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What is Perimenopause?

Dr. Johnny Franco

And How Do I Know If I’m Experiencing It?

Perimenopause is the natural transition leading up to menopause, when a woman’s hormone levels begin to rise and fall erratically. (1) It often shows up quietly, starting with subtle changes: your periods may become irregular, or you may begin experiencing unexplained hot flashes and mood swings. You may also feel more anxious, tired, or just less like yourself. You are not imagining it. These shifts are common and often progressive but manageable with effective care options.

Austin Plastic Surgeon stands as a leading aesthetic destination across Texas, and our skilled team of medical specialists has helped numerous women navigate this transition. We provide compassionate, individualized care, taking the time to listen to your experience, help you understand what is going on, and discuss treatment options that can provide meaningful relief.

To learn more about perimenopause and explore your treatment options, please contact us online or call us at one of our offices:

About Perimenopause

As you enter perimenopause, your ovaries gradually wind down reproductive function and lose their eggs, causing unpredictable shifts in estrogen and progesterone. (2) Instead of the steady monthly rhythm of a typical menstrual cycle, these hormones can fluctuate dramatically. This hormonal rollercoaster explains why symptoms such as hot flashes or mood swings may feel intense one week and seem to vanish the next.

Feeling like your body is constantly changing the rules without warning can be deeply frustrating, but this unpredictability is a completely natural response to the internal changes occurring. Over time, as egg supplies decline, your periods will stop altogether.

The timing of perimenopause varies significantly among women. Most women first notice changes, like irregular periods, in their mid-40s, while others notice shifts as early as their 30s or as late as their 50s. (2) On average, it lasts about four years, though it can range from a few months to eight years. Various biological, genetic, and lifestyle factors affect the timing and onset of perimenopause. For instance, smoking is linked to an earlier start, and your mother’s age at menopause is a key indicator as well. (1)

Perimenopause vs. Menopause

While perimenopause is the transitional period leading to menopause, menopause is a single milestone confirmed once you have gone twelve consecutive months without a menstrual period. During perimenopause, pregnancy is still possible because of occasional ovulation, but it is no longer possible once you reach menopause because your ovaries stop releasing eggs entirely. Additionally, you will no longer experience the wildly erratic estrogen fluctuations when you reach menopause, as your hormones settle into a permanently low baseline. (2)

Signs and Symptoms of Perimenopause

Determining whether you are in perimenopause relies on evaluating several factors together. Because hormone levels fluctuate significantly during this transition, no single test can definitively confirm it. Instead, doctors diagnose perimenopause through a clinical evaluation of your age, changes in your menstrual cycle, and the presence of characteristic symptoms like hot flashes or mood shifts. As this transition unfolds, every woman experiences a unique combination of symptoms. You may notice various subtle and distinct physical and emotional changes, including: (1)

  • Menstrual Cycle Changes: Often the main indicator, periods become less predictable. They may change in frequency or flow, becoming shorter, longer, heavier, or lighter, and eventually occurring months apart.
  • Hot Flashes and Night Sweats: Sudden sensations of heat in the face, neck, or chest, sometimes with flushing, sweating, or nighttime awakenings. They can vary in intensity, duration, and frequency.
  • Sleep Disturbances: Trouble falling or staying asleep, even without night sweats or hot flashes.
  • Mood and Cognitive Shifts: Increased irritability, anxiety, low mood, brain fog, and trouble focusing.
  • Physical, Skin, and Sexual Changes: Lower estrogen levels can cause your body to store more fat around your abdomen and your skin to lose the plumpness and moisture that keep it firm. This hormonal change also reduces blood flow and lubrication to vaginal tissues, which can lower sexual desire and result in discomfort during intercourse.

Before your visit, it helps to log your cycle and symptoms in a journal or tracking app for a few months to identify your personal patterns. Noting when these symptoms occur, how they affect your daily life, and how often they happen helps our specialists tailor an optimal approach for you.

When to See a Doctor

Some changes need a closer look, even during perimenopause. If you experience any of the following, you should consult your OB-GYN: (2)

  • Menstrual bleeding lasting more than 7 days.
  • Periods that come fewer than 21 days apart.
  • Heavy bleeding that requires changing pads or tampons every one to two hours.
  • Spotting or bleeding following sexual intercourse or between menstrual cycles.
  • Bleeding after going 12 consecutive months without a period.

While these signs do not automatically mean that something is wrong, a physician must rule out underlying causes. Similarly, vaginal discomfort should not be immediately attributed to perimenopause, given that infections or other health conditions often present with similar symptoms. (1)

We recommend seeking care when symptoms begin to interfere with your daily life. Whether night sweats, hot flashes, or mood changes disrupt your sleep, relationships, or professional life, you do not have to wait until symptoms feel unbearable. (1) Our team of specialists can evaluate your symptoms and guide you through personalized treatment options that fit your needs.

