If you’re going through menopause and still feeling tired, foggy, or dismissed by your doctor, you’re not alone. For millions of women, midlife care is filled with confusion, misdiagnosis, and silence. You’re told it’s “just part of aging,” even when the symptoms are stealing your sleep, your focus, and your sense of self. Labs come back normal. But nothing feels normal.
In this episode of Sofia Unfiltered, award-winning science writer Amy Alkon—author of Going Menopostal—breaks down the science most providers were never trained to understand. She shares the questions that could change your care, your confidence, and your health.
This blog unpacks Amy’s most important insights—from hormone truths to the hidden flaws in medical training—and shows you exactly what to ask if you want better answers and real support through menopause.
What is Perimenopause—and Why Is It So Misunderstood?
Perimenopause is the 3 to 10-year transition before menopause, and it’s anything but simple. While many women are told it’s just the beginning of declining hormones, the reality is far more complex. Estrogen doesn’t slowly taper off—it surges, dips, and spikes in unpredictable ways. These fluctuations can cause disruptive symptoms like:
- Night sweats
- Anxiety
- Insomnia
- Brain fog
- Mood swings
- Hot Flashes
According to science writer Amy Alkon, most doctors mislabel perimenopause as “menopause lite.” They assume estrogen is always low, which leads to incorrect treatment—or no treatment at all.
If your provider isn’t aware of these patterns, they may overlook the real cause of your symptoms.
Want to learn more about how hormones change during and after perimenopause? Check out Dr. Tami Meraglia’s blog post, “Perimenopause, Menopause & Hormones: What Every Woman Needs to Know” for a deeper look into hormonal health and balance.
Why Aren’t More Doctors Trained in Menopause Care?
It’s a truth most women don’t hear: the majority of OB-GYNs receive little to no formal training in menopause or perimenopause. Yet they’re still the ones treating it.
As Amy Alkon explains, many doctors are operating outside their scope—often unknowingly—and without disclosing that they lack specialized knowledge. That’s not just frustrating. It’s a breach of medical ethics.
"Your doctors, I mean, they want to treat you, you know, and help you. They just have not a clue in menopause and perimenopause area" – Amy Alkon
If your provider hasn’t studied hormone therapy or midlife women’s health, they may not recognize your symptoms—or know how to treat them effectively.
Book a session with a Women’s Hormone Health Specialist and start advocating for your menopause care today.
Are Hormone Blood Tests Helpful in Perimenopause?
Short answer: not really. During perimenopause, hormone levels—especially estrogen and progesterone—can swing wildly from day to day, or even hour to hour. A single blood test offers a snapshot, not the full story.
According to Amy Alkon, a better way to assess what’s happening is by tracking your basal body temperature. This simple method helps determine whether you’re ovulating—an important clue, because many perimenopausal symptoms stem from anovulatory cycles (when your body doesn’t release an egg and doesn’t produce enough progesterone).
When progesterone is too low, you might experience:
- Restless or disrupted sleep
- Irritability or mood swings
- Increased anxiety
- Higher risk of endometrial overgrowth (linked to abnormal bleeding or cancer risk)
So if your doctor is relying only on labs to evaluate your hormones during perimenopause, they may be missing key information.
As Amy explains: “In perimenopause, you cannot test estrogen because [...]estrogen is pulsatile. That means it comes out in pulses, and the level changes like maybe every 20 minutes”.
Looking for proper care for your perimenopause symptoms? Get a perimenopause-focused provider, on Sofia Health today.
Is Estrogen Therapy Safe—And Are Women Being Denied It Unfairly?
Many women are told they’re “too old” for estrogen therapy—especially after age 60. That advice often comes from outdated fears about breast cancer or heart disease, not current science.
But as Amy Alkon explains, estrogen isn’t just about easing hot flashes. It plays a protective role in your heart, bones, brain, and metabolism. Denying estrogen solely based on age can put women at higher risk for serious, preventable conditions—like osteoporosis and cardiovascular disease.
If your provider dismisses hormone therapy without considering your full health picture, it may be time to ask why.
Looking for personalized and holistic healthcare? Schedule a session with Integrative Health Experts on Sofia Health today.
What If You Don’t Feel Confident Speaking Up?
Many women are taught to be polite, agreeable—even in the doctor’s office. But when it comes to your health, staying quiet can come at a cost.
Amy Alkon reminds us that "confidence isn’t something you wait for—it’s something you practice". You don’t need to know all the answers. You just need to ask better questions.
Advocating for yourself doesn’t mean being difficult. It means being clear, curious, and committed to getting the care you deserve.
“You need to stand up for your health, to stand up against being dismissed by doctors" – Amy Alkon
Top Questions Women Ask About Perimenopause
Perimenopause can feel overwhelming, especially when your symptoms don’t match what you’ve been told to expect—or when your doctor brushes them off as “normal.” Below are some of the most common (and important) questions women are asking as they try to make sense of this transition:
1. What is perimenopause, and how do I know if I’m in it?
Perimenopause is the transitional phase leading up to menopause, often starting in your 40s—but it can begin earlier. It’s marked by hormonal fluctuations, especially in estrogen and progesterone. Signs you might be in it include irregular periods, sleep disruptions, mood changes, and brain fog.
