Internal Medicine

Perimenopause and menopause

Hot flashes, poor sleep, periods that no longer make sense. Every treatment choice, explained in plain words.

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Before you come, it helps to note the dates of your last few periods and when the hot flashes or bad nights happen. Please bring your medicines, supplements and herbs too.

One blood test cannot tell you

In perimenopause, hormone levels go up and down from week to week. So one normal blood test means very little. The diagnosis comes from your periods and your symptoms.

Blood tests are still useful — to check for thyroid problems, low iron and other things that feel the same.

Hormone therapy

Hormone therapy works best for hot flashes and night sweats. It usually cuts them down a lot, but may not stop them completely. For most women who start within ten years of menopause, it is safer than the old news stories said.

It is not right for everyone. Breast cancer, blood clots, stroke, heart disease, liver disease or unexplained bleeding change the answer. Dr. Pan goes through your own history with you.

If you cannot take hormones

Some non-hormone medicines also reduce hot flashes. Chinese herbs are another choice. They may help some women, but less than hormones do. Some herbs act like estrogen, so after breast cancer they are chosen with care. Plan on about two months, and keep a note of your hot flashes and your sleep. Then you and Dr. Pan look at those notes together and decide whether to go on.

Also worth checking now

Blood pressure, cholesterol and blood sugar
Bone health
Birth control — you still need it until you have gone a full year without a period
Any bleeding after a full year without periods — tell Dr. Pan, it needs to be checked

Common questions

Do I need a blood test to know if I am in perimenopause?

Usually not. Hormone levels change so much that one test tells you little. Your periods and your symptoms tell more.

Is hormone therapy safe?

For many healthy women who start before 60, or within ten years of menopause, the benefits usually outweigh the risks — more than older news reports said. It is not for everyone. Dr. Pan will go through your own history with you.

Can Chinese medicine help hot flashes?

It may help some women, but less than hormones do. Some herbs act like estrogen, so after breast cancer they are chosen with care.

My periods are irregular. Do I still need birth control?

Yes — until you have gone a full 12 months without a period.