When I Knew It Was Time to Seek Help for Perimenopause

midlife
Written by Roxanne Banta

How I knew lifestyle support wasn't enough anymore—and what I wish I'd understood sooner.

Finding our way through life one hike at a time!

For a long time, I thought feeling healthy mostly came down to doing the right things.

Move your body. Eat nourishing food. Get enough sleep. Manage your stress. Spend time outside. Take care of yourself.

But perimenopause complicated that story for me.

At some point, the question stopped being, What else can I do to be healthy? and became:

Wait. Am I trying to lifestyle my way through symptoms that actually deserve treatment?

In the previous post in this series, How To Support Your Body Through Perimenopause, I explored how movement, nourishment, sleep, recovery and closer attention can support us through perimenopause. Those foundations made a huge difference for me and continue to support me in many ways.

But sometimes support also means recognizing when the things we can do for ourselves are no longer enough.

For me, that line was surprisingly difficult to see. For far too long, I kept trying harder at taking care of myself and not seeing the perimenopause forest for the trees.

I kept thinking I could manage it myself

My first obvious sign of perimenopause was that my cycles started becoming more erratic after the birth of my son, when I was 43. My OB-GYN basically said, “You’re probably in perimenopause. Keep doing all the healthy things. Good luck.”

And for a while, that seemed reasonable. It wasn’t exactly an easy season of life, but I was still active and nourishing myself reasonably well—for a midlife mom of two living through a pandemic.

Then, at an annual checkup with my GP, I was told I had prediabetes. It scared the crap out of me and spun me into action. My dad had type 2 diabetes, and I did not want to go down that path if I could help it.

I spent the next few years learning about blood sugar and working pretty aggressively to improve my metabolic health. Along the way, I noticed some welcome side effects: my mood and energy felt steadier, my body weight stabilized, and even my cycles became more regular.

For a while.

I wholeheartedly believe that movement, nutrition, stress management, sleep habits, and other daily practices can have a huge effect on how we feel throughout our lives—including during perimenopause. I don't see medical treatment and lifestyle support as opposing camps.

But I eventually learned that there is a limit to what lifestyle can fix.

Over the course of about a year, my symptoms became harder and harder to manage. My sleep grew wildly unpredictable. No matter what I did, I couldn't seem to secure myself a solid night's rest. I've always been someone who needs her 8.5 hours, and the accumulated sleep deprivation started affecting my mood, energy, and ability to focus.

My libido basically disappeared. I felt like I had a UTI all the time, even though I didn't. Sex stopped feeling good. Then came the joint pain. It was intense, in several areas of my body, and began interfering with the things I loved to do.

And honestly, it was difficult to know what belonged to perimenopause and what belonged to life.

It had been a full era. I'd had a surprise baby at 43 during a pandemic, while my older child was supposed to be entering kindergarten and schools weren't even open. I was hospitalized several times for health issues related to my C-sections. I lost a career I loved. And then my dad died unexpectedly.

Of course I was tired. Of course I was stressed. Of course I didn't feel quite like myself.

So I think I spent too long asking what I should be doing better.

Maybe I needed to eat differently.

Exercise differently.

Manage my stress better.

Improve my sleep routine.

Take another supplement.

Recover more.

There was always another lever I could pull.

Eventually, though, I realized that trying harder at wellness was becoming part of the problem.

My body wasn't asking me to become more disciplined. It was giving me information.

I just wasn't hearing it yet.

Quality of life counts

The most helpful shift was learning to think about treatment in terms of quality of life—not whether my symptoms were dramatic enough to count.

I was still functioning, but I was organizing more and more of my life around poor sleep, pain, depleted energy and not feeling like myself. A collection of symptoms that seemed manageable individually had become genuinely disruptive together.

I didn’t need to prove exactly which symptom belonged to perimenopause before asking for help. I could begin with something simpler:

Something has changed, and it is affecting my life.

Track patterns, not perfection

Tracking helped me recognize the cumulative burden I had been adapting to. My Greene Climacteric Scale score was in the 30s, and seeing my sleep, joint pain, libido, urinary symptoms and mood together made it clear that this was more than a handful of unrelated annoyances. It gave me something concrete to bring to a provider.

If you want more help with this, I created a perimenopause symptom tracker and wrote a separate article about why tracking has been so useful for me.

» Read:‍ ‍Why Tracking Your Perimenopause Symptoms Is a Game Changer

Treatment doesn't automatically mean hormone therapy

This distinction matters.

Deciding that your symptoms deserve treatment does not mean deciding on your own that you need hormone therapy.

It means deciding that your symptoms deserve a real conversation.

Depending on your symptoms, health history, age, preferences, and other factors, that conversation might include lifestyle changes, treatment for a specific symptom, hormone therapy, nonhormonal medications, vaginal therapies, mental health support, sleep support, or evaluation for another medical issue.

Because not every midlife symptom is caused by perimenopause.

Thyroid conditions, iron deficiency, sleep disorders, medication effects, depression, anxiety, and other health conditions can overlap with symptoms women experience during the menopause transition.

That isn't a reason to dismiss perimenopause.

It's a reason to look at the whole picture.

When I knew I wanted more help

After the slow buildup of symptoms over the course of about a year, with sleep continuing to deteriorate—joint pain kicked in—and kept getting worse. There were several weeks when I couldn’t do my normal movement activities, which was basically the straw that broke this camel’s back.

Regular movement is my lifeline. It’s sometimes my job, one of my favorite ways to spend my time, and a major regulator of my mental health. When pain started taking that away from me, I finally took the full picture of my symptoms more seriously.

