Menopause vs. Perimenopause | Donaldson Plastic Surgery

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By Courtney Gilbert, PA-C |

Menopause vs. Perimenopause 

They Don't Define You, But Understanding Them Can Empower You

Menopause vs. Perimenopause 

Perimenopause. Menopause. These stages aren’t diseases or disorders. They are natural biological transitions that mark a shift in your body’s hormonal rhythm. And while they may bring on a mix of changes, you’re not powerless in the process.

With the right knowledge and care, you can move through this phase with confidence, poise and control. Our practice often starts this process by answering one of the most common patient questions we face: menopause vs. perimenopause: what’s happening with me?

The Differences Between Menopause & Perimenopause

Perimenopause is the transitional phase leading up to menopause, where hormone levels begin to fluctuate and symptoms start to appear. Menopause is officially diagnosed when you’ve gone 12 consecutive months without a menstrual period, signaling the end of reproductive hormone cycles.

Happy Younger Functional Medicine Patient

Perimenopause: A Period Of Flux & Inconsistent Discomfort 

Perimenopause is the stage where estrogen and progesterone levels begin to fluctuate in preparation for menopause, often marked by changes in ovulation. Most women enter perimenopause between the ages of 40 and 44, but it can begin as early as your mid-30s.

Patient handling menopause symptoms

The Details: What Happens To Hormones During Perimenopause

Estrogen and progesterone levels begin to fluctuate, often in unpredictable patterns. Estradiol (the dominant form of estrogen) may spike and dip irregularly, leading to symptoms like mood swings and hot flashes. Progesterone typically starts declining first, which can affect sleep and cause heavier or irregular periods.

  • Common Symptoms: Irregular periods, mood swings, sleep disruption, hot flashes, vaginal dryness and brain fog.
  • Uncommon Symptoms: Breast tenderness, gum sensitivity, phantom smells, taste changes, migraines, irregular heartbeats, acne, skin dryness and itchy ears.

What You Can Do To Treat Perimenopause Symptoms

  • Keep A Symptom Diary: Track your symptoms by date to identify patterns and better guide conversations with your provider
  • Prioritize Sleep Hygiene: Aim for 7 – 9 hours of restful sleep by creating a cool, dark, tech-free environment
  • Practice Mindful Movement: Walking, yoga or low-impact strength training can ease joint pain, retain strength and improve mood
  • Reduce Alcohol & Caffeine: Both of these, in addition to spicy foods, can amplify hot flashes and sleep disruption
  • Dietary Support: Focus on protein-rich, nutrient-dense meals to support hormonal shifts and energy levels; don’t forget to eat enough fiber (aim for at least 25 grams per day)
  • Get Professional Insight: Partner with a trusted medical provider who can help evaluate whether starting hormone therapy is right for you

“One of the hardest things I have to do? Tell a patient — who is already navigating all of these symptoms & life changes — that they might need to skip that glass of red wine. It’s not easy, but it can make a profound difference.”

-Courtney Gilbert, PA-C | Menopause Treatment Expert 

Menopause: Navigating A New Normal 

Menopause is defined as the permanent end of menstrual cycles, confirmed when a person has gone 12 consecutive months without a period due to the natural decline of estrogen and progesterone. The average age of menopause in the U.S. is 51, though it can occur anytime in your 40s or 50s — or earlier, depending on health and genetic factors.

Confident Menopause Patient Outside

The Details: What Happens to Hormones During Menopause

Estrogen levels (especially estradiol) drop significantly and remain consistently low. Progesterone production also essentially halts. FSH (follicle-stimulating hormone) and LH (luteinizing hormone) levels rise as the body tries to stimulate ovaries that are no longer responsive. This hormonal shift confirms menopause in lab testing.

  • Common Symptoms: Hot flashes, night sweats, mood changes, decreased libido, weight gain, vaginal dryness and memory issues.
  • Uncommon Symptoms: Altered taste, tingling extremities, change in body odor, histamine sensitivity, vertigo and electric shock sensations, specifically before a hot flash.

Note: These are similar to perimenopause symptoms but are often more intense and frequent. 

What You Can Do To Treat Menopause Symptoms

  • Consider Bioidentical Hormone Therapy: This is the most effective treatment for many menopause-related symptoms
  • Keep It Moving: Stay consistent with physical activity (especially strength training) to support bone density, reduce stress and regulate mood
  • A Stronger Foundation: Practice pelvic floor exercises or consider pelvic physical therapy to support sexual wellness and prevent incontinence
  • Sexual Wellness Matters: Explore vaginal moisturizers or lubricants to ease dryness and discomfort during intimacy
  • Nutrition Care: Fuel your body with calcium-rich and anti-inflammatory foods to support bone and heart health
  • Emotional Support: Mental health is vital at this stage; cognitive behavioral therapy, mindfulness practices and social support have all been shown to improve therapeutic outcomes

Guide: Treat Menopause Holistically

Courtney discussing menopause treatments with a patient

“We can reduce symptoms, but menopause will never be ‘simple.’ You may feel like cloistering away from the world. That’s okay, sometimes. But I always urge my patients to stay connected. Take time for yourself, but keep talking about what you’re going through. Community support is so important!” 

-Courtney Gilbert, PA-C | Menopause Treatment Expert

Why Do Some People Experience Menopause Earlier?

Menopause doesn’t follow a universal timeline. It can vary from patient to patient. Several factors can cause it to begin earlier than expected, including:

  • Genetics: Family history plays a major role in when menopause begins
  • Medical Treatments: Chemotherapy, radiation or surgery that removes the ovaries can lead to early or sudden menopause
  • Lifestyle Choices: Smoking, high chronic stress, low body weight and poor nutrition may accelerate hormonal changes
  • Underlying Conditions: Autoimmune diseases or conditions like Addison’s disease can affect hormone production
  • Environmental Factors: Endocrine disruptors from plastics or chemicals may also play a subtle role over time

Hormone Therapy: The Most Effective Treatment For Most Symptoms

Hormone therapy (HRT) is increasingly recognized as the gold standard for relieving both perimenopausal and menopausal symptoms. By supplementing your body’s declining hormone levels, HRT can help restore balance physically and emotionally by addressing the root cause of the most common symptoms associated with these transitions.

While it’s not a one-size-fits-all solution, many of our patients have experienced profound mental and physical health benefits from consistent bioidentical hormone replacement therapy (BHRT) — from fewer hot flashes and improved sexual health to sharper mental clarity and more sustainable weight management.

Courtney Gilbert, PA-C Author Photo

About The Author

Courtney Gilbert, PA-C, is a nationally certified physician assistant and menopause treatment specialist in Columbus, Ohio. With a focus on hormone health, sexual wellness and patient education, she brings both clinical expertise and compassionate care to every conversation. Courtney’s clinical approach blends science with compassion and respect in a way that is uniquely approachable and destigmatizes sensitive subject matter.

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