’t have your period for a long time but then it comes back with a vengeance — like with painful cramps, large blood clots and spotting between cycles — then it’s also time for a conversation with a doctor.

“Let your doctor know if you’re skipping your period for months and months at a time, and then, the one you have after that is really heavy, like your body’s trying to compensate,” Dr. Batur advises.

You’re skipping periods before age 45

The typical time to begin menopause is between ages 45 and 58. If you’re in your mid-40s or younger and start to notice skipped periods, it’s extra-important to bring it to your provider’s attention.

“You need to seek guidance from your physician so they can explore a little further, like making sure your medical health is OK and that they’re not missing other reasons for your symptoms,” Dr. Batur says. “If it is menopause, they’ll want to talk about the pros and cons of hormone replacement therapy.”

Your periods have become heavy, painful or otherwise unusual

You may still be having regular (or regular-ish) periods in terms of timing. But perimenopause can always cause your periods to look or feel different from what they used to.

Let’s say your periods used to be four days long, and now, they’re always seven. Or you’re soaking through pads and tampons, which was never the case before. Or maybe you’re seeing heavy spotting between periods. All of those are issues to take to your healthcare provider.

Be on the lookout for:

• Periods that are much heavier than usual (menorrhagia)
• Passing large blood clots
• New or heavy spotting between cycles
• Significant cramping (dysmenorrhea)
• Periods that last longer than a week
• Periods that come more often than every 21 days
• Bleeding or spotting after not having a period for a year (postmenopausal bleeding)

“Anything that trends toward heavy bleeding should be discussed with your doctor,” Dr. Batur emphasizes. “While these issues can be hormonal, we need to be sure you don't have a uterine polyp. We also never want to miss a sign of uterine cancer.”

You’re experiencing vaginal dryness

Your vagina is sensitive to your body’s estrogen levels, so perimenopause and menopause can bring vaginal dryness. Over time, this can lead to genitourinary syndrome of menopause (GSM), aka vaginal atrophy — when the tissue lining the wall of your vagina becomes thin, dry and irritated.

This can cause itchiness, burning and even pain when you do everyday activities like walking, peeing, exercising or even just sitting down. It may also bring a yellowish vaginal discharge.

There are some home remedies for vaginal dryness, like vaginal moisturizers and lubricants. But it’s a problem that’s likely to get worse over time, not better — so, again, it’s important to talk to your healthcare provider about your options.

“About a half of people who go through menopause experience some vaginal dryness that may get in the way of intercourse,” Dr. Batur notes. “And while other symptoms of menopause tend to get better with time, vaginal dryness symptoms typically worsen.”

Sex has become painful

Vaginal dryness can make for painful sex (dyspareunia), which you may confuse for low libido. But think about it: If sex hurts, of course you’re avoiding it! Instead of focusing on your interest (or lack thereof) in having sex, Dr. Batur recommends talking to your healthcare provider, who can help treat the underlying cause of painful sex.

“I often hear from patients who tell me they just can’t figure out why they don’t want to have sex. But when we talk through it, it becomes clear that sex is painful for them,” she shares. “When we focus on treating their vaginal dryness, their sex drive often improves, too.”

Lubricants can help ease vaginal dryness and make sex less painful. But talk to your healthcare provider about what you’re experiencing, too.

“Vaginal hormones are very effective,” Dr. Batur adds. “Options like creams, vaginal rings and suppositories deliver hormones straight to the vagina to relieve your symptoms.”

You’re having frequent UTIs or other urinary problems

Genitourinary syndrome of menopause doesn't just affect the vagina. It can also impact the urinary structures, which can cause problems with your urinary system.

Talk to your healthcare provider if you experience symptoms like:

• Frequent urinary tract infections (UTIs)
• Being unable to hold your pee (urinary incontinence)
• Peeing more than usual
• Pain or a burning feeling when you pee (dysuria)
• Blood in your pee (hematuria)

“Some women feel like they can’t get a break from urinary tract infections,” Dr. Batur says, “and vaginal hormones can be very, very helpful in providing relief there as well.”

You can’t find relief from hot flashes or night sweats

Suddenly, it feels like a heat wave is taking over … from the inside. Your skin flushes, your heart rate goes up and now, you’re drenched in sweat, even on a perfectly temperate day. Hot flashes are one of the most well-known symptoms of the menopause transition, as are their close friend, night sweats (basically, hot flashes of the p.m. variety). Together, they’re known as vasomotor symptoms.

