Q&A: A comprehensive look into perimenopause
While many people have a general understanding of menopause, fewer are aware of perimenopause, the transitional stage that precedes it. Perimenopause usually begins in a woman’s 40’s but can start earlier or later. During this time, fluctuating hormone levels can cause irregular menstrual cycles and a range of symptoms.
Perimenopause can span several years before a woman reaches menopause, which is marked by 12 consecutive months without a menstrual period, signaling the end of their reproductive years.1 As societal support and awareness of menopause grows, more women are also becoming informed about perimenopause and its potential ongoing impact on their lives.
Read the Q&A below to hear from Ovia’s Chief Medical Officer, Dr. Leslie Saltzman, as she explains what perimenopause is, what women can expect, and how to manage symptoms.
Tell us about yourself and your role at Ovia
I serve as the Chief Medical Officer at Ovia Health, where I oversee the clinical team, guiding our studies and research initiatives to ensure that Ovia’s solutions are evidence-based and inform our business and program developments.
In addition to my role at Ovia, I am a practicing physician, specializing in internal medicine with a focus on women’s health.
What is perimenopause?
Perimenopause is the time period when your body is transitioning to menopause. The level of estrogen — the main female hormone — in your body rises and falls unevenly during perimenopause. Your menstrual cycles may lengthen or shorten, and you may begin having menstrual cycles in which your ovaries don’t release an egg (ovulate). As your body progresses towards menopause, you may experience a range of physical and emotional symptoms. While this is a natural and normal process, some of the symptoms can be disruptive or uncomfortable.
What are the symptoms of perimenopause and how long does it last?
Typically, the first indication of perimenopause is irregular periods. You might notice that your once-predictable menstrual cycles become erratic, with random spotting or missed periods. Many people also experience common menopause symptoms, such as hot flashes/night sweats, and vaginal dryness. Although symptoms can vary widely, it’s common to experience mood changes like irritability, depression, or mood swings, along with low libido, urinary urgency, and sleep disturbances. Perimenopause may begin as early as your mid-30s or as late as your mid-50s. Some people are in perimenopause for only a short time, while others are in it for several years.
Can hormonal birth control mask symptoms?
Hormonal contraceptives can sometimes mask symptoms of perimenopause, and because of this, they are often used to manage the symptoms of perimenopause in patients.
What are the best treatment options for perimenopause? Are there any associated health risks?
Treatment is typically aimed at managing symptoms. Hormone therapy can help relieve the symptoms of perimenopause and menopause. Hormone therapy means taking estrogen and, if you have never had a hysterectomy and still have a uterus, a hormone called progestin. Hormone therapy can be given in different formats including pills, patches, creams, and vaginal inserts. Antidepressants can help with night sweats, mood swings, and emotional issues. It’s best to speak with your provider and track your symptoms carefully to figure out the best management plan.
Additionally, the menopausal transition is linked to a higher risk of cardiovascular disease, the leading cause of death for women in the U.S., so it’s really important to monitor women’s health during midlife.
What if a woman still intends to get pregnant?
You may be less likely to get pregnant during perimenopause, but it’s still possible. As long as you have a period, you can still get pregnant. For women over 40, we typically recommend that you consult with a reproductive endocrinologist if you are trying to get pregnant.
At what point does perimenopause end and menopause begin?
When you have no menstrual cycle for 12 months in a row, you have officially reached menopause. It is common for women to go months without a period and then randomly have one. That starts the countdown clock all over again.
What resources does Ovia provide that can help women experiencing perimenopause?
We offer a perimenopause program within the Ovia app. Members can choose “Menopause preparation” from the available programs listed under the Health tab. This provides them with access to relevant perimenopause articles and educational resources. They can use this information as a guide when tracking their health and monitoring day-to-day symptoms. Additionally, they can connect with a member of our Care Team, to assist in managing symptoms and finding the appropriate care and treatments.
Ovia also provides a menopause solution for women who have passed the transition. How does that differ?
Ovia’s menopause solution is a more expanded resource. Members begin by downloading the Ovia app and selecting “Managing menopause” as their goal at sign up. From there, they complete a health assessment that personalizes their experience by delivering content based upon where they are at on their menopause journey. At this point, Ovia customizes the user experience to explain specific symptoms and deliver relevant resources.
