Recently, I was sharing gory details at a bar with a friend about our perimenopausal symptoms. I told her that I’d had some form of my period – from a splash of rosé to a full-on murder scene – since January of 2023. Then I revealed this summer I got repeat urinary tract infections that survived two rounds of antibiotics and left me with what felt like a few hundred paper cuts in my vag.

My friend was empathetic, but not shocked. She told me her symptoms and together we agreed – as I had with women for years now – that this stage of a woman’s life is ridiculously under-researched and over stigmatized. The way it affects women can be debilitating and it's often a lot more than hot flashes and mood swings.

I’m 54 and have been in perimenopause for six years. The national average age for a woman to cross the line into menopause is 51. I am grateful for my overall health, but a bit miffed that my body can’t just part with the Red Sea already. I’ve spent thousands of dollars on menstrual products from fat pads to sleek Diva cups. And it’s not like I have a closet full of white trousers I can’t wait to slip into again, but I want to stop having to think about the amount of blood pooling in my pants region.

On top of all this, my own doctor, although kind and usually knowledgable, can’t really tell me much about this life stage. Thus, it’s up to me to do my own research and figure out some big medical decisions like whether or not to take hormones when the Internet is once again a twisty road littered with conflicting information.

I just want to move on with the crone years, witches.

In the meantime, though, I’m gonna talk about perimenopause a lot. Like a lot a lot. I also reached out for information from someone who knows a lot more than I do about the unnecessarily mysterious "change of life." Jackie Giannelli is a Founding Nurse Practitioner at Elektra Health, a digital health company that offers menopause care and support to women through education, community and telemedicine. Finally!

OnMilwaukee: What are some basic things all women should know about menopause when they are going into it?

Jackie Giannelli, FNP-BC, MSCP: So many things! But if I had to list three, it’d be:

1. Menopause/perimenopause can be wildly unpredictable. Periods change dramatically, at times becoming heavier and more frequent, or they can go in the other direction. It’s generally a confusing time that catches a lot of us by surprise (so no, it’s not just you). There’s no such thing as a one-size-fits-all menopause experience. Hormonal changes and the way symptoms show up are anything but linear. 

2. The transition in its entirety can take 8-10 years to move through, and while most of us will start in our early to mid-40s, some may begin years earlier. Perimenopause is often broken down into two general phases: early perimenopause (when periods can still be regular, which causes some confusion) and late perimenopause (marked by skipped and/or irregular periods — more aligned with what people typically think of when they hear perimenopause or menopause).

3. You don’t have to “just deal with it.” Probably the biggest misconception that I encounter in my work is that women have to suffer in silence through this period of their life when, in reality, there is so much that can be done: hormone therapy, non-hormonal treatments, supplements, lifestyle changes, etc. Unfortunately, only 1 in 5 OBGYNs have received any menopause training in medical school or residency, which certainly contributes to this misconception. I recommend seeking out a provider certified by The Menopause Society (formerly known as NAMS). And if you’re going to talk to your doctor about menopause, don’t do it during your annual visit! Make a separate appointment, write down your questions in advance, and focus on your main symptoms. 

How do women know if they are premenopausal or just experiencing mental health and/or physical issues?

There are several common conditions, including thyroid abnormalities and even medication side effects, that can cause similar symptoms, so be sure you are properly evaluated by your healthcare provider.

Also, we’re seeing more and more hormone tests pop up on the market that can supposedly tell you if you’re in perimenopause or not. These are imperfect at best since hormones fluctuate all the time during perimenopause. Also, tests will not be accurate for anyone on hormonal birth control or who have PCOS. 

Bottom line: An overview of any changes in your menstrual cycle over a period of time coupled with trends in your symptoms are the guiding principles your provider uses to determine your stage of perimenopause. Hopefully one day we will have an accurate test for predicting or benchmarking perimenopause and menopause, but we just aren’t there yet. 

How does a woman begin to decide if she should take hormone therapy?

Whether or not to take hormone therapy is a deeply personal decision that should be made alongside your healthcare provider while considering your symptoms, health history, and individual risk factors. Key considerations to discuss include:

• Age: We generally follow the “timing hypothesis” of menopause, which states that when hormone therapy is started within 10 years of the final menstrual period or generally less than age 60, the benefits of MHT far outweigh the risks.  However, these are simply guidelines and ultimately it is up to the individual patient to have a personalized risk and benefit discussion with her provider to decide what is best.
• Menopausal status: Women in early perimenopause may explore oral contraceptives, while women in late perimenopause have the option of both traditional HRT and oral contraceptives. It is a common menopause misconception that you have to wait after your final menstrual period to start MHT. 
• Health history: The decision around whether to take systemic hormone therapy (i.e. absorbed throughout the body) and in what form may be influenced by things such as unexplained vaginal bleeding, stroke or blood clot(s), breast/endometrial cancer, active liver disease, increased risk of cardiovascular disease, and migraine with aura, among other conditions.
• Symptoms: Systemic hormone therapy isn’t a solution for all menopause symptoms; however, it is often prescribed for hot flashes/night sweats, osteoporosis prevention, and genitourinary syndrome of menopause (vaginal dryness and urinary symptoms). And it may have an indirect effect on anxiety, depression, dry skin, joint and muscle aches, mood changes, and sleep problems – although it’s not explicitly prescribed for them. 
• Presence of a uterus: While the presence of a uterus doesn’t impact eligibility, it does affect what type of hormone therapy you may take. Women with a uterus need BOTH estrogen and progesterone, while women without a uterus can take estrogen alone.

Can you share more about Elektra Health and its mission?

Elektra is built around one simple mission: smashing the menopause taboo. We’re creating a movement to reimagine menopause as the beginning of a new chapter, one that is powerful and transformative. Our approach is comprehensive, combining telemedicine care education, community, and support from Elektra Guides – aka "menopause doulas." We believe women deserve better. Every woman deserves a bold, fearless, healthy and thriving menopause – and beyond. 

Visit the Elektra website here.