“Hot flashes aren’t dangerous, but they can certainly be upsetting for women who experience them frequently,” Dr. Batur recognizes. “If you’re having one or two hot flashes a day and you feel like you can get through them just fine, that’s no big deal.”

There are ways to try to manage your hot flashes and find relief from night sweats on your own, like by managing stress, avoiding triggers and eating a balanced diet. But that’s not always enough.

“If you’re plagued by them — you can’t sit through a meeting at work, you’re constantly flushing and sweating, you're not getting enough sleep because you’re waking up in a pool of sweat — then it becomes a quality-of-life issue,” she continues. In this case, your provider can talk to you about prescription medication that can help.

You can’t sleep

Sleep troubles can have all kinds of origins, from anxiety and caffeine to sleep disorders like sleep apnea and restless legs syndrome. Many people report disrupted sleep during menopause, too.

“Night sweats and urinary issues can be very disruptive to the sleep cycle, making it impossible for women to get through the night as well as they usually could,” Dr. Batur says.

If you’re having trouble falling asleep or staying asleep (or both), it’s always a good idea to talk to your healthcare provider to try to get to the root of the issue.

You’re under 45 and suspect perimenopause

It’s uncommon to begin menopause before age 45, but it can happen.

“If you’re in your early 40s or younger and you’re having symptoms of perimenopause, like skipping periods, you definitely need to bring that up to your doctor,” Dr. Batur stresses.

You may have primary ovarian insufficiency (POI), a condition that happens when your ovaries stop functioning earlier than age 40. When you have POI, your estrogen levels are low and your level of follicle-stimulating hormone (the brain hormone that regulates your ovaries’ hormone production) is high.

Low estrogen from POI can raise your risk of health conditions like:

• Osteoporosis
• Heart disease
• Hypothyroidism (underactive thyroid)
• Infertility

Because of these health risks, people with POI often start hormone replacement therapy (HRT). Your healthcare provider can talk you through the options and help you protect your health.

Your symptoms are interfering with your daily life

At the end of the day, no one can tell you how bad your symptoms need to be before you should seek help from a healthcare provider. But if what you’re experiencing is making your life worse, it’s time to make an appointment.

Plus, you can read every list of symptoms in the world and still not see your exact experience outlined or explained. Maybe you’re having an issue that doesn’t quiiiite fit what you’ve read here. Maybe you’re not even sure that what you’re going through is an issue. Maybe something just feels off.

So, if that’s you? Don’t rely on the parameters of this list to decide whether or not to make an appointment.

“Speak up and tell them, ‘You know, I'm having a lot of pain with intercourse’ or ‘My hot flashes are absolutely terrible,’” Dr. Batur urges. “These conversations can be very in-depth, so if you bring it up at an annual exam, they may not be able to address it in that short time. But they may ask you to come back — or you can tell them you want to come back for a dedicated discussion.”

When to follow up with your doctor

This next part is key: As the patient, you have to be the one to follow through and make that appointment. And if, after you’ve tried one type of treatment, you’re still not feeling better? Then, you need to make another appointment.

“When I talk to people who have been frustrated with their healthcare experience or feel like they’ve been blown off or misdiagnosed, I always almost hear an element of broken-down communication between the provider and the patient,” Dr. Batur says.

If your healthcare provider recommends a particular treatment and it doesn’t work for you, you’ve got to come back and say so.

Bring it up again. Continue to advocate for yourself and your health.

“If your provider doesn’t hear back from you, we assume you’re feeling great,” she points out. “We come up with a list of A, B and C types of treatment to try for you. But if you never reach out to say, ‘Hey, this isn’t working for me,’ then we never get the opportunity to talk about plans B or C or to do more investigating.”

What kind of doctor should you see for menopause?

You can always start with your primary care physician or Ob/Gyn. But Dr. Batur also suggests seeing a provider who’s trained in menopausal medicine.

“Hormone therapy especially is a confusing field of risks and benefits,” she says, “which is one of the reasons why it’s so important to see a doctor who is comfortable with them.”

Working with a program that has a strong focus on menopause care can ensure that you feel seen and heard (if one is available near you). And some healthcare providers have earned the credential of Menopause Society Certified Practitioner (MSCP). This independent, evidence-based organization credentials qualified healthcare providers who demonstrate their expertise in the field of women’s health and menopause medicine.

You can use The Menopause Society’s online directory to find certified providers near you — though Dr. Batur clarifies that you may also find skilled providers who do not have this certification: “No certification is required for a provider to take great care of menopause concerns.”