Members have access to comprehensive health tracking where they can monitor their symptoms, mental health, medications, and more in order to keep record and recognize patterns. This data can help identify potential triggers of symptoms and reveal health issues related to menopause such as the risk of cardiovascular disease and changes in lipids, body fat, blood sugar and blood pressure. It’s crucial that these risk factors are identified, monitored, and treated appropriately. Critical alerts are triggered in the app for symptoms such as heart palpitations with instructions to follow up with a provider.
The Ovia Care Team is also available to help with managing symptoms and finding care. For women experiencing significant symptoms, we hope they recognize the signs and seek appropriate treatment. With a personalized, proactive approach, we want to help members understand their bodies and find relief across all life stages.
Why is it important for employers and payers to invest in all aspects of women’s health including perimenopause?
Women constitute about half of the workforce, and many are grappling with health conditions like perimenopause and menopause. A recent study found that three out of five women have faced challenging symptoms while at work, with one in three actively hiding these symptoms from colleagues and managers.2 Additionally, another study revealed that nearly 20 percent of those experiencing menopause in the U.S. have either quit or considered leaving their jobs due to their symptoms.3
The burden impacts employers and payers. Women with untreated symptoms often have 121% higher healthcare utilization and experience 57% more days of lost productivity, resulting in an additional $2,100 per woman per year in healthcare and absenteeism costs.4 As budgets tighten and population health demands grow, employers and payers must seek strategies to reduce rising healthcare costs. Supporting menopause and women’s health is one of the most effective ways to accomplish this for a substantial segment of the population.
What advice would you give employers and payers considering adding a menopause program or more support for women’s health?
There are several ways to support employees going through menopause. Start by fostering an open environment where staff feel comfortable discussing their experiences without fear of discrimination. A key step in creating this culture is to train managers on menopause symptoms and how to offer support. Incorporate menopause education into your health awareness programs, covering symptoms, treatment options, and available benefits. Additionally, establish a formal company-wide menopause leave policy and work to normalize taking leave, so employees feel confident in making such requests.
Most importantly, consider investing in a solution like Ovia, which empowers members to learn about menopause, monitor their health, manage symptoms, and access expert guidance when needed. Offering these types of benefits can lead to a happier, healthier, and more productive workforce. In turn, this can help control medical costs, boost overall satisfaction, and improve productivity. Data shows that the long-standing silence around women’s health has had serious consequences. Many individuals have been forced to manage overwhelming stress due to shame or fear of discrimination, with some even leaving their jobs when the burden became too great. However, organizations have the opportunity to create a significant positive change – normalize conversations about menopause, provide accessible education so people understand what to expect and how to seek treatment, and build workplaces that support individuals through these major life transitions.
In recent years, there has been a notable increase in employers and payers investing in women’s health benefits and solutions. The fem-tech industry, as it’s been called, has already secured over $2.5 billion in funding, with this figure projected to rise further.5 Despite this encouraging trend, many organizations are still hesitant to invest in women’s health. Frequently, resources are directed toward general wellness or specific conditions rather than women’s health solutions. Some even dismiss women’s health as “niche.” However, delaying investments in this area is a missed opportunity and may prove to be shortsighted. With October being World Menopause Awareness Month, now is the perfect time to invest in the cultural shift and support that women experiencing menopause truly deserve.
For a more in-depth demonstration of the Ovia menopause program, or Ovia’s solution in general, schedule a discovery call with our team.
- National Institute of Aging: https://www.nia.nih.gov/health/menopause/what-menopause
- Vodafone: https://www.vodafone.com/sites/default/files/2021-10/menopause-global-research-report-2021.pdf
- Biote: https://biote.com/learning-center/biote-women-in-the-workplace-survey
- Sarrel, P., Portman, D., Lefebvre, P., Lafeuille, M.-H., Grittner, A. M., Fortier, J., Gravel, J., Duh, M. S., & Aupperle, P. M. (2015). Incremental direct and indirect costs of untreated vasomotor symptoms. Menopause (New York, N.Y.), 22(3), 260–266. https://doi.org/10.1097/GME.0000000000000320.
- World Economic Forum: https://www.weforum.org/agenda/2023/05/femtech-healthcare-bipoc