2. How long does perimenopause last?
The average length of perimenopause is 3 to 10 years, but it varies. Some women experience symptoms for only a few months, while others struggle for nearly a decade before reaching menopause.
3. What are the first signs of perimenopause?
Common early signs include: Irregular periods; Mood changes; Night sweats or hot flashes; Difficulty sleeping; Trouble focusing or memory lapses.
4. Can perimenopause cause anxiety or depression?
Yes. Hormonal shifts—especially declining progesterone—can directly impact mood. Many women report feeling more anxious, irritable, or emotionally volatile during perimenopause, even if they’ve never struggled with mental health before.
5. Are hormone tests accurate during perimenopause?
Not always. Because hormone levels fluctuate daily (and even hourly), a single lab test may not reflect what’s really going on. Symptom tracking and basal body temperature monitoring are often more helpful in identifying patterns.
6. What’s the difference between perimenopause and menopause?
Perimenopause is the lead-up to menopause, when hormone levels fluctuate and cycles become irregular. Menopause is defined as 12 consecutive months without a period—after which hormone levels remain consistently low.
7. How can I get relief from perimenopause symptoms naturally?
Lifestyle changes like nutrition support, sleep hygiene, mindfulness practices, and movement (such as yoga or tai chi) can help regulate symptoms. Many women also benefit from working with health coaches, nutritionists, and therapists who specialize in midlife care.
8. What treatments are available for perimenopause symptoms?
Options range from bioidentical hormone therapy and FDA-approved HRT to supplements, adaptogens, acupuncture, and cognitive behavioral therapy (CBT). The best treatment depends on your symptoms, health history, and goals.
9. Why does my doctor say everything is “normal” if I feel terrible?
Many doctors rely on outdated guidelines or basic labs that don’t reflect hormonal fluctuations. If you’re being told things are normal but you know something’s off, it’s time to ask different questions—or find a new provider.
10. Who should I see for perimenopause care?
Not all OB-GYNs are trained in menopause medicine. You may want to seek out a hormone health specialist, functional medicine provider, or a menopause-literate coach who can look at your whole health picture and help you feel heard and supported.
Book with a Functional Medicine Expert and start to break down these questions about perimenopause today.
Top Questions About Menopause
Whether you’re approaching menopause or already past it, it’s normal to feel uncertain about what’s happening in your body—and what support is actually available. Here are some of the most commonly asked questions about menopause, answered clearly and compassionately.
1. What is menopause, and when does it start?
Menopause is officially diagnosed after 12 consecutive months without a period. The average age is 51, but it can happen earlier or later depending on your genetics, health conditions, or surgeries like a hysterectomy.
2. What symptoms are normal during menopause?
Common symptoms include: Hot flashes and night sweats; Vaginal dryness or discomfort; Mood swings or irritability; Sleep disturbances; Memory or focus issues; Changes in libido.
3. Is it normal to still have symptoms after menopause starts?
Yes. Some women continue to experience symptoms for years after their periods stop. Hormonal shifts can continue to affect sleep, energy, and mood even post-menopause.
4. How does menopause affect bone, heart, and brain health?
Declining estrogen levels can increase the risk of osteoporosis, heart disease, and cognitive decline. This is why some women benefit from hormone therapy or targeted nutrition and fitness plans to protect long-term health.
5. What treatments are available for menopause symptoms?
Hormone therapy is one option, but not the only one. Non-hormonal treatments, supplements, pelvic floor therapy, acupuncture, and coaching can all support symptom relief based on your specific needs.
6. Can menopause affect mental health?
Absolutely. Mood changes, anxiety, and even depression can be triggered or worsened by hormonal shifts. Seeking support from a therapist or mental wellness coach can make a big difference.
7. Is hormone therapy safe after age 60?
It depends on your personal health profile. New research shows that for many women, estrogen therapy offers protection—not just symptom relief. Always work with a hormone health expert who considers your full medical history.
8. How can I support my body naturally during menopause?
Nutrition, stress management, resistance training, sleep hygiene, and mindfulness practices can all support hormone balance and symptom relief. Consider working with a functional medicine provider or coach for a customized plan.
9. Do I need to keep seeing a gynecologist after menopause?
Yes. Postmenopausal health still includes important screenings for things like cervical cancer, breast health, bone density, and vaginal health. Your care needs may shift, but they don’t stop.
10. Where can I find menopause-literate providers?
You can search by condition or specialty on Sofia Health, where you’ll find licensed professionals and coaches who understand menopause and can help you feel heard, supported, and informed.