I didn’t want to keep adapting my life around feeling so lousy. I wanted to understand what was happening and what my options were, if there were any. I started looking for a menopause specialist who could help me have that conversation. I specifically looked for a menopause trained specialist because my recent interactions with my General Practicitioner and OB / GYN left me craving more specific support.

For me, seeking treatment with a specialist wasn't an admission that my healthy habits had failed.

Self care, a healthy lifestyle, movement, nourishment, and sleep still mattered.

But I stopped expecting those things to single-handedly solve every problem happening inside a changing midlife body.

I could support my body and seek medical care.

Those things could belong in the same picture.

I wrote more about recognizing the symptom overwhelm threashold in How to Support Your Body Through Perimenopause. For me, the clearest sign was that symptoms were taking away something central to my well-being: my ability to move without persistent pain.

» Read:‍ How to Support Your Body Through Perimenopause

I wasn’t looking for someone to promise that hormones would make me young again. I wanted help sleeping, moving comfortably and feeling at home in my body. I also wanted someone who could look at my symptoms as a connected picture rather than treating each one as an unrelated complaint.

Seeking care also gave me an opportunity to consider whether perimenopause was the whole explanation—or whether anything else needed attention.

» Read: Wait, Is This Perimenopause? Signs, Symptoms, and What to Notice

You don't have to suffer your way through perimenopause

I wish I'd understood this earlier.

There isn't an award for white-knuckling your way through perimenopause.

There also isn't one universally correct way to manage it.

Some women will have relatively mild symptoms and need very little intervention. Others will experience symptoms that substantially affect their sleep, relationships, work, movement, mental health, or overall quality of life.

And what you need may change as you move through the transition.

The goal isn't to eliminate every uncomfortable sensation or optimize your hormones into submission.

It's to have enough information and support to make thoughtful decisions about the body you're living in now.

I found a care provider who specialized in perimenopause and menopause to help me navigate the hormonal chaos of this transition. In preparation for my first appointment, I took the time to gather and share my recent blood work, symptom tracker, and biggest areas of concern (sleep, joint pain, and energy). Our first meeting was a one hour virtual meeting which was super helpful in sharing documents and taking notes.

At this point, I had suffered enough and had done my research, so I was open to try HRT if she felt it might help. She pointed out a couple things that really helped me feel better about trying HRT. First, she shared that the types of HRT being prescribed today are bioidentical, which is a much better form for the body to be ingesting compared to the synthetic options of the past. Second, HRT is prescribed in much smaller doses than traditional (low dose) birth control pills. Both of these points give me great piece of mind in making the decision to try this more medical intervention. I’ve already been messing with my hormones by being on birth control during most of my reproductive years and I’m grateful for the freedom and life choices it afforded me. I am glad to know we’ve improved our methods of hormonally supporting women in midlife.

For me, treatment with hormone replacement therapy (HRT) made a noticeable difference surprisingly quickly and continues to support me as I move through perimenopause.

Some of my most disruptive symptoms—including poor sleep, joint pain, energy, and genitourinary symptoms—improved significantly. Most importantly, I was able to return to regular, joyful movement without too much disruption.

I was incredibly grateful to feel more like myself again—not because every symptom disappeared, but because they were no longer running the show.

I bring an experimental mindset to my perimenopause treatment approach. I meet with my care provider about once every quarter to check in on current symptoms and possible care approaches including adjustments to my HRT. A few times I’ve had to reach out additionally when things start to go sideways and my symptom load gets consistently heavy again. It seems like my cycles and hormones go through waves of being more erratic and longer and longer stretches with things feeling stable - although I’ve been in perimenopause for 6 years so far. We get lab work at least once per 6 months to year to ensure there aren’t any unseen issues.

Care for the body you actually live in

hiking sunrise roxy

This has become one of the bigger lessons of perimenopause for me.

I spent years believing that taking good care of myself meant doing the right things consistently.

Now I think taking good care of myself also means responding when the things that used to work aren't enough anymore.

Sometimes the answer is movement.

Sometimes it's rest.

Sometimes it's changing how you eat or train.

Sometimes it's tracking long enough to see a pattern.

And sometimes it's saying:

I don't want to keep managing this by myself. I'd like some help and perspective.

That isn't giving up on lifestyle.

It's part of caring for the whole person.

When did you realize that your perimenopause symptoms deserved more support?

This article shares my personal experience and general educational information and is not a substitute for individualized medical advice.

Next in the Perimenopause Series

If you're wondering whether the changes you're experiencing could be hormonal, start here:

(⏪ Previous Post) - Wait, Is This Perimenopause? Signs, Symptoms, and What To Notice

If you're trying to understand your symptom patterns:

(⏪ Previous Post) - Why Tracking Your Perimenopause Symptoms Is A Game Changer

Coming next:

  • (⏭️ Next Post: Coming Soon!) - How To Talk To Your Doctor & Get Perimenopause Support

  • (⏭️ Next Post: Coming Soon!) - Lifestyle Levers That Help Perimenopause

We'll get practical about what to bring, what to ask, how to describe what you're experiencing, and what to do when “everything looks normal” doesn't feel like an adequate answer.

Resources & Further Reading

I have used the following as references while researching and fact-checking this post. These can be helpful resources if you’d like to dig more deeply into the science, symptoms, and treatment options surrounding perimenopause and menopause.

Roxanne Banta
Previous

How to Support Your Body Through Perimenopause
Next

Wait, Is This Perimenopause? Signs, Symptoms, and What To Notice