Perimenopause Treatment Options

For a long time, perimenopause was something many women endured without talking about. They felt they just had to power through their symptoms. But that mindset is changing, and conversations about perimenopause are everywhere. Now, women are realizing that there are many treatment options available, and they no longer have to suffer in silence. The perimenopausal transition is a chance to make yourself a priority. This stage of life is not just about managing symptoms, but rather an opportunity to protect your future health.

No two women experience perimenopause the same way, so there is not a one-size-fits-all treatment either. Choosing the right treatment depends on your symptoms, how much they disrupt daily life, and your personal health history. Our team starts with an open conversation to understand your symptoms, along with relevant lab work. This helps us discuss your options and build a personalized approach for you.

Perimenopause is also a time when women start to become more vulnerable to conditions that can impact their long-term health, such as heart disease, and osteoporosis. (2) That is why it is especially important to prioritize your overall health, from heart health and bone density to exercise, nutrition, and sleep. We encourage women not to dismiss these symptoms as simply part of getting older. We want them to recognize these changes before they become long-term health problems.

Hormone Therapy

You may benefit from hormone therapy if night sweats, hot flashes, or poor sleep are disrupting your daily life. It manages symptoms by regulating fluctuating estrogen, progesterone, and, occasionally, testosterone levels. Hormone therapy is one of the most effective treatments for relieving hot flashes and night sweats. (3)

Our team offers bioidentical hormone replacement therapy (BHRT). During a brief in-office visit, we insert small plant-derived hormone pellets under the skin. These pellets provide a steady, continuous release of hormones for four to six months.

Before starting BHRT, we will evaluate whether it is an appropriate treatment for you. Patients will complete initial lab work, along with an up-to-date Pap smear and mammogram, to assess baseline hormone levels and overall health. We then use these results and your wellness goals to tailor your treatment plan. (3)

Treatments for Related Changes

Beyond hot flashes and sleep disruptions, many women also notice changes in their body, skin, and intimacy. Our team offers tailored treatments that can help with these perimenopause-related changes:

  • Vaginal Rejuvenation: A non-surgical option that may help with vaginal dryness or discomfort through targeted heat from lasers or radiofrequency energy to stimulate tissue healing and blood flow.
  • Women’s Sexual Health Treatments: Personalized treatment options designed to address low sexual desire or changes in intimacy.
  • Medical Weight Loss: A tailored program to help manage the midsection weight gain often caused by hormonal changes.
  • Sofwave and RF Microneedling: Treatments that help restore firmness and smooth the skin by stimulating collagen production, which naturally declines as estrogen levels drop.

Our team at Austin Plastic Surgeon has taken a holistic approach to aesthetics, building from the foundation up. This means optimizing your hormones and the changes associated with hormonal changes. This allows our team to address all your needs from skin, sex drive and energy as one journey.

As we mature there are many issues that can change how we look and feel. Some of our patients come in for skin rejuvenation, surgery, weight loss or hormone replacement, but it is important to really see all of these cohesively.

Our team has helped many women feel more like themselves with treatments tailored to their goals. At your consultation, we can talk through these options so you can proactively take control of your long-term health.

Cost of Perimenopause Treatment in Austin

The cost of perimenopause treatments depends on several factors, including the type of approach chosen, how often you need it, and other cost variables. After establishing your care plan during your consultation, we will provide a comprehensive price estimate. We also recommend checking out our perks memberships for exciting deals and specials.

To discover the total cost of your treatment, please contact us online or call us at one of our offices:

FAQ

Can you still get pregnant during perimenopause?

Yes, you can still get pregnant during perimenopause. Although your periods may be irregular or infrequent, your body can still release an egg in any given month. Pregnancy remains a possibility until you have gone 12 consecutive months without getting a period. Talk to one of our specialists or continue using birth control if you do not wish to become pregnant. (1)

Is there a test for perimenopause?

There is no single definitive test that can confirm perimenopause. Because your hormone levels fluctuate unpredictably from day to day, a single blood test may not reliably confirm it. Instead, we look at your age, menstrual history, symptoms, and lab work as the main clues to guide your treatment plan.

References

  1. Cleveland Clinic. Perimenopause: Age, Stages, Signs, Symptoms & Treatment. Cleveland Clinic. August 8, 2024. Accessed October 21, 2026. https://my.clevelandclinic.org/health/diseases/21608-perimenopause
  2. Mayo Clinic. Perimenopause – Symptoms and Causes. Mayo Clinic. May 25, 2023. Accessed October 21, 2026. https://www.mayoclinic.org/diseases-conditions/perimenopause/symptoms-causes/syc-20354666
  3. North American Menopause Society. The 2022 Hormone Therapy Position Statement of the North American Menopause Society. Menopause (New York, NY). 2022;29(7):767-794. doi:10.1097/GME.0000000000002028