Hormonal changes can feel unpredictable as women age. Many women aren’t sure what’s normal and what’s not. Dr. Suzanne Ciotti, a Family Medicine physician at San Juan Health Partners Family and Specialty Medicine, talks about the difference between perimenopause and menopause. 

“We usually define menopause as having no periods for 12 months,” Dr. Ciotti explained. “Sometimes you may stop having periods for a few months, and then all of a sudden you have one again — and that resets the 12-month clock.”

Perimenopause refers to the years leading up to menopause, sometimes up to a decade prior. 

“For a lot of people, it’s very intense in the three years prior to menopause,” she said.

What Symptoms Are Common?

Many women are surprised by how their cycles change.

“Women often have periods that are heavier and closer together,” Dr. Ciotti noted. “Intuitively, you might think they get lighter and farther apart, but typically they’re heavier.”

Other common symptoms include:

• Mood changes
• Trouble sleeping
• Brain fog
• Hot flashes
• Fatigue

“You can feel really, really bad in perimenopause,” she said. “Especially those first six months after your last period.”

While many symptoms are normal during hormonal transitions, some require medical evaluation.

When to Call Your Provider

“When you’ve gone 12 months with no period, and then you start having bleeding again, we worry about that,” Dr. Ciotti explained. “That can be a sign of something going on in the uterus.”

In those cases, evaluation may include imaging or additional testing. Heavy bleeding can also signal underlying issues.

“If you’re having really heavy periods, a lot of clotting, and they’re very close together — and you’re getting fatigued or anemic — sometimes that can be a sign of a fibroid.”

But even without red flags, quality of life matters.

“It’s always reasonable to see a provider if you’re feeling like you can’t do your usual activities. If you’re not sleeping well, having a lot of hot flashes, there are a lot of interventions we can do.”

San Juan Health Partners Family and Specialty Medicine is accepting new patients. To schedule a visit with one of our providers, call 970.444.0260.