Understanding perimenopause and the importance of caring for women in body, mind and spirit
By Amy Miller
Natural Family Planning
For many women, perimenopause, the period of time when a woman’s fertility begins to decline, can feel like entering unfamiliar territory. When changes in sleep, mood, energy and physical health arrive, sometimes women are left wondering what is happening to their bodies. Perimenopause is a natural transition, but that does not mean it is always easy. It can bring questions, challenges and, at times, a sense of isolation. Having accurate information, compassionate health care and a supportive community can make a meaningful difference. Women do not have to navigate perimenopause alone.
Many types of natural, restorative-focused perimenopause resources are available, from specially trained health care providers and coaches to natural family planning practitioners, to help women understand the hormonal and cycle changes that often accompany this phase of life.
Rachel Beier, RN, is a Board-Certified Health and Wellness Coach, Certified Menopause Coaching Specialist, Certified Personal Trainer and Certified Nutrition Coach and works closely with women in perimenopause in her private coaching practice, Be Well with Rachel. Lisa Rauscher, PA-C is a family practice PA with nearly 30 years of experience with Ascension Medical Group. In 2024, she completed formal training to become a FEMM Health medical consultant. Her clinical training has given her a strong foundation of understanding hormone health in menopausal women. Both Rachel and Lisa offered their insights into the best ways to support women through the uncertainty of perimenopause.
Perimenopause usually begins between ages 35-37, although many women don’t notice the symptoms of perimenopause until their mid to late 40s. According to Lisa, the first clinical sign of perimenopause is the shortening of the menstrual cycle, particularly the post-Peak or luteal phase.
Many women reach this phase of life feeling unprepared because perimenopause has historically been under-discussed and under-taught. Many women expect menopause to mean only hot flashes and the end of their periods. While hot flashes and night sweats are the most well-known symptoms, other common symptoms include fatigue, mood changes, anxiety, brain fog, headaches and weight gain. Both Lisa and Rachel have found that increased anxiety and mood changes, like high irritability, along with symptoms like itchy or dry skin are the symptoms women often describe as the most surprising.
Women also may not realize that symptoms can begin years before their final period (perimenopause can actually last an average of 4-10 years) or that hormone fluctuations can affect the brain, bones, muscles, cardiovascular system and sleep.
Since symptoms can also appear gradually and may be attributed to parenting, work, caregiving, stress or simply getting older, recognizing that hormonal changes and mid-life pressures may be interacting can help a woman seek appropriate support sooner.
If a woman is not tracking her cycles, she may not even notice changes to her cycle as the start of her perimenopausal transition. Rachel adds that cycle tracking gives a woman useful information about how her body is changing. She can record period dates and flow along with symptoms she is experiencing.
A cycle record also helps a healthcare provider understand the timing, frequency and severity of symptoms, helping to recognize emerging patterns that can be difficult to identify from memory alone. Cycle tracking is especially useful because a single hormone test often cannot capture day-to-day hormone fluctuations common in perimenopause. Charting the menstrual cycle is not a method of diagnosing every symptom, but it can provide valuable information. Women should also remember that pregnancy remains possible during perimenopause until menopause has been confirmed, so tracking days of fertility and infertility continues to be important throughout perimenopause.
Lisa suggests that any time a woman has two cycles in a row that are not normal, or three cycles within any period of time that are not normal, she should seek evaluation with her health care provider or with a fertility awareness medical consultant. There are many conditions in addition to perimenopause that affect the cycles, such as insulin resistance or changes in thyroid health. If no other underlying conditions are playing a role in her symptoms, the benefits and risks of hormone therapy can be discussed and a treatment plan determined. For many years, the healthcare community would not offer hormone replacement therapy until a woman has entered full menopause, a year after her periods have stopped. We now know that a woman will benefit the most from hormone therapy if it is started during the perimenopausal transition.
Rachel agrees that women should not wait until symptoms become unbearable to seek medical help. They should seek care whenever symptoms are interfering with sleep, relationships, work, exercise or quality of life. She also stresses that urgent evaluation is important for severe or unusual symptoms. Bleeding after menopause should always be discussed with a clinician.
Both Rachel and Lisa emphasize the importance of continuing yearly gynecological exams in addition to periodic cancer screenings as recommended by their health care provider, such as mammograms, pap smears and colon cancer screening. Rachel notes this is an important time to review overall health as well. Additional screenings, such as blood pressure, cholesterol, bone-density and other testing, based on a woman’s age and risk factors, should be discussed with a healthcare provider.
Women can and should advocate for themselves if they know something is not right with their cycles or their symptoms. This can be scary and frustrating, but having a supportive community helps empower women to speak up for themselves. Honest conversations allow women to realize that they are not imagining their symptoms and are not alone. Other women can share encouragement, practical ideas and trusted resources. Spouses can offer practical support like sharing meal preparation, helping with family responsibilities and offering patience during difficult days. The support of a faith community can be especially powerful: listening without judgment, helping with practical needs, praying together and encouraging women to seek appropriate care. Supportive relationships remind a woman that she is more than what she produces or how she looks. No woman should have to walk through this season silently.
An important note both Lisa and Rachel added is that not all health care providers have in-depth training regarding perimenopause and the benefits of hormone replacement therapy. If their primary care provider or gynecologist does not seem to be well versed in how to help during the perimenopausal transition, it is OK to seek a consultation with another provider who has the experience and knowledge specific to their perimenopausal needs and will listen to concerns with compassion and understanding.
We are fortunate to have many resources in our area to support women through the perimenopausal transition. The Holy Family Center for Life is here for education and guidance in modern methods of Natural Family Planning and to help women connect with a medical consultant if needed. Be Well with Rachel offers a variety of programs, including individual and group coaching sessions to bring midlife women together and build community. Lisa, along with other specially trained medical consultants, works to find the underlying causes of symptoms and other health issues common in perimenopause and restore a woman’s reproductive health. For more information about perimenopausal support services, contact www.holyfamilycenterforlife.com or www.bewellwithrachel.com.
As Catholics, we are called to recognize the dignity of every person and to care for the whole person — body, mind, and spirit. The call to care is especially important during times of change. For women experiencing perimenopause, support can come in many forms: a trusted health-care provider, a spouse or friend, a faith community, or simply another woman who understands the journey.
Perimenopause is more than a collection of symptoms, It is a new season—one that can bring greater self-awareness, compassion and connection. With faith, good information and the support of others, women can approach this transition with greater confidence and grace.
Amy Miller is a FertilityCare Practitioner with the Holy Family Center for Life, teaching the Creighton Model System since 2015. She and her family reside in Evansville and are members of St. Benedict Cathedral.