If you want to listen more about personalized care for those navigating mid-life shifts in hormones, energy, and metabolism. Listen to our podcast episode “Midlife Metabolism, Menopause & the Power of Precision Medicine” with Dr. Onikepe Adegbola
Questions to Ask Your Doctor to Get Better Menopause Care
If you're struggling with symptoms like fatigue, brain fog, mood swings, or sleep disruptions—and being told everything looks "normal"—it's time to ask better questions.
Most women aren't taught how to advocate for themselves in medical appointments, and many doctors aren’t trained in menopause care. That’s why knowing what to ask can make all the difference in getting the support and treatment you deserve.
Here are some of the most important questions to bring to your next appointment:
Top Questions to Ask Your Doctor About Menopause or Perimenopause
- Do you have specific training in menopause and perimenopause care?
(If not, ask for a referral to someone who does.) - How do you evaluate hormone fluctuations beyond basic lab work?
(Especially for progesterone, which can’t always be captured in a blood test.) - What is your approach to treating perimenopausal symptoms like insomnia, anxiety, or brain fog?
- How do you decide whether hormone therapy is appropriate for someone my age and health profile?
- Are you familiar with the protective benefits of estrogen in heart, bone, and brain health?
- Can you explain the risks and benefits of hormone therapy—and how they apply to me personally?
- If I’m not ovulating, how might that affect my progesterone levels and symptoms?
- Do you consider lifestyle, nutrition, and stress when evaluating hormone balance and treatment options?
- If my labs are “normal,” how do you take my symptoms into account?
- Would you be open to collaborating with a health coach, functional medicine provider, or therapist to support my care?
Bringing these questions into the conversation can shift how you're treated—and how confident you feel. You don’t have to be a medical expert. You just need to be prepared, clear, and willing to ask for the support you deserve.
Need help finding the right support? Explore hormone health specialists, midlife coaches, or functional medicine providers on Sofia Health today.
Final Thoughts: You Deserve Better Menopause Care
Feeling dismissed in the doctor’s office isn’t just frustrating—it’s avoidable. The right questions can shift the conversation, unlock new treatment options, and even change the course of your health.
As Amy Alkon reminds us: "you deserve to be heard, you deserve science-based care, and you deserve to feel like yourself again".
If your doctor isn’t helping—or you’re not sure what to ask next—it’s not your fault. Sofia Health connects you with trusted experts to help you get care that reflects your unique experience, instead of outdated standards. From mindfulness coaching and therapy sessions to hormone health services, explore the Sofia Marketplace to discover services and tools designed to help you in this stage of life and book with those who are trained to listen, assess, and support you through it.
Check out the full episode of the Sofia Unfiltered podcast, "Going Menopausal: How to Speak Up, Push Back & Advocate for Your Health with Amy Alkon", for a conversation that goes beyond women's health. Learn how proper care can shift your trajectory through perimenopause and menopause. Available on Apple Podcasts and Spotify.
We’re here to help you meet your wellness goals—physically, mentally, emotionally, and spiritually. Whether you prefer a subscription for ongoing support or want to shop for individual services, classes, or products, Sofia Health provides the tools you need to thrive. Plus, with Sofia Prime, you can access both live classes and an extensive on-demand video library, featuring expert-led content in wellness, nutrition, fitness, and meditation.
Start your two-week trial today and discover the difference that dedication and expert help can make.
FAQs About Menopause and Perimenopause
What’s the difference between perimenopause and menopause?
Perimenopause is the transition phase before menopause. It’s marked by fluctuating hormone levels, irregular cycles, and symptoms like mood swings or insomnia. Menopause officially begins when you’ve gone 12 consecutive months without a period—at which point hormone levels stabilize at a lower baseline.
Are hormone therapies safe?
Yes, when used appropriately. Personalized hormone therapy—such as bioidentical hormones or FDA-approved treatments—can be safe and effective when prescribed by a trained provider who understands your health history and menopause stage.
Can I ask my doctor about hormone therapy?
You should. Be prepared to share your symptoms, ask about the risks and benefits, and confirm whether your doctor has training in menopause or hormone care. If they don’t, you can always seek a second opinion or a menopause-literate specialist.
What if my blood work is “normal,” but I still feel off?
Hormone levels can fluctuate daily—especially in perimenopause—so a single blood test doesn’t always reflect what’s really happening. Track your symptoms, cycles, and sleep patterns to bring a fuller picture to your provider.
Where can I find a provider who specializes in menopause care?
Sofia Health makes it easy to find vetted providers who understand midlife health. Explore menopause support services, including hormone health experts, coaches, and functional medicine providers who will actually listen—and help.
Resources
Disclaimer: The Sofia Unfiltered Podcast by Sofia Health is for general informational and entertainment purposes only and does not constitute the practice of medicine, nursing, or other professional healthcare services, including the giving of medical advice. No doctor/patient relationship is formed. The use of information on this podcast or materials linked from this podcast is at the user’s own risk. The content of this podcast is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Users should not disregard or delay in obtaining medical advice for any medical condition they may have. For any health concerns, users should seek the assistance of their healthcare